Sec. 1301.0041. APPLICABILITY. (a) Except as otherwise specifically provided by this chapter, this chapter applies to each preferred provider benefit plan in which an insurer provides, through the insurer's health insurance policy, for the payment of a level of coverage that is different depending on whether an insured uses a preferred provider or a nonpreferred provider.
(b) Unless otherwise specified, an exclusive provider benefit plan is subject to this chapter in the same manner as a preferred provider benefit plan.
(c) This chapter does not apply to:
(1) the child health plan program under Chapter 62, Health and Safety Code; or
(2) a Medicaid managed care program under Chapter 533, Government Code.
Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.0271(b), eff. September 1, 2007.
Added by Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.0271(b), eff. September 1, 2007.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 288 (H.B. 1772), Sec. 4, eff. September 1, 2011.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1301 - Preferred Provider Benefit Plans
Subchapter A. General Provisions
Section 1301.002. Nonapplicability to Dental Care Benefits
Section 1301.003. Preferred Provider Benefit Plans and Exclusive Provider Benefit Plans Permitted
Section 1301.0041. Applicability
Section 1301.0042. Applicability of Insurance Law
Section 1301.0045. Construction of Chapter
Section 1301.0046. Coinsurance Requirements for Services of Nonpreferred Providers
Section 1301.005. Availability of Preferred Providers
Section 1301.0051. Exclusive Provider Benefit Plans: Quality Improvement and Utilization Management
Section 1301.0052. Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services
Section 1301.0053. Exclusive Provider Benefit Plans: Emergency Care
Section 1301.0055. Network Adequacy Standards
Section 1301.0056. Examinations and Fees
Section 1301.0057. Access to Out-of-Network Providers
Section 1301.0058. Protected Communications by Preferred Providers
Section 1301.006. Availability of and Accessibility to Health Care Services
Section 1301.0061. Terms of Enrollee Eligibility
Section 1301.008. Conflict With Other Law