{"data":{"id":"us-tx/tex.-insurance-code-1452.101","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1452.101","heading":"DEFINITIONS.","body":"In this subchapter:\n(1) \"Applicant physician\" means a physician applying for expedited credentialing under this subchapter.\n(2) \"Enrollee\" means an individual who is eligible to receive health care services under a managed care plan.\n(3) \"Health care provider\" means:\n(A) an individual who is licensed, certified, or otherwise authorized to provide health care services in this state; or\n(B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.\n(4) \"Managed care plan\" means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires enrollees to use participating providers or that provides a different level of coverage for enrollees who use participating providers. The term includes a health benefit plan issued by:\n(A) a health maintenance organization;\n(B) a preferred provider benefit plan issuer; or\n(C) any other entity that issues a health benefit plan, including an insurance company.\n(5) \"Medical group\" means:\n(A) a single legal entity owned by two or more physicians;\n(B) a professional association composed of licensed physicians;\n(C) any other business entity composed of licensed physicians as permitted under Subchapter B, Chapter 162, Occupations Code; or\n(D) two or more physicians on the medical staff of, or teaching at, a medical school or medical and dental unit, as defined or described by Section 61.003, 61.501, or 74.601, Education Code.\n(6) \"Participating provider\" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.\nAdded by Acts 2007, 80th Leg., R.S., Ch. 1203 (H.B. 1594), Sec. 1, eff. September 1, 2007.\nAmended by:\nActs 2009, 81st Leg., R.S., Ch. 296 (H.B. 389), Sec. 1, eff. September 1, 2009.\nActs 2011, 82nd Leg., R.S., Ch. 414 (S.B. 822), Sec. 1, eff. September 1, 2011.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE F. PHYSICIANS AND HEALTH CARE PROVIDERS","CHAPTER 1452. PHYSICIAN AND PROVIDER CREDENTIALS","SUBCHAPTER C. EXPEDITED CREDENTIALING PROCESS FOR CERTAIN PHYSICIANS"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1452.htm#1452.101","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"069863b6a370108296d1f8ccb9af5a8f6f42ad45ec890600b27b5e73e00857fb","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1452.052","next":"us-tx/tex.-insurance-code-1452.102"},"notice":"GroundRules: Original legal text. Not legal advice."}