§ 140.002.Applicability of Chapter

A long applicability provision, and its exclusions matter as much as its inclusions.

Subsection (a) reaches an issuer of a health benefit plan providing benefits for medical or surgical expenses, a disability benefit plan, or an employee welfare benefit plan — and lists eight entity types, including an insurance company, a group hospital service corporation, a fraternal benefit society, a reciprocal exchange, an HMO, a multiple employer welfare arrangement, and an approved nonprofit health corporation.

Subsections (b) through (d) each open with "notwithstanding any other law", which is the drafter reaching entities that would otherwise argue their way out: local government risk pools, the state employee and teacher plans under the named Insurance Code chapters, and any self-funded issuer.

Subsection (e) sets the territorial hook — a policy delivered, issued for delivery, or entered into in this state, or under which an individual or group in this state is entitled to benefits.

Subsection (f) excludes six things, and one of them removes most of the field: workers’ compensation, Medicare, Medicaid, Medicaid managed care, the child health plan, and a self-funded plan subject to ERISA.

The ERISA exclusion is the significant one, and it is a recognition of federal preemption rather than a policy choice. Most large employer plans are self-funded ERISA plans, and their subrogation rights are governed by federal law and the plan document — where no state cap applies.

Note the interaction with subsection (d), which reaches self-funded issuers generally: the two read together cover self-funded plans that are not ERISA plans, principally governmental ones.