The following words and terms when used in this subchapter
have the following meanings, unless the context clearly indicates
otherwise.
(1) Association--An association (other than an employer
association), including but not limited to a labor union or organizations
of such unions, membership corporations organized or holding a certificate
of authority under the Texas Non-profit Corporation Act, and cooperatives
and corporations subject to the supervision and control of the Farm
Credit Administration of the United States of America, that:
(A) has a constitution and bylaws;
(B) has been actively in existence for at least 2 years;
and
(C) has been formed and maintained in good faith for
purposes other than obtaining coverage under a health benefit plan
to cover members for the benefit of persons other than the association
or its officers or trustees.
(2) Bona Fide Association--An association that, in
addition to meeting the requirements of an association in paragraphs
(1)(A) and (C) of this subsection:
(A) has been actively in existence for at least 5 years;
(B) does not condition membership in the association
on any health-status-related factor relating to an individual (including
the individual eligible for membership or a dependent of the individual
eligible for membership, if dependent coverage is offered);
(C) makes coverage under a health benefit plan offered
through the association available to all members, regardless of any
health-status-related factor relating to the members (or dependents
eligible for coverage through a member, if dependent coverage is offered);
and
(D) does not make a health benefit plan offered through
the association available other than in connection with a member of
the association.
(3) Creditable Coverage--As defined in §21.1101
of this title (relating to Definitions).
(4) Genetic information--Information derived from the
results of a genetic test.
(5) Genetic test--A laboratory test of an individual's
deoxyribonucleic acid (DNA), ribonucleic acid (RNA), proteins, or
chromosomes to identify by analysis of the DNA, RNA, proteins, or
chromosomes the genetic mutations or alterations in the DNA, RNA,
proteins, or chromosomes that are associated with a predisposition
for a clinically recognized disease or disorder. The term does not
include:
(A) a routine physical examination or a routine test
performed as a part of a physical examination;
(B) a chemical, blood or urine analysis;
(C) a test to determine drug use; or
(D) a test for the presence of the human immunodeficiency
virus.
(6) HMO--A health maintenance organization as defined
in Insurance Code §843.002.
(7) Health benefit plan--A group insurance policy,
a certificate issued under a group policy, a group hospital service
contract, or a group subscriber contract or evidence of coverage issued
by a health carrier that provides benefits for health care benefits
or services. The term does not include the following plans of coverage:
(A) Under all circumstances:
(i) coverage only for accident;
(ii) credit-only insurance;
(iii) disability insurance coverage;
(iv) Medicare services under a federal contract;
(v) coverage issued as a supplement to liability insurance;
(vi) insurance coverage arising out of workers' compensation
or similar insurance;
(vii) automobile medical payment insurance coverage;
(viii) jointly managed trusts authorized under 29 United
States Code §§141 et seq. that contain 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 United States Code §157;
(ix) short-term limited duration insurance as defined
in this section;
(x) liability insurance, including general liability
insurance and automobile liability insurance; or
(xi) coverage for onsite medical clinics.
(B) Only if the benefits are provided under a separate
policy or contract of insurance or evidence of coverage:
(i) coverage for a specified disease or illness;
(ii) Medicare supplement and Medicare select policies
regulated in accordance with federal law;
(iii) 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;
(iv) coverage that provides limited-scope dental or
vision benefits;
(v) coverage provided by a single-service HMO;
(vi) hospital indemnity or other fixed indemnity insurance;
(vii) coverage supplemental to the coverage provided
under Chapter 55, Title 10 of the United States Code (also known as
CHAMPUS supplemental programs);
(viii) coverage that provides other limited benefits
specified by federal regulations; or
(ix) other coverage that is:
(I) similar to the coverage described in subparagraphs
(A) and (B) of this paragraph under which benefits for medical care
are secondary or incidental to other insurance benefits; and
(II) specified in federal regulations.
(8) Health carrier--Any entity authorized under the
Texas Insurance Code or another insurance law of this state that provides
health benefit plans in this state, including an insurance company;
a group hospital service corporation operating under Insurance Code
Chapter 842; a stipulated premium insurance company operating under
Insurance Code Chapter 884; an approved nonprofit health corporation
that is certified under Occupations Code Chapter 162 and that holds
a certificate of authority issued by the Commissioner under Insurance
Code Chapter 844, or an HMO.
(9) Health-status-related factor--Any of the following
in relation to an individual:
(A) health status;
(B) medical condition, including both physical and
mental illness;
(C) claims experience;
(D) receipt of health care;
(E) medical history;
(F) genetic information;
(G) evidence of insurability, including conditions
arising out of acts of domestic violence, including family violence
as defined by Insurance Code Chapter 544, Subchapter D; or
(H) disability.
(10) Short-term limited duration coverage--Health coverage
provided under a contract with a health carrier that has an expiration
date specified in the contract (taking into account any extensions
that may be elected by the policyholder without the health carrier's
consent) that is within 12 months of the date the contract becomes
effective.
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