2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 846 - Multiple Employer Welfare Arrangements › Subchapter A. General Provisions › Section 846.001. Definitions

Sec. 846.001.  DEFINITIONS.  In this chapter:
(1)  "Board" means the board of trustees or directors, as applicable, of a multiple employer welfare arrangement.
(2)  "Employee welfare benefit plan" has the meaning assigned by Section 3(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002(1)).
(3)  "Health benefit plan" includes any plan that provides benefits for health care services.  The term does not include:
(A)  accident-only or disability income insurance coverage, or a combination of accident-only and disability income insurance coverage;
(B)  credit-only insurance coverage;
(C)  disability insurance;
(D)  coverage for a specified disease or illness;
(E)  Medicare services under a federal contract;
(F)  Medicare supplement and Medicare Select policies regulated in accordance with federal law;
(G)  long-term care coverage or benefits, nursing home care coverage or benefits, home health care coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits;
(H)  coverage that provides limited-scope dental or vision benefits;
(I)  coverage provided by a single service health maintenance organization;
(J)  workers' compensation insurance coverage or similar insurance coverage;
(K)  coverage provided through a jointly managed trust authorized under 29 U.S.C. Section 141 et seq. that contains a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U. S.C. Section 157;
(L)  hospital indemnity or other fixed indemnity insurance coverage;
(M)  reinsurance contracts issued on a stop-loss, quota-share, or similar basis;
(N)  short-term major medical contracts;
(O)  liability insurance coverage, including general liability insurance coverage and automobile liability insurance coverage;
(P)  coverage issued as a supplement to liability insurance coverage;
(Q)  automobile medical payment insurance coverage;
(R)  coverage for on-site medical clinics;
(S)  coverage that provides other limited benefits specified by federal regulations;  or
(T)  other coverage that is:
(i)  similar to the coverage described by this subdivision under which benefits for medical care are secondary or incidental to other coverage benefits;  and
(ii)  specified in federal regulations.
(4)  "Health status related factor" means:
(A)  health status;
(B)  medical condition, including both physical and mental illness;
(C)  claims experience;
(D)  receipt of health care;
(E)  medical history;
(F)  genetic information;
(G)  evidence of insurability, including conditions arising out of acts of family violence;  and
(H)  disability.
(5)  "Multiple employer welfare arrangement" has the meaning assigned by Section 3(40) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002(40)).
(6)  "Organizational document" means the articles, bylaws, agreements, trusts, or other documents or instruments describing the rights and obligations of employers, employees, and beneficiaries with respect to a multiple employer welfare arrangement.
(7)  "Participation criteria" means any criteria or rules established by an employer to determine the employees who are eligible for enrollment or continued enrollment under the terms of a health benefit plan.
(8)  "Preexisting condition provision" means a provision that excludes or limits coverage for a disease or condition for a specified period after the effective date of coverage.
(9)  "Waiting period" means a period established by a multiple employer welfare arrangement that must elapse before an individual who is a potential participating employee in a health benefit plan is eligible to be covered for benefits.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.