| (a) Except as otherwise specified in this subchapter,
this subchapter applies to any preferred provider benefit plan or
exclusive provider benefit plan as specified in this subsection.
(1) This subchapter applies to any preferred or exclusive
provider benefit plan policy that is offered, delivered, issued for
delivery, or renewed on or after 150 days from the effective date
of this section. Any preferred or exclusive provider benefit plan
policy delivered, issued for delivery, or renewed prior to this applicability
date is subject to the statutes and provisions of this subchapter
in effect at the time the policy was delivered, issued for delivery,
or renewed.
(2) This subchapter does not apply to:
(A) provisions for dental care benefits in any health
insurance policy; or
(B) an exclusive provider benefit plan regulated under
Subchapter KK of this chapter (relating to Exclusive Provider Benefit
Plan) written by an insurer pursuant to a contract with the Texas
Health and Human Services Commission to provide services under the
Texas Children's Health Insurance Program, Medicaid, or with the Statewide
Rural Health Care System.
(b) This subchapter is not an interpretation of and
has no application to any law requiring licensure to act as a principal
or agent in the insurance or related businesses including, but not
limited to, health maintenance organizations.
(c) The provisions of this subchapter are subject to
Insurance Code Chapter 1301; Insurance Code §§1353.001,
1353.002, 1451.001, 1451.053, and 1451.054; and Insurance Code Chapter
1451, Subchapter C, as they relate to insurers and the practitioners
named therein.
(d) These sections do not create a private cause of
action for damages or create a standard of care, obligation, or duty
that provides a basis for a private cause of action. These sections
do not abrogate a statutory or common law cause of action, administrative
remedy, or defense otherwise available.
(e) If a court of competent jurisdiction holds that
any provision of this subchapter or its application to any person
or circumstance is invalid for any reason, the invalidity does not
affect other provisions or applications of this subchapter that can
be given effect without the invalid provision or application, and
to this end the provisions of this subchapter are severable.
(f) A provision of this title applicable to a preferred
provider benefit plan is applicable to an exclusive provider benefit
plan unless specified otherwise.
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| Source Note: The provisions of this §3.3701 adopted to be effective July 1, 1986, 11 TexReg 2810; amended to be effective December 28, 1990, 15 TexReg 7183; amended to be effective December 6, 1995, 20 TexReg 9697; amended to be effective July 15, 1999, 24 TexReg 5204; amended to be effective December 6, 2011, 36 TexReg 3411; amended to be effective February 21, 2013, 38 TexReg 827; amended to be effective March 30, 2021, 46 TexReg 2026 |
