(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 offered 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) the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;
- (8) the child health plan program under Chapter 62, Health and Safety Code; and
- (9) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
Added by Acts 2023, 88th Leg., R.S., Ch. 279 (S.B. 989), Sec. 1, eff. September 1, 2023.