Words and terms defined in Insurance Code Chapter 1467, concerning Out-of-Network Claim Dispute Resolution, have the same meaning when used in this subchapter unless the context clearly indicates otherwise.

1. (1) Administrator--Has the meaning assigned by Insurance Code §1467.001, concerning Definitions. The term also includes a nonprofit agricultural organization under Chapter 1682, concerning Health Benefits Provided by Certain Nonprofit Agricultural Organizations, offering a health benefit plan.

2. (2) Health benefit plan--A plan that provides coverage under:

   1. (A) a health benefit plan offered by an HMO operating under Insurance Code Chapter 843, concerning Health Maintenance Organizations;
   2. (B) a preferred provider benefit plan, including an exclusive provider benefit plan, offered by an insurer under Insurance Code Chapter 1301, concerning Preferred Provider Benefit Plans; or
   3. (C) a plan, other than an HMO plan, under Insurance Code Chapters 1551, concerning Texas Employees Group Benefits Act; 1575, concerning Texas Public School Employees Group Benefits Program; 1579, concerning Texas School Employees Uniform Group Health Coverage; or 1682.

Source Note:The provisions of this §21.4902 adopted to be effective June 25, 2020, 45 TexReg 4204; amended to be effective June 27, 2023, 48 TexReg 3409.