28 Tex. Admin. Code § 11.2201 - General Provisions
(a) Each single
service HMO must provide uniquely described services with any corresponding
copayments for each covered service and benefit and must provide a single
health care service plan as defined in Insurance Code §
843.002 (concerning
Definitions). Each single service HMO must comply with all requirements for a
single health care service plan specified in this subchapter.
(b) Each single service HMO schedule of
enrollee copayments must specify an appropriate description of covered services
and benefits, as required by §
11.506 of this title (relating to
Mandatory Contractual Provisions: Group, Individual, and Conversion Agreement
and Group Certificate), and may specify recognized procedures or other
information used for the purpose of maintaining a statistical reporting
system.
(c) Each single service HMO
evidence of coverage must include a glossary of terminology, including the
terms used in the evidence of coverage required by §
11.501 of this title (relating to
Contents of the Evidence of Coverage). The glossary must be included in the
information to prospective and current group contract holders and enrollees, as
required by Insurance Code §
843.201 (concerning
Disclosure of Information About Health Care Plan Terms).
(d) In the event of a conflict between the
provisions of this subchapter and other provisions of this chapter, this
subchapter prevails with regard to single service HMOs. It is not considered a
conflict if a topic that is not addressed in this subchapter appears elsewhere
in this chapter.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.