Texas § IN.1252.001 - DEFINITIONS

§ IN.1252.001. DEFINITIONS

DEFINITIONS. In this chapter: (1) "Carrier" means: (A) an insurer; or (B) a group hospital service corporation operating under Chapter 842 . (2) "Health benefit plan" means: (A) any accident and health insurance policy; (B) a subscriber contract of a group hospital service corporation; or (C) an accident and health benefits package of a multiple employer trust that is not exempt from regulation by this state as an employee welfare benefit plan under the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), as amended. (3) "Previous carrier" means a carrier whose health benefit plan coverage has been replaced with health benefit plan coverage provided by a succeeding carrier. (4) "Succeeding carrier" means a carrier that replaces the health benefit plan coverage provided by another carrier with its own health benefit plan coverage. (5) "Total disability" or "totally disabled" means: (A) with respect to an employee or other primary insured covered under a health benefit plan, the complete inability of that individual to perform all of the substantial and material duties and functions of the individual's occupation and any other gainful occupation in which the individual earns substantially the same compensation earned before the disability; and (B) with respect to any other individual covered under a health benefit plan, confinement as a bed patient in a hospital. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.