Applicability of Chapter

Sec. 1222.0002. APPLICABILITY OF CHAPTER. (a) This chapter 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 an individual or group evidence of coverage or similar coverage document that is issued by: (1) an insurance company; (2) a group hospital service corporation operating under Chapter 842; (3) a health maintenance organization operating under Chapter 843; (4) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; (5) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; (6) a stipulated premium company operating under Chapter 884; (7) a fraternal benefit society operating under Chapter 885; (8) a Lloyd's plan operating under Chapter 941; or (9) an exchange operating under Chapter 942. (b) Notwithstanding any other law, this chapter applies to: (1) a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter; (2) a standard health benefit plan issued under Chapter 1507; (3) a basic coverage plan under Chapter 1551; (4) a basic plan under Chapter 1575; (5) a primary care coverage plan under Chapter 1579; (6) a plan providing basic coverage under Chapter 1601; (7) health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code; (8) group health coverage made available by a school district in accordance with Section 22.004, Education Code; (9) the state Medicaid program, including the Medicaid managed care program operated under Chapters 540 and 540A, Government Code; (10) the child health plan program under Chapter 62, Health and Safety Code; (11) a regional or local health care program operated under Section 75.104, Health and Safety Code; and (12) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code. Added by Acts 2019, 86th Leg., R.S., Ch. 488 (H.B. 3041), Sec. 1, eff. September 1, 2019. Amended by: Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.121, eff. April 1, 2025.