Section 1452.101 - Definitions In this subchapter:
(1) "Applicant physician" means a physician applying for expedited credentialing under this subchapter.(2) "Enrollee" means an individual who is eligible to receive health care services under a managed care plan.(3) "Health care provider" means: (A) an individual who is licensed, certified, or otherwise authorized to provide health care services in this state; or(B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.(4) "Managed care plan" means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires enrollees to use participating providers or that provides a different level of coverage for enrollees who use participating providers. The term includes a health benefit plan issued by:(A) a health maintenance organization;(B) a preferred provider benefit plan issuer; or(C) any other entity that issues a health benefit plan, including an insurance company.(5) "Medical group" means: (A) a single legal entity owned by two or more physicians;(B) a professional association composed of licensed physicians;(C) any other business entity composed of licensed physicians as permitted under Subchapter B, Chapter 162, Occupations Code; or(D) two or more physicians on the medical staff of, or teaching at, a medical school or medical and dental unit, as defined or described by Section 61.003, 61.501, or 74.601, Education Code.(6) "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.Tex. Ins. Code § 1452.101
Amended By Acts 2011, 82nd Leg., R.S., Ch. 414, Sec. 1, eff. 9/1/2011.Amended By Acts 2009, 81st Leg., R.S., Ch. 296, Sec. 1, eff. 9/1/2009.Added by Acts 2007, 80th Leg., R.S., Ch. 1203, Sec. 1, eff. 9/1/2007.