Terms Used In Texas Insurance Code 1661.001

  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.

In this chapter:
(1) “Health benefit plan” means a 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 that is offered by:
(A) an insurance company;
(B) a group hospital service corporation operating under Chapter 842;
(C) a fraternal benefit society operating under Chapter 885;
(D) a stipulated premium company operating under Chapter 884;
(E) a Lloyd’s plan operating under Chapter 941;
(F) an exchange operating under Chapter 942;
(G) a health maintenance organization operating under Chapter 843;
(H) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;
(I) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or
(J) an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis.
(2) “Health benefit plan issuer” means an entity authorized to issue a health benefit plan in this state.
(3) “Health care provider” means:
(A) an individual who is licensed, certified, or otherwise authorized to provide health care services; or
(B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.
(4) “Participating provider” means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.