28 Tex. Admin. Code § 21.4902 - Definitions
Words and terms defined in Insurance Code Chapter 1467, concerning Out-of-Network Claim Dispute Resolution, have the same meaning when used in this subchapter unless the context clearly indicates otherwise, and the following words and terms have the following meanings when used in this subchapter unless the context clearly indicates otherwise.
(1) Administrator--Has the meaning assigned
by Insurance Code §
1467.001, concerning
Definitions. The term also includes an administrator of a nonprofit
agricultural organization under Insurance Code Chapter 1682, concerning Health
Benefits Provided by Certain Nonprofit Agricultural Organizations, and an
administrator of a self-insured or self-funded ERISA plan under Insurance Code
Chapter 1275, concerning Balance Billing Prohibitions and Out-of-Network Claim
Dispute Resolution for Certain Plans, offering a health benefit plan.
(2) ERISA--The Employee Retirement Income
Security Act of 1974 (29 USC
§
1001 et seq.).
(3) Health benefit plan--A plan that provides
coverage under:
(A) a health benefit plan
offered by an HMO operating under Insurance Code Chapter 843, concerning Health
Maintenance Organizations;
(B) a
preferred provider benefit plan, including an exclusive provider benefit plan,
offered by an insurer under Insurance Code Chapter 1301, concerning Preferred
Provider Benefit Plans;
(C) a plan,
other than an HMO plan, under Insurance Code Chapters 1551, concerning Texas
Employees Group Benefits Act; 1575, concerning Texas Public School Employees
Group Benefits Program; 1579, concerning Texas School Employees Uniform Group
Health Coverage; or 1682; or
(D) a
self-insured or self-funded plan established by an employer under ERISA
(29 USC §
1001 et seq.) for which the plan sponsor has
elected to apply Insurance Code Chapter 1275 to the plan for the relevant plan
year.
Notes
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