2023 Texas Statutes › Insurance Code › Title 4 - Regulation of Solvency › Subtitle D - Guaranty Associations › Chapter 463 - Texas Life and Health Insurance Guaranty Association › Subchapter A. General Provisions › Section 463.003. General Definitions

Sec. 463.003.  GENERAL DEFINITIONS.  In this chapter:
(1)  "Association" means the Texas Life and Health Insurance Guaranty Association.
(1-a)  "Benefit plan" means a specific employee, union, or association of natural persons benefit plan.
(2)  "Board" means the board of directors of the association.
(3)  "Contractual obligation" means an obligation under a policy or contract or certificate under a group policy or contract, or part of a policy or contract or certificate, for which coverage is provided under Subchapter E.
(4)  "Covered policy" or "covered contract" means a policy or contract, or portion of a policy or contract, including a health maintenance organization contract, with respect to which this chapter provides coverage as determined under Subchapter E.
(4-a)  "Enrollee" means an individual who is enrolled in a health maintenance organization contract with respect to which this chapter provides coverage as determined under Subchapter E.  For purposes of this chapter, an enrollee is considered to be an insured.
(4-b)  "Health benefit plan" means a hospital and medical expense incurred policy or certificate, health maintenance organization enrollee contract, or any other similar health contract.  The term does not include:
(A)  accident-only insurance;
(B)  credit insurance;
(C)  dental-only insurance;
(D)  vision-only insurance;
(E)  Medicare supplement insurance;
(F)  long-term care coverage or benefits, home health care coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits;
(G)  disability income insurance;
(H)  coverage for on-site medical clinics; or
(I)  specified disease, hospital confinement indemnity, or limited benefit health insurance coverage if the types of coverage do not provide coordination of benefits and are provided under separate policies or certificates.
(5)  "Impaired insurer" means a member insurer that is designated an "impaired insurer" by the commissioner and is:
(A)  placed by a court in this state or another state under an order of supervision, liquidation, rehabilitation, or conservation;
(B)  placed under an order of liquidation or rehabilitation under Chapter 443; or
(C)  placed under an order of supervision or conservation by the commissioner under Chapter 441.
(5-a)  "Insurance" includes health benefit plan coverage.
(6)  "Insolvent insurer" means a member insurer that has been placed under an order of liquidation with a finding of insolvency by a court in this state or another state.
(6-a)  "Insurer" includes a health maintenance organization.
(7)  "Member insurer" means an insurer that is required to participate in the association under Section 463.052.
(7-a)  "Owner" means the owner of a policy or contract and "policyholder," "policy owner," and "contract owner" mean the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and is properly recorded as the owner on the books of the member insurer.  The terms "owner," "contract owner," "policyholder," and "policy owner" do not include persons with a mere beneficial interest in a policy or contract.
(8)  "Person" means an individual, corporation, limited liability company, partnership, association, governmental body or entity, or voluntary organization.
(8-a)  "Plan sponsor" means:
(A)  the employer in the case of a benefit plan established or maintained by a single employer;
(B)  the employee organization in the case of a benefit plan established or maintained by an employee organization; or
(C)  in a case of a benefit plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan.
(9)  "Premium" means an amount received on a covered policy, less any premium, consideration, or deposit returned on the policy, and any dividend or experience credit on the policy.  The term does not include:
(A)  an amount received for a policy or contract or part of a policy or contract for which coverage is not provided under Section 463.202, except that assessable premiums may not be reduced because of:
(i)  an interest limitation provided by Section 463.203(b)(3); or
(ii)  a limitation provided by Section 463.204 with respect to a single individual, participant, annuitant, or policy or contract owner;
(B)  premiums in excess of $5 million on an unallocated annuity contract not issued under a governmental benefit  plan established under Section 401, 403(b), or 457, Internal Revenue Code of 1986;
(C)  premiums received from the state treasury or the United States treasury for insurance for which this state or the United States contracts to:
(i)  provide welfare benefits to designated welfare recipients; or
(ii)  implement:
(a)  Title 2, Health and Safety Code;
(b)  Title 2, Human Resources Code; or
(c)  the Social Security Act (42 U.S.C. Section 301 et seq.); or
(D)  premiums in excess of $5 million with respect to multiple nongroup policies of life insurance owned by one owner, regardless of whether the policy owner is an individual, firm, corporation, or other person and regardless of whether the persons insured are officers, managers, employees, or other persons, regardless of the number of policies or contracts held by the owner.
(10)  "Resident" means a person who resides in this state on the earlier of the date a member insurer becomes an impaired insurer or the date of entry of a court order that determines a member insurer to be an impaired insurer or the date of entry of a court order that determines a member insurer to be an insolvent insurer and to whom the member insurer owes a contractual obligation.  For the purposes of this subdivision:
(A)  a person is considered to be a resident of only one state;
(B)  a person other than an individual is considered to be a resident of the state in which the person's principal place of business is located; and
(C)  a United States citizen who is either a resident of a foreign country or a resident of a United States possession, territory, or protectorate that does not have an association similar to the association created by this chapter is considered a resident of the state of domicile of the insurer that issued the policy or contract.
(10-a)  "Structured settlement annuity" means an annuity purchased to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant.
(11)  "Supplemental contract" means a written agreement for the distribution of policy or contract proceeds.
(12)  "Unallocated annuity contract" means an annuity contract or group annuity certificate that is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 1, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.013(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.013(a), eff. September 1, 2007.
Acts 2011, 82nd Leg., R.S., Ch. 14 (S.B. 567), Sec. 3, eff. September 1, 2011.
Acts 2019, 86th Leg., R.S., Ch. 432 (S.B. 1153), Sec. 2, eff. September 1, 2019.