28 Tex. Admin. Code § 11.2402 - General Provisions
(a) A limited
service HMO must develop and maintain an ongoing quality improvement structure
and program that complies with Chapter 11, Subchapter T, of this title
(relating to Quality of Care).
(b)
Each limited service HMO must provide uniquely described services with any
corresponding copayments for each covered service and benefit, and provide a
limited health care service plan as defined in Insurance Code §
843.002 (concerning
Definitions). Each limited service HMO must comply with all requirements for a
limited health care service plan specified in this subchapter.
(c) Each limited 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 procedure codes or other
information used for maintaining a statistical reporting system.
(d) Each limited service HMO evidence of
coverage must include a glossary of terms, 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).
Notes
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