Section 19.1801 - Applicability(a) Applicable health benefit plans. This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or a small or large employer group contract or similar coverage document that is offered by: (1) an insurance company;(2) a group hospital service corporation operating under Chapter 842;(3) a fraternal benefit society operating under Chapter 885;(4) a stipulated premium company operating under Chapter 884;(5) a reciprocal exchange operating under Chapter 942;(6) a health maintenance organization operating under Chapter 843;(7) a multiple employer welfare arrangement holding a certificate of authority under Chapter 846; or(8) an approved nonprofit health corporation holding a certificate of authority under Chapter 844.(b) Other applicable coverages and programs. (1) This subchapter applies to group health coverage made available by a school district under Education Code § 22.004.(2) This subchapter applies to: (A) a basic coverage plan under Chapter 1551;(B) a basic plan under Chapter 1575;(C) a primary care coverage plan under Chapter 1579; and(D) basic coverage under Chapter 1601.(3) This subchapter applies to coverage under the child health program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code.(4) This subchapter applies to a Medicaid managed care program operated under Chapter 533, Government Code, or a Medicaid program operated under Chapter 32, Human Resources Code.28 Tex. Admin. Code § 19.1801
Adopted by Texas Register, Volume 39, Number 50, December 12, 2014, TexReg 9702, eff. 9/1/2015