The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise.(1) Enrollee--An individual who is eligible for coverage under a health benefit plan, including a covered dependent.(2) Health benefit plan--A group, blanket, or franchise insurance policy, a certificate issued under a group policy, a group hospital service contract, or a group subscriber contract or evidence of coverage issued by a health maintenance organization that provides benefits for health care services. The term does not include:(A) accident-only or disability income insurance coverage or a combination of accident-only and disability income insurance coverage;(B) credit-only insurance coverage;(C) disability insurance coverage;(D) coverage only for a specified disease or illness;(E) Medicare services under a federal contract;(F) Medicare supplement, Medicare Select, Medicare Advantage, or any successor policies regulated in accordance with federal law;(G) long-term care coverage or benefits, nursing home care coverage or benefits, home health care coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits;(H) coverage that provides only dental or vision benefits;(I) coverage provided by a single service health maintenance organization;(J) coverage issued as a supplement to liability insurance;(K) workers' compensation insurance coverage or similar insurance coverage;(L) automobile medical payment insurance coverage;(M) a jointly managed trust authorized under 29 U.S.C. Section 141 et seq. that contains a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U.S.C. Section 157;(N) hospital indemnity or other fixed indemnity insurance coverage;(O) reinsurance contracts issued on a stop-loss, quota-share, or similar basis;(P) liability insurance coverage, including general liability insurance and automobile liability insurance coverage; or(Q) coverage that provides other limited benefits specified by federal regulations.(3) Health benefit plan issuer--Any entity that issues a health benefit plan, including:(A) a health maintenance organization operating under Insurance Code Chapter 843;(B) an approved nonprofit health corporation that holds a certificate of authority under Insurance Code Chapter 844;(C) an insurance company, including an insurance company offering a preferred provider benefit plan under Insurance Code Chapter 1301;(D) a group hospital service corporation operating under Insurance Code Chapter 842;(E) a fraternal benefit society operating under Insurance Code Chapter 885; or(F) a stipulated premium company operating under Insurance Code Chapter 884.(4) Health care provider--(A) a person, other than a physician, who is licensed or otherwise authorized to provide a health care service in this state, including:(i) a pharmacist or dentist; or(ii) a pharmacy, hospital, or other institution or organization;(B) a person who is wholly owned or controlled by a provider or by a group of providers who are licensed or otherwise authorized to provide the same health care service; or(C) a person who is wholly owned or controlled by one or more hospitals and physicians, including a physician-hospital organization.(5) Participating provider--(A) a physician or health care provider who contracts with a health benefit plan issuer to provide medical care or health care to enrollees in a health benefit plan; or(B) a physician or health care provider who accepts and treats a patient on a referral from a physician or provider described by subparagraph (A) of this paragraph.(6) Physician--(A) an individual licensed to practice medicine in this state under Subtitle B,