Section 21.2702 - DefinitionsThe following words and terms when used in this subchapter have the following meanings, unless the context clearly indicates otherwise.
(1) Association--An association (other than an employer association), including but not limited to a labor union or organizations of such unions, membership corporations organized or holding a certificate of authority under the Texas Non-profit Corporation Act, and cooperatives and corporations subject to the supervision and control of the Farm Credit Administration of the United States of America, that: (A) has a constitution and bylaws;(B) has been actively in existence for at least 2 years; and(C) has been formed and maintained in good faith for purposes other than obtaining coverage under a health benefit plan to cover members for the benefit of persons other than the association or its officers or trustees.(2) Bona Fide Association--An association that, in addition to meeting the requirements of an association in paragraphs (1)(A) and (C) of this subsection:(A) has been actively in existence for at least 5 years;(B) does not condition membership in the association on any health-status-related factor relating to an individual (including the individual eligible for membership or a dependent of the individual eligible for membership, if dependent coverage is offered);(C) makes coverage under a health benefit plan offered through the association available to all members, regardless of any health-status-related factor relating to the members (or dependents eligible for coverage through a member, if dependent coverage is offered); and(D) does not make a health benefit plan offered through the association available other than in connection with a member of the association.(3) Creditable Coverage--As defined in § 21.1101 of this title (relating to Definitions).(4) Genetic information--Information derived from the results of a genetic test.(5) Genetic test--A laboratory test of an individual's deoxyribonucleic acid (DNA), ribonucleic acid (RNA), proteins, or chromosomes to identify by analysis of the DNA, RNA, proteins, or chromosomes the genetic mutations or alterations in the DNA, RNA, proteins, or chromosomes that are associated with a predisposition for a clinically recognized disease or disorder. The term does not include: (A) a routine physical examination or a routine test performed as a part of a physical examination;(B) a chemical, blood or urine analysis;(C) a test to determine drug use; or(D) a test for the presence of the human immunodeficiency virus.(6) HMO--A health maintenance organization as defined in Insurance Code § 843.002.(7) Health benefit plan--A group insurance policy, a certificate issued under a group policy, a group hospital service contract, or a group subscriber contract or evidence of coverage issued by a health carrier that provides benefits for health care benefits or services. The term does not include the following plans of coverage: (A) Under all circumstances: (i) coverage only for accident;(ii) credit-only insurance;(iii) disability insurance coverage;(iv) Medicare services under a federal contract;(v) coverage issued as a supplement to liability insurance;(vi) insurance coverage arising out of workers' compensation or similar insurance;(vii) automobile medical payment insurance coverage;(viii) jointly managed trusts authorized under 29 United States Code §§141 et seq. that contain a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 United States Code §157;(ix) short-term limited duration insurance as defined in this section;(x) liability insurance, including general liability insurance and automobile liability insurance; or(xi) coverage for onsite medical clinics.(B) Only if the benefits are provided under a separate policy or contract of insurance or evidence of coverage: (i) coverage for a specified disease or illness;(ii) Medicare supplement and Medicare Select policies regulated in accordance with federal law;(iii) long-term care coverage or benefits, nursing home care coverage or benefits, home health care coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits;(iv) coverage that provides limited-scope dental or vision benefits;(vii) coverage supplemental to the coverage provided under Chapter 55, Title 10 of the United States Code (also known as CHAMPUS supplemental programs);(viii) coverage that provides other limited benefits specified by federal regulations; or(ix) other coverage that is: (I) similar to the coverage described in subparagraphs (A) and (B) of this paragraph under which benefits for medical care are secondary or incidental to other insurance benefits; and(II) specified in federal regulations.(8) Health carrier--Any entity authorized under the Texas Insurance Code or another insurance law of this state that provides health benefit plans in this state, including an insurance company; a group hospital service corporation operating under Insurance Code Chapter 842; a stipulated premium insurance company operating under Insurance Code Chapter 884; an approved nonprofit health corporation that is certified under Occupations Code Chapter 162 and that holds a certificate of authority issued by the Commissioner under Insurance Code Chapter 844 , or an HMO.(9) Health-status-related factor--Any of the following in relation to an individual:(B) medical condition, including both physical and mental illness;(D) receipt of health care;(G) evidence of insurability, including conditions arising out of acts of domestic violence, including family violence as defined by Insurance Code Chapter 544, Subchapter D; or(10) Short-term limited duration coverage--Health coverage provided under a contract with a health carrier that has an expiration date specified in the contract (taking into account any extensions that may be elected by the policyholder without the health carrier's consent) that is within 12 months of the date the contract becomes effective.28 Tex. Admin. Code § 21.2702
The provisions of this §21.2702 adopted to be effective July 5, 1999, 24 TexReg 5014; Amended by Texas Register, Volume 46, Number 44, October 29, 2021, TexReg 7420, eff. 11/7/2021