This section says which health benefit plans this subchapter applies to, which plans are excluded, and lets the commissioner exclude certain plans by rule.
Sec. 38.353. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies to the issuer of a group health benefit plan, including: (1) an insurance company; (2) a group hospital service corporation; (3) a fraternal benefit society; (4) a stipulated premium company; (5) a reciprocal or interinsurance exchange; or (6) a health maintenance organization. (b) Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, and except as provided by Subsection (e), this subchapter applies to: (1) a basic coverage plan under Chapter 1551; (2) a basic plan under Chapter 1575; (3) a primary care coverage plan under Chapter 1579; and (4) basic coverage under Chapter 1601. (c) Except as provided by Subsection (d), this subchapter applies to a small employer health benefit plan provided under Chapter 1501. (d) This subchapter does not apply to: (1) standard health benefit plans provided under Chapter 1507; (2) children's health benefit plans provided under Chapter 1502; (3) health care benefits provided under a workers' compensation insurance policy; (4) Medicaid managed care programs operated under Chapter 540 or 540A, Government Code, as applicable; (5) Medicaid programs operated under Chapter 32, Human Resources Code; or (6) the state child health plan operated under Chapter 62 or 63, Health and Safety Code. (e) The commissioner by rule may exclude a type of health benefit plan from the requirements of this subchapter if the commissioner finds that data collected in relation to the health benefit plan would not be relevant to accomplishing the purposes of this subchapter. Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007. Amended by: Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.116, eff. April 1, 2025.