# 28 Tex. Admin. Code § 21.5002: 28 TAC § 21.5002. Scope, DIVISION 1. GENERAL PROVISIONS > Texas · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5002 ## Section - **Citation:** 28 Tex. Admin. Code § 21.5002 - **Heading:** 28 TAC § 21.5002. Scope, DIVISION 1. GENERAL PROVISIONS - **Jurisdiction:** Texas - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Texas Administrative Code / Title 28 INSURANCE / Part 1 TEXAS DEPARTMENT OF INSURANCE / Chapter 21 TRADE PRACTICES / 28 TAC § 21.5002 ## Text (a) This subchapter applies to a qualified mediation claim or qualified arbitration claim filed under health benefit plan coverage: (1) issued by an insurer as a preferred provider benefit plan under Insurance Code Chapter 1301, concerning Preferred Provider Benefit Plans, including an exclusive provider benefit plan; (2) administered by an administrator of a health benefit plan, other than a health maintenance organization (HMO) plan, under Insurance Code Chapters 1551, concerning Texas Employees Group Benefits Act; 1575, concerning Texas Public School Employees Group Benefits Program; 1579, concerning Texas School Employees Uniform Group Health Coverage; or 1682, concerning Health Benefits Provided by Certain Nonprofit Agricultural Organizations; (3) offered by an HMO operating under Insurance Code Chapter 843, concerning Health Maintenance Organizations; or (4) offered by a self-insured or self-funded plan established by an employer under ERISA if the plan sponsor submitted election according to §21.5060 of this title (relating to Election Submission Requirements). (b) This subchapter does not apply to a claim for health benefits that is not a covered claim under the terms of the health benefit plan coverage. (c) Except as provided in §21.5050 of this title (relating to Submission of Information), this subchapter applies to a claim for emergency care or health care or medical services or supplies, provided on or after January 1, 2020. A claim for health care or medical services or supplies provided before January 1, 2020, is governed by the rules in effect immediately before the effective date of this subsection, and those rules are continued in effect for that purpose. This subchapter applies to a claim filed for emergency care or health care or medical services or supplies by the administrator of a health benefit plan under Insurance Code Chapter 1682. ## Nearby sections - [28 Tex. Admin. Code § 21.5001 28 TAC § 21.5001. Purpose, DIVISION 1. GENERAL PROVISIONS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5001.md) - [28 Tex. Admin. Code § 21.5002 28 TAC § 21.5002. Scope, DIVISION 1. GENERAL PROVISIONS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5002.md) - [28 Tex. Admin. Code § 21.5003 28 TAC § 21.5003. Definitions, DIVISION 1. GENERAL PROVISIONS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5003.md) - [28 Tex. Admin. Code § 21.5010 28 TAC § 21.5010. Qualified Mediation Claim Criteria, DIVISION 2. MEDIATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5010.md) - [28 Tex. Admin. Code § 21.5011 28 TAC § 21.5011. Mediation Request Procedure, DIVISION 2. MEDIATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5011.md) - [28 Tex. Admin. Code § 21.5012 28 TAC § 21.5012. Informal Settlement Teleconference, DIVISION 2. MEDIATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5012.md) - [28 Tex. Admin. Code § 21.5013 28 TAC § 21.5013. Mediation Participation, DIVISION 2. MEDIATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5013.md) - [28 Tex. Admin. Code § 21.5020 28 TAC § 21.5020. Qualified Arbitration Claim Criteria, DIVISION 3. ARBITRATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5020.md) - [28 Tex. Admin. Code § 21.5021 28 TAC § 21.5021. Arbitration Request Procedure, DIVISION 3. ARBITRATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5021.md) - [28 Tex. Admin. Code § 21.5022 28 TAC § 21.5022. Informal Settlement Teleconference, DIVISION 3. ARBITRATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5022.md) - [28 Tex. Admin. Code § 21.5023 28 TAC § 21.5023. Arbitration Participation, DIVISION 3. ARBITRATION PROCESS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5023.md) - [28 Tex. Admin. Code § 21.5030 28 TAC § 21.5030. Complaint Resolution, DIVISION 4. COMPLAINT RESOLUTION AND OUTREACH](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5030.md) - [28 Tex. Admin. Code § 21.5040 28 TAC § 21.5040. Required Explanation of Benefits and Enrollee Identification Card Information, DIVISION 5. EXPLANATION OF BENEFITS](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5040.md) - [28 Tex. Admin. Code § 21.5050 28 TAC § 21.5050. Submission of Information, DIVISION 6. BENCHMARKING](https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5050.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C21_S21_5002. Check the current official text before relying on it. Not legal advice.