The following words and terms when used in this division have the following meanings, unless the context clearly indicates otherwise:
  (1) Administrator--As defined in Insurance Code §4151.001(1), for plans subject to Insurance Code Chapter 1369, Subchapter D.
  (2) Drug--As defined in the Texas Pharmacy Act, Occupations Code §551.003.
  (3) Drug formulary--A list of drugs for which a health benefit plan provides coverage, approves payment, or encourages or offers incentives for physicians or other health care providers to prescribe.
  (4) Effective date--The date that the health benefit plan's current prescription drug benefit levels became effective, or the date the subscriber's coverage first became effective, whichever is later.
  (5) Enrollee--A person covered by a health benefit plan.
  (6) Enrollee identification card--A printed card issued to enrollees of a health benefit plan that includes all necessary information to allow an enrollee to access all coverage under the health benefit plan.
  (7) Health benefit plan--As described in Insurance Code §1369.151, including a health benefit plan providing coverage for pharmacy benefits only, but not those described in Insurance Code §1369.152. This definition includes the term "plan," as defined in Insurance Code §4151.001(4), but does not include a self-funded employee welfare benefit plan exempt from state regulation under ERISA, 29 U.S.C. §1002(1)(A).
  (8) Identification code--Any unique code used by an issuer of a health benefit plan, administrator, or pharmacy benefit manager that identifies and differentiates among enrollees.
  (9) Issuer--Those entities described in Insurance Code §1369.151, but not those excluded by Insurance Code §1369.152.
  (10) Pharmacy benefit manager--As defined in Insurance Code §4151.151, but does not include a pharmacy benefit manager for a self-funded employee welfare benefit plan exempt from state regulation under ERISA, 29 U.S.C. §1002(1)(A).
  (11) Pharmacy benefits--Coverage in a health benefit plan for prescription drugs that are ordinarily and customarily dispensed by a pharmacy or pharmacist licensed under the Texas Pharmacy Act, Occupations Code §551.001, et seq.
  (12) Standard identification card--A printed card containing the written information required by §21.3003(b) of this title (relating to Standard Identification Cards).
  (13) Subscriber--The individual who is the contract holder and who is responsible for payment of premiums to the issuer of an individual health benefit plan; or the individual who is the certificate holder and whose employment or membership status, except for family dependency, is the basis for eligibility for enrollment in a health benefit plan.

Source Note: The provisions of this §21.3002 adopted to be effective December 20, 2000, 25 TexReg 12441; amended to be effective August 18, 2016, 41 TexReg 6035