Texas § IN.1452.101 - DEFINITIONS

§ IN.1452.101. DEFINITIONS

DEFINITIONS. In this subchapter: (1) "Applicant physician" means a physician applying for expedited credentialing under this subchapter. (2) "Enrollee" means an individual who is eligible to receive health care services under a managed care plan. (3) "Health care provider" means: (A) an individual who is licensed, certified, or otherwise authorized to provide health care services in this state; or (B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services. (4) "Managed care plan" means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires enrollees to use participating providers or that provides a different level of coverage for enrollees who use participating providers. The term includes a health benefit plan issued by: (A) a health maintenance organization; (B) a preferred provider benefit plan issuer; or (C) any other entity that issues a health benefit plan, including an insurance company. (5) "Medical group" means: (A) a single legal entity owned by two or more physicians; (B) a professional association composed of licensed physicians; (C) any other business entity composed of licensed physicians as permitted under Subchapter B , Chapter 162 , Occupations Code; or (D) two or more physicians on the medical staff of, or teaching at, a medical school or medical and dental unit, as defined or described by Section 61.003 , 61.501 , or 74.601 , Education Code. (6) "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees. Added by Acts 2007, 80th Leg., R.S., Ch. 1203 (H.B. 1594 ), Sec. 1, eff. September 1, 2007. Amended by: Acts 2009, 81st Leg., R.S., Ch. 296 (H.B. 389 ), Sec. 1, eff. September 1, 2009. Acts 2011, 82nd Leg., R.S., Ch. 414 (S.B. 822 ), Sec. 1, eff. September 1, 2011.