Texas Insurance Code
§ 843.201 — DISCLOSURE OF INFORMATION ABOUT HEALTH CARE PLAN TERMS
IN § 843.201Title 6. ORGANIZATION OF INSURERS AND RELATED ENTITIES · Part C. LIFE, HEALTH, AND ACCIDENT INSURERS AND RELATED ENTITIES · Ch. 843. HEALTH MAINTENANCE ORGANIZATIONS · Art. F. RELATIONS WITH ENROLLEES AND GROUP CONTRACT HOLDERS
Statute text
View on source(a)A health maintenance organization shall provide an accurate written or electronic description of health care plan terms, including restrictions or limitations related to a limited provider network or delegated network within a health care plan, to allow a current or prospective group contract holder or current or prospective enrollee to make comparisons and informed decisions before selecting among health care plans. The written or electronic description must:
(1)be in readable and understandable format prescribed by the commissioner; and
(2)include a current list of physicians and providers, including a delineation of any limited provider network or delegated network.
(b)A health maintenance organization may satisfy the requirement imposed under Subsection (a) through the member handbook provided under Section 843.205 if:
(1)the handbook's contents are substantially similar to and provide the same level of disclosure as the written or electronic description prescribed by the commissioner; and
(2)the current list of physicians and providers is also provided.
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Legislative history
Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 12, eff. September 1, 2007.