Section 1451.252 - Applicability of Subchapter This subchapter applies only to a health benefit plan that requires an enrollee to obtain certain specialty health care services through a referral made by a primary care physician or other gatekeeper and that:
(1) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:(A) an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage that is offered by:(i) an insurance company;(ii) a group hospital service corporation operating under Chapter 842;(iii) a fraternal benefit society operating under Chapter 885;(iv) a stipulated premium company operating under Chapter 884; or(v) a health maintenance organization operating under Chapter 843; and(B) to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:(i) a multiple employer welfare arrangement as defined by Section 3 of that Act; or(ii) another analogous benefit arrangement;(2) is offered by: (A) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or(B) an entity that is not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis; or(3) provides health and accident coverage through a risk pool created under Chapter 172, Local Government Code, notwithstanding Section 172.014, Local Government Code, or any other law.Tex. Ins. Code § 1451.252
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. 4/1/2005.