Definitions

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise.

(1) Accident and health insurance policy--Any policy or contract that provides insurance against loss resulting from:

(A) accidental bodily injury;

(B) accidental death; or

(C) sickness.

(2) Evidence of coverage--Any certificate, agreement, or contract, including a blended contract, that:

(A) is issued to an enrollee; and

(B) states the coverage to which the enrollee is entitled.

(3) Health benefit Plan--An accident and health insurance policy or evidence of coverage.

(4) Health carrier--A health insurer or health maintenance organization.

(5) Health insurer--Includes:

(A) a life, health, and accident insurance company;

(B) a mutual insurance company, including:

(i) a mutual life insurance company; and

(ii) a mutual assessment life insurance company;

(C) a local mutual aid association;

(D) a mutual or natural premium life or casualty insurance company;

(E) a general casualty company;

(F) a Lloyd's plan;

(G) a reciprocal or interinsurance exchange;

(H) a nonprofit hospital, medical, or dental service corporation, including a corporation operating under Texas Insurance Code Chapter 842; and

(I) another insurer issuing an accident and health insurance policy and required by law to be authorized by the department.

(6) Health maintenance organization--A person who arranges for or provides to enrollees on a prepaid basis a health care plan, a limited health care service plan, or a single health care service plan.

(7) High deductible health benefit plan--Has the meaning assigned by Section 223, Internal Revenue Code of 1986.

(8) Preventive care--Has the meaning assigned by Section 223(c)(2)(C), Internal Revenue Code of 1986.

Source Note: The provisions of this §21.3902 adopted to be effective May 31, 2006, 31 TexReg 4439.