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

1. (1) Carrier--An insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, a health maintenance organization, or a multiple employer welfare arrangement that has a certificate of authority under Insurance Code, Article 3.95-2.
2. (2) Enrollee--An individual who is enrolled in a health benefit plan, including covered dependents.

3. (3) Health benefit plan--Subject to subparagraphs (A), (B) and (C) of this paragraph, 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. The term does not include a plan that provides coverage only for accidental death or dismemberment, disability income, supplement to liability insurance, Medicare supplement, workers' compensation, medical payment insurance issued as a part of a motor vehicle insurance policy or a long-term care policy.

   1. (A) For the inpatient mastectomy coverage notice required by subsection (a)(1) of §21.2103 of this title (relating to Notices), the definition of health benefit plan includes a plan that provides coverage only for a specific disease or condition for the treatment of breast cancer or for hospitalization. The term does not include a small employer health benefit plan issued under the Insurance Code, Chapter 26, Subchapters A-G.
   2. (B) For the prostate cancer examination notice required by subsection (a)(2) of §21.2103 of this title (relating to Notices), the definition of health benefit plan does not include a small employer health benefit plan written under the Insurance Code Chapter 26, Subchapters A-G, or plans that provide coverage only for a specified disease or other limited benefit or only for indemnity for hospitalization.
   3. (C) For the inpatient maternity and childbirth coverage notice required by subsections (a)(3) and (4) of §21.2103 of this title (relating to Notices), the definition of health benefit plan does not include credit insurance, or plans that provide coverage only for a specified disease or other limited benefits, only for dental or vision care, or only for indemnity for hospital confinement.
4. (4) Other limited benefit--A plan that provides coverage singularly or in combination, for benefits for a specifically named disease, accident or combination of diseases or accidents, including but not limited to heart attack, stroke, AIDS, and travel, farm or occupational accident.
5. (5) Primary Enrollee--For group coverage, the covered member or employee of the group. For individual coverage, the person first named on the application/enrollment form.

Source Note:The provisions of this §21.2102 adopted to be effective March 29, 1998, 23 TexReg 3009.