(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 § 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. § 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. § 1001 et seq.).