The following words and terms when used in this division have
the following meanings, unless the context clearly indicates otherwise:
(1) Administrator--As defined in Insurance Code §4151.001(1),
for plans subject to Insurance Code Chapter 1369, Subchapter D.
(2) Drug--As defined in the Texas Pharmacy Act, Occupations
Code §551.003.
(3) Drug formulary--A list of drugs for which a health
benefit plan provides coverage, approves payment, or encourages or
offers incentives for physicians or other health care providers to
prescribe.
(4) Effective date--The date that the health benefit
plan's current prescription drug benefit levels became effective,
or the date the subscriber's coverage first became effective, whichever
is later.
(5) Enrollee--A person covered by a health benefit
plan.
(6) Enrollee identification card--A printed card issued
to enrollees of a health benefit plan that includes all necessary
information to allow an enrollee to access all coverage under the
health benefit plan.
(7) Health benefit plan--As described in Insurance
Code §1369.151, including a health benefit plan providing coverage
for pharmacy benefits only, but not those described in Insurance Code §1369.152.
This definition includes the term "plan," as defined in Insurance
Code §4151.001(4), but does not include a self-funded employee
welfare benefit plan exempt from state regulation under ERISA, 29
U.S.C. §1002(1)(A).
(8) Identification code--Any unique code used by an
issuer of a health benefit plan, administrator, or pharmacy benefit
manager that identifies and differentiates among enrollees.
(9) Issuer--Those entities described in Insurance Code §1369.151,
but not those excluded by Insurance Code §1369.152.
(10) Pharmacy benefit manager--As defined in Insurance
Code §4151.151, but does not include a pharmacy benefit manager
for a self-funded employee welfare benefit plan exempt from state
regulation under ERISA, 29 U.S.C. §1002(1)(A).
(11) Pharmacy benefits--Coverage in a health benefit
plan for prescription drugs that are ordinarily and customarily dispensed
by a pharmacy or pharmacist licensed under the Texas Pharmacy Act,
Occupations Code §551.001, et seq.
(12) Standard identification card--A printed card containing
the written information required by §21.3003(b) of this title
(relating to Standard Identification Cards).
(13) Subscriber--The individual who is the contract
holder and who is responsible for payment of premiums to the issuer
of an individual health benefit plan; or the individual who is the
certificate holder and whose employment or membership status, except
for family dependency, is the basis for eligibility for enrollment
in a health benefit plan.
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