Definition of Health Benefit Plan

Sec. 1213.001. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this chapter, "health benefit plan" means a plan that provides benefits for medical, surgical, or other treatment expenses incurred as a result of a health condition, a mental health condition, an accident, sickness, or substance abuse, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage 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 insurance company operating under Chapter 884; (5) a Lloyd's plan operating under Chapter 941; (6) an exchange operating under Chapter 942; (7) a health maintenance organization operating under Chapter 843; (8) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or (9) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844. (b) The term includes: (1) a small employer health benefit plan written under Chapter 1501; and (2) a health benefit plan offered under Chapter 1551, 1575, 1579, or 1601. Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.