Texas House Bill 610
("Clean Claims") 5-29-99

Texas Department of Insurance 28 TAC 21.2801 - 21.2809
(Proposed definition of a "clean claim") 9-7-99

Texas Insurance Code Article 3.70-3C 3(m)
(PPOs) 1997

Texas Insurance Code Article 20A.09 (j)
(HMOs) 1997

Texas Insurance Code Article 21.55
(Indemnity Health Insurance Companies) 10-1-91

Plans that are self-funded by the employer (ERISA Plans) are exempt from state laws, including the above regulations. An estimated 85% of PPOs in Texas are exempt. In a self-funded plan, an employer hires a third party (i.e. - Aetna) to handle claims and paperwork but the employer pays the actual claim.