| (a) Terms in this subchapter have the same meaning
as defined and used in Insurance Code Chapter 1458.
(b) The following words and terms when used in this
subchapter have the following meanings unless the context clearly
indicates otherwise:
(1) Affiliate--Includes each person that is an affiliate
under Insurance Code Chapter 823.
(2) Fee schedule--Includes payment or reimbursement
terms of the provider network contract.
(3) Primary provider network--A provider network in
which the contracting entity submitting the form is the contracting
entity for the provider network.
(4) Other provider network--A provider network that
may be accessed by the contracting entity submitting the form or the
submitting entity's affiliate, but in which the contracting entity
for the provider network is not an affiliate of the entity submitting
the form.
(5) Subsidiary provider network--A provider network
in which the contracting entity or entities for the provider network
are an affiliate of the entity submitting the form, except for provider
networks that also qualify as a primary provider network.
(6) TDI--Texas Department of Insurance.
(c) In this subchapter:
(1) the term "provider network contracting entity"
has the same meaning as contracting entity;
(2) a person begins acting as a contracting entity
in this state when the person enters into or offers to enter into
direct contracts with one or more providers for the delivery of health
care services to covered individuals that serve to create a provider
network or networks to be accessed by another party; and
(3) access to a provider network or networks by another
party includes access by an affiliate.
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