28 Tex. Admin. Code § 11.2403 - Prohibited Practices

A limited service HMO may not:

(1) exclude services required for preexisting conditions which would otherwise be covered under the plan;

(2) establish waiting periods for coverage of preexisting conditions;

(3) impose a lifetime coverage maximum for any covered service or benefit;

(4) limit or otherwise interfere with an enrollee's right to terminate his or her membership in the plan before the end of the enrollment year;

(5) limit coverage for emergency services under a limited health care service plan;

(6) charge an emergency fee in addition to a copayment for emergency services; or

(7) count medication-related services and services provided by telephone toward the annual outpatient visit total for either serious or nonserious mental illness.

Notes

28 Tex. Admin. Code § 11.2403

The provisions of this §11.2403 adopted to be effective February 14, 1999, 24 TexReg 726; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2264, eff. 8/1/2017