28 Tex. Admin. Code § 3.3701 - Applicability and Scope
(a) Except as
otherwise specified in this subchapter, this subchapter applies to any
preferred provider benefit plan or exclusive provider benefit plan as specified
in this subsection.
(1) This subchapter
applies to any preferred or exclusive provider benefit plan policy that is
offered, delivered, issued for delivery, or renewed on or after 150 days from
the effective date of this section. Any preferred or exclusive provider benefit
plan policy delivered, issued for delivery, or renewed prior to this
applicability date is subject to the statutes and provisions of this subchapter
in effect at the time the policy was delivered, issued for delivery, or
renewed.
(2) This subchapter does
not apply to:
(A) provisions for dental care
benefits in any health insurance policy; or
(B) an exclusive provider benefit plan
regulated under Subchapter KK of this chapter (relating to Exclusive Provider
Benefit Plan) written by an insurer pursuant to a contract with the Texas
Health and Human Services Commission to provide services under the Texas
Children's Health Insurance Program, Medicaid, or with the Statewide Rural
Health Care System.
(b) This subchapter is not an interpretation
of and has no application to any law requiring licensure to act as a principal
or agent in the insurance or related businesses including, but not limited to,
health maintenance organizations.
(c) The provisions of this subchapter are
subject to Insurance Code Chapter 1301; Insurance Code §§
1353.001,
1353.002,
1451.001,
1451.053, and
1451.054; and
Insurance Code Chapter 1451, Subchapter C as they relate to insurers and the
practitioners named therein.
(d)
These sections do not create a private cause of action for damages or create a
standard of care, obligation, or duty that provides a basis for a private cause
of action. These sections do not abrogate a statutory or common law cause of
action, administrative remedy, or defense otherwise available.
(e) If a court of competent jurisdiction
holds that any provision of this subchapter or its application to any person or
circumstance is invalid for any reason, the invalidity does not affect other
provisions or applications of this subchapter that can be given effect without
the invalid provision or application, and to this end the provisions of this
subchapter are severable.
(f) A
provision of this title applicable to a preferred provider benefit plan is
applicable to an exclusive provider benefit plan unless specified
otherwise.
Notes
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