Sec. 140.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies to an issuer of a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, a disability benefit plan, or an employee welfare benefit plan, 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, including:
(1)  an insurance company;
(2)  a group hospital service corporation operating under Chapter 842, Insurance Code;
(3)  a fraternal benefit society operating under Chapter 885, Insurance Code;
(4)  a stipulated premium insurance company operating under Chapter 884, Insurance Code;
(5)  a reciprocal exchange operating under Chapter 942, Insurance Code;
(6)  a health maintenance organization operating under Chapter 843, Insurance Code;
(7)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846, Insurance Code; or
(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844, Insurance Code.
(b)  Notwithstanding Section 172.014, Local Government Code, or any other law, this chapter applies to a risk pool providing health and accident coverage under Chapter 172, Local Government Code.
(c)  Notwithstanding any other law, this chapter applies to an issuer of a plan or coverage under Chapter 1551, 1575, 1579, or 1601, Insurance Code.
(d)  Notwithstanding any other law, this chapter applies to any self-funded issuer of a plan that provides a benefit described by Subsection (a).
(e)  This chapter applies to any policy, evidence of coverage, or contract under which a benefit described by Subsection (a) is provided and:
(1)  that is delivered, issued for delivery, or entered into in this state; or
(2)  under which an individual or group in this state is entitled to benefits.
Text of subsection effective until April 01, 2025
(f)  This chapter does not apply to:
(1)  a workers' compensation insurance policy or any other source of medical benefits under Title 5, Labor Code;
(2)  Medicare;
(3)  the Medicaid program under Chapter 32, Human Resources Code;
(4)  a Medicaid managed care program operated under Chapter 533, Government Code;
(5)  the state child health plan or any other program operated under Chapter 62 or 63, Health and Safety Code; or
(6)  a self-funded plan that is subject to the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.).
Text of subsection effective on April 01, 2025
(f)  This chapter does not apply to:
(1)  a workers' compensation insurance policy or any other source of medical benefits under Title 5, Labor Code;
(2)  Medicare;
(3)  the Medicaid program under Chapter 32, Human Resources Code;
(4)  a Medicaid managed care program operated under Chapter 540 or Chapter 540A, Government Code, as applicable;
(5)  the state child health plan or any other program operated under Chapter 62 or 63, Health and Safety Code; or
(6)  a self-funded plan that is subject to the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.).
Added by Acts 2013, 83rd Leg., R.S., Ch. 180 (H.B. 1869), Sec. 1, eff. January 1, 2014.
Amended by: 
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.02, eff. April 1, 2025.