| (a) This subchapter applies to:
(1) group, blanket, or franchise accident and health
insurance policies as described by Insurance Code Chapter 1251, concerning
Group and Blanket Health Insurance;
(2) individual and group health maintenance organization
(HMO) evidences of coverage as defined by Insurance Code §843.002,
concerning Definitions;
(3) individual accident and health insurance policies
as defined by Insurance Code §1201.001, concerning Definitions;
(4) individual and group preferred provider benefit
plans and exclusive provider benefit plans as described by Insurance
Code Chapter 1301, concerning Preferred Provider Benefit Plans;
(5) group insurance contracts, individual insurance
contracts, and subscriber contracts that pay or reimburse for the
cost of dental care;
(6) individual and group health benefit plans or vision
benefit plans, as described by Insurance Code Chapter 1203, Subchapter
C, concerning Vision and Eye Care Benefits; and
(7) the medical care components of individual and group
long-term care contracts.
(b) This subchapter does not apply to:
(1) disability income protection coverage;
(2) workers' compensation insurance coverage;
(3) hospital indemnity coverage benefits or other fixed
indemnity coverage;
(4) accident only coverage;
(5) specified disease or specified accident coverage;
(6) school accident-type coverages that cover students
for accidents only, including athletic injuries, either on a "24-hour"
or a "to and from school" basis;
(7) benefits provided in long-term care insurance policies
for nonmedical services, for example, personal care, adult day care,
homemaker services, assistance with activities of daily living, respite
care, custodial care, or for contracts that pay a fixed daily benefit
without regard to expenses incurred or the receipt of services;
(8) Medicare supplement policies;
(9) a state plan under Medicaid;
(10) a governmental plan, which, by law, provides benefits
that are in excess of those of any private insurance plan or other
nongovernmental plan; or
(11) an individual accident and health insurance policy
that is designed to fully integrate with other policies through a
variable deductible.
(c) This subchapter does not apply to individual policies
issued before March 25, 2014, that are noncancellable or guaranteed
renewable.
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