1. (a) This subchapter applies to the issuer of a group health benefit plan as defined in §21.4503 of this subchapter (relating to Definitions), including, as provided by the Insurance Code §38.353(a):

   1. (1) an insurance company;
   2. (2) a group hospital service corporation;
   3. (3) a fraternal benefit society;
   4. (4) a stipulated premium company;
   5. (5) a reciprocal or interinsurance exchange; and
   6. (6) a health maintenance organization.

2. (b) In accordance with the Insurance Code §38.353(b), and notwithstanding any provision in the Insurance Code Chapters 1551, 1575, 1579, or 1601 or any other law, this subchapter applies to:

   1. (1) a basic coverage plan under the Insurance Code Chapter 1551;
   2. (2) a basic plan under the Insurance Code Chapter 1575;
   3. (3) a primary care coverage plan under the Insurance Code Chapter 1579; and
   4. (4) basic coverage under the Insurance Code Chapter 1601.

3. (c) Pursuant to the Insurance Code §38.353(d), this subchapter does not apply to:

   1. (1) standard health benefit plans provided under the Insurance Code Chapter 1507;
   2. (2) children's health benefit plans provided under the Insurance Code Chapter 1502;
   3. (3) health care benefits provided under a workers' compensation insurance policy;
   4. (4) Medicaid managed care programs operated under the Government Code Chapter 533;
   5. (5) Medicaid programs operated under the Human Resources Code Chapter 32; or
   6. (6) the state child health plan operated under the Health and Safety Code Chapters 62 or 63.
4. (d) Notwithstanding subsection (c)(1) of this section, a group health benefit plan issuer is not prohibited from electively including data concerning reimbursement rates for standard health benefit plans provided under the Insurance Code Chapter 1507 in its submission of the report required in §21.4506 of this subchapter (relating to Submission of Report) for purposes of administrative convenience. Data from all other plans identified in subsection (c) of this section shall be excluded from the report.

Source Note:The provisions of this §21.4502 adopted to be effective January 9, 2011, 35 TexReg 11868.