SECTION 3.9801. Definitions and General Provisions

(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.

Source Note: The provisions of this §3.9801 adopted to be effective November 19, 2014, 39 TexReg 9020