The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

1. (1) Act--The HMO Act, Texas Insurance Code, Chapter 20A.
2. (2) Delegated entity--An entity, other than an HMO authorized to do business under the Act, that by itself, or through subcontracts with one or more entities, undertakes to arrange for or to provide medical care or health care to an enrollee in exchange for a predetermined payment on a prospective basis and that accepts responsibility to perform on behalf of the HMO any function regulated by the Act. The term does not include an individual physician or a group of employed physicians practicing medicine under one federal tax identification number and whose total claims paid to providers not employed by the group is less than 20 percent of the total collected revenue of the group calculated on a calendar year basis.
3. (3) Delegated network--Any delegated entity that assumes total financial risk for more than one of the following categories of health care services: medical care, hospital or other institutional services, or prescription drugs, as defined by Section 551.003, Occupations Code. The term does not include a delegated entity that shares risk for a category of services with an HMO.

4. (4) Delegated third party--A third party other than a delegated entity that contracts with a delegated entity, either directly or through another third party, to:

   1. (A) accept responsibility to perform any function regulated by the Act; or
   2. (B) receive, handle, or administer funds, if the receipt, handling, or administration of the funds is directly or indirectly related to a function regulated by the Act.
5. (5) Health care--Any services, including the furnishing to any individual of pharmaceutical services, medical, chiropractic, or dental care, or hospitalization, or incident to the furnishing of such services, care, or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing or healing human illness or injury.

Source Note:The provisions of this §11.2602 adopted to be effective October 13, 2002, 27 TexReg 9585.