AI-assisted research summary: This section defines "health benefit plan" and lists coverage types that are included or excluded.
Sec. 1458.002. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this chapter, "health benefit plan" means: (1) a hospital and medical expense incurred policy; (2) a nonprofit health care service plan contract; (3) a health maintenance organization subscriber contract; or (4) any other health care plan or arrangement that pays for or furnishes medical or health care services. (b) "Health benefit plan" does not include one or more or any combination of the following: (1) coverage only for accident or disability income insurance or any combination of those coverages; (2) credit-only insurance; (3) coverage issued as a supplement to liability insurance; (4) liability insurance, including general liability insurance and automobile liability insurance; (5) workers' compensation or similar insurance; (6) a discount health care program, as defined by Section 7001.001; (7) coverage for on-site medical clinics; (8) automobile medical payment insurance; (9) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or (10) other similar insurance coverage, as specified by federal regulations issued under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191), under which benefits for medical care are secondary or incidental to other insurance benefits. (c) "Health benefit plan" does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance, or are otherwise not an integral part of the coverage: (1) dental or vision benefits; (2) benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these benefits; (3) other similar, limited benefits, including benefits specified by federal regulations issued under the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191); or (4) a Medicare supplement benefit plan described by Section 1652.002. (d) "Health benefit plan" does not include coverage limited to a specified disease or illness or hospital indemnity coverage or other fixed indemnity insurance coverage if: (1) the coverage is provided under a separate policy, certificate, or contract of insurance; (2) there is no coordination between the provision of the coverage and any exclusion of benefits under any group health benefit plan maintained by the same plan sponsor; and (3) the coverage is paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health benefit plan maintained by the same plan sponsor. Added by Acts 2013, 83rd Leg., R.S., Ch. 197 (S.B. 822), Sec. 1, eff. September 1, 2013.