Definitions

Sec. 1661.001. DEFINITIONS. In this chapter: (1) "Health benefit plan" means a 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 that is offered by: (A) an insurance company; (B) a group hospital service corporation operating under Chapter 842; (C) a fraternal benefit society operating under Chapter 885; (D) a stipulated premium company operating under Chapter 884; (E) a Lloyd's plan operating under Chapter 941; (F) an exchange operating under Chapter 942; (G) a health maintenance organization operating under Chapter 843; (H) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; (I) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or (J) an entity 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. (2) "Health benefit plan issuer" means an entity authorized to issue a health benefit plan in this state. (3) "Health care provider" means: (A) an individual who is licensed, certified, or otherwise authorized to provide health care services; or (B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services. (4) "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees. Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.