for group health benefits, coverage, or services in this state for hospital, medical, or surgical expenses inamd as a result of accident or sickness shall o@r and make 4wa&bk lo each graup pdiqvholder, cmt?acl ho&r, employer. muMp& emplqwr, unit amciaticw or bvslce under a group policy, contraq pkn. program or ='=w"- that provides hos&aw~cr2alld~m8dic81bw~uweragefor-and ~scrviccorprepaidbasisforexpcnxs balrredflirihe~can,diagJl0sis,andEregtment of serious mentaliuMsws. Id. art. 3.51-14, 5 2(a) (anpb&.s added). As with section 3A of article 3.Sl-6, this grovkhn does not myair that the offa for ,coverage of expacxa inwnd in the tmtmwt of serious mental iUncss be made to the employee. Bather, article 3.51-14 rqtires a singbmployer, tdf4imded plan to offa coverage to the employer.
p. 1448 Mr. David Horns - Page 6 (N-276)
Finally. you also ask whether article 20.12 of the Insurance Code*sections 3.3701 through 3.3705 of title 28 of the Texas Admh&ak Code, and section 161.091 ofthe Health and Safety Code apply to "an employer-controlledentity which has arranged for a sdcct group of providers at preferred rates to be availableto cormacting employers."
Artide 20.12 of the lnsurancs Code prohiits group hospital service corporations subject to chapter 20 from engaging in certain autkities. Article 20.01, which dcscrii the corporations which are subject to chapter 20, provides that [a]ny seven (7) or more persons, a majority of whom arc superinteudentsof hospitals or physiciansor surgeons lkensed by the State Board of Medical Examiners,upon application to the Secretary of State of the State of Texas for a corporate charter may be incnrporated for the purpose of establi&ng __. a nonprofit hospital service plan, whereby hospital care may be provided by said corporation through an establishedhospital. . . . Thesrtitywhichyou~isrubjecttoptide20.12oftheInsurance codeordyifitis comprised of aeven or mornperson& the majority of whom are buspitd sqaimendatts, physiCisnsoraurganns"inc0rpomtedfbrtbepurposeofprovidinghosphalcareata hoopitrl.
sections 3.3701 through 3.3705 of title 28 of the Texas AdnrinistrativeCode apply to prekrd provider phms. Section 3.3701 expressly providus that "[t&e sections of this mrbchaptado~tapplytoeordotheyranctionanyplaaarrangedarprovided~byany providp,,employa,~~~-partyadity~~MypaJw~aditlothatbanMhwrnr aukmzedtoengageintheb&nessofbealtb insurance in this state." 28 T.A.C. 83.3701. Th~anerltityiswbjwttotheseregulmionsoldyifitisalliwurer . autkaed to engage in the business of health insummx in Texas.
!Sect.ion161.091 of the Health and Safbty Code was recently Mlcnded by the 73rd
initind,toor~m~yptrson,6rm,aJsociationofpasons,partnaJhp,~~corporationfbr secmingorsokitingpatientsorpMonagefororfromaperxmli~cutitied,or mgkkred by a state health care regulatory agency." Health & Safety Code 8 161.091(a). rrramendedbyAc& 1993,73dLeg..ch. 573, ~S.Ol,at2171c8dch. 706, gl,at2772. The term "person" in section 161.091 of the Health and Safety Code indudes a "wrpomtio4 tLugddo4 govemment or gowmmemd alhdivision or agemy, business trust, estate, trust, partnership, association, and any other legal entity." Attomey General Opinion DM-138 (1992) at 1 nl (citing Gov't Code 8 311.005(2)). Subsection (t) of section161.091oftheHeaithandSafetyCodeprovidesthatitdoesnotapplytoavariay
p. 1449 Mr. David Hores - Page 7 (DMy276)
of entities. including governmental entities, which reimburse, provide. offer to provide, or administer medical benefits under a health benefits plan for which 'it is the payor. Therefore, ifthe entity you de&i is a governmental entity which rdmbwes. provides, offers to provide, or adminkters medical beneSts under a health benefits plan for which it istbepayor,itisnotsubjecttosection161.091.
SUMMARY
Artide 1.24C. article 3.51-9, and article 21.53 of the Insurance Code apply to