2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1222 - Preauthorization for Medical or Health Care Service › Section 1222.0002. Applicability of Chapter

Sec. 1222.0002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan that 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 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.
Text of subsection effective until April 01, 2025
(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)  health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;
(8)  group health coverage made available by a school district in accordance with Section 22.004, Education Code;
(9)  the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;
(10)  the child health plan program under Chapter 62, Health and Safety Code;
(11)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and
(12)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
Text of subsection effective on April 01, 2025
(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)  health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;
(8)  group health coverage made available by a school district in accordance with Section 22.004, Education Code;
(9)  the state Medicaid program, including the Medicaid managed care program operated under Chapters 540 and 540A, Government Code;
(10)  the child health plan program under Chapter 62, Health and Safety Code;
(11)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and
(12)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
Added by Acts 2019, 86th Leg., R.S., Ch. 488 (H.B. 3041), Sec. 1, eff. September 1, 2019.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.121, eff. April 1, 2025.