Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS
Subchapter S - FORMS TO REQUEST PRIOR AUTHORIZATION
Division 1 - TEXAS STANDARD PRIOR AUTHORIZATION REQUEST FORMS
Section 19.1801 - Applicability
Universal Citation: 28 TX Admin Code § 19.1801
Current through Reg. 50, No. 13; March 28, 2025
(a) Applicable health benefit plans. This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or a small or large employer group contract or similar coverage document that is offered by:
(1) an insurance
company;
(2) a group hospital
service corporation operating under Chapter 842;
(3) a fraternal benefit society operating
under Chapter 885;
(4) a stipulated
premium company operating under Chapter 884;
(5) a reciprocal exchange operating under
Chapter 942;
(6) a health
maintenance organization operating under Chapter 843;
(7) a multiple employer welfare arrangement
holding a certificate of authority under Chapter 846; or
(8) an approved nonprofit health corporation
holding a certificate of authority under Chapter 844.
(b) Other applicable coverages and programs.
(1) This subchapter applies to group health
coverage made available by a school district under Education Code §
22.004.
(2) This subchapter applies to:
(A) a basic coverage plan under Chapter
1551;
(B) a basic plan under
Chapter 1575;
(C) a primary care
coverage plan under Chapter 1579; and
(D) basic coverage under Chapter
1601.
(3) This
subchapter applies to coverage under the child health program under Chapter 62,
Health and Safety Code, or the health benefits plan for children under Chapter
63, Health and Safety Code.
(4)
This subchapter applies to a Medicaid managed care program operated under
Chapter 533, Government Code, or a Medicaid program operated under Chapter 32,
Human Resources Code.
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