Texas § IN.847.003 - DEFINITIONS

§ IN.847.003. DEFINITIONS

DEFINITIONS. In this chapter: (1) "Commission" means the Health and Human Services Commission. (2) "Health benefit plan" means an individual, group, blanket, or franchise insurance policy, a certificate issued under a group policy, a group hospital service contract, or an individual or group subscriber contract or evidence of coverage issued by a health maintenance organization that provides benefits for health care services. The term does not include: (A) accident-only or disability income insurance coverage or a combination of accident-only and disability income insurance coverage; (B) credit-only insurance coverage; (C) disability insurance coverage; (D) Medicare services under a federal contract; (E) Medicare supplement and Medicare Select benefit plans regulated in accordance with federal law; (F) long-term care coverage or benefits, nursing home care coverage or benefits, home health care coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits; (G) workers' compensation insurance coverage or similar insurance coverage; (H) coverage provided through a jointly managed trust authorized under 29 U.S.C. Section 141 et seq. that contains a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U.S.C. Section 157; (I) hospital indemnity or other fixed indemnity insurance coverage; (J) reinsurance contracts issued on a stop-loss, quota-share, or similar basis; (K) short-term major medical contracts; (L) liability insurance coverage, including general liability insurance coverage and automobile liability insurance coverage, and coverage issued as a supplement to liability insurance coverage, including automobile medical payment insurance coverage; (M) coverage for on-site medical clinics; (N) coverage that provides other limited benefits specified by federal regulations; (O) coverage that provides limited scope dental or vision benefits; or (P) other coverage that: (i) is similar to the coverage described by this subdivision under which benefits for medical care are secondary or incidental to other coverage benefits; and (ii) is specified by federal regulations. (3) "National accreditation organization" means: (A) the Accreditation Association for Ambulatory Health Care; (B) the Joint Commission on Accreditation of Healthcare Organizations; (C) the National Committee for Quality Assurance; (D) the American Accreditation HealthCare Commission ("URAC"); or (E) any other national accreditation entity recognized by rules jointly adopted by the commissioner of insurance and the executive commissioner of the commission. Added by Acts 2005, 79th Leg., Ch. 789 (S.B. 155 ), Sec. 1, eff. June 17, 2005.