Sec. 1456.002. APPLICABILITY OF CHAPTER. (a) This chapter applies to any health benefit plan that: (1) 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 that is offered by: (A) an insurance company; (B) a group hospital service corporation operating under Chapter 842 ; (C) a fraternal benefit society operating under Chapter 885 ; (D) a stipulated premium company operating under Chapter 884 ; (E) a health maintenance organization operating under Chapter 843 ; (F) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 ; (G) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 ; or (H) an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis; or (2) provides health and accident coverage through a risk pool created under Chapter 172 , Local Government Code, notwithstanding Section 172.014 , Local Government Code, or any other law. (b) This chapter applies to a person to whom a health benefit plan contracts to: (1) process or pay claims; (2) obtain the services of physicians or other providers to provide health care services to enrollees; or (3) issue verifications or preauthorizations. (c) This chapter does not apply to: (1) Medicaid managed care programs operated under Chapter 540 or 540A , Government Code, as applicable; (2) Medicaid programs operated under Chapter 32 , Human Resources Code; or (3) the state child health plan operated under Chapter 62 or 63 , Health and Safety Code.
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