Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses or pharmacy benefits 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 issued 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) nonprofit agricultural organization health benefits offered by a nonprofit agricultural organization under Chapter 1682 ; (8) alternative health benefit coverage offered by a subsidiary of the Texas Mutual Insurance Company under Subchapter M , Chapter 2054 ; (9) group health coverage made available by a school district in accordance with Section 22.004 , Education Code; (10) the state Medicaid program, including the Medicaid managed care program operated under Chapter 540 , Government Code; (11) the child health plan program under Chapter 62 , Health and Safety Code; (12) a regional or local health care program operated under Section 75.104 , Health and Safety Code; (13) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 , Labor Code; (14) county employee group health benefits provided under Chapter 157 , Local Government Code; and (15) health and accident coverage provided by a risk pool created under Chapter 172 , Local Government Code. (c) This chapter applies to coverage under a group health benefit plan provided to a resident of this state regardless of whether the group policy, agreement, or contract is delivered, issued for delivery, or renewed in this state. (d) This chapter does not apply to a self-funded health benefit plan as defined by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.).
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