reglab/housing_qa huggingface dataset:
TX Ins Code § 1271.151 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter D. Certain Benefits Required|Section 1271.151. Provision of Basic Health Care Services

Sec. 1271.151.  PROVISION OF BASIC HEALTH CARE SERVICES.  A health maintenance organization that offers a basic health care plan shall provide or arrange for basic health care services to its enrollees as needed and without limitation as to time and cost other than any limitation prescribed by rule of the commissioner.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.152 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter D. Certain Benefits Required|Section 1271.152. Standards for Basic Health Care Services

Sec. 1271.152.  STANDARDS FOR BASIC HEALTH CARE SERVICES.  The commissioner may adopt minimum standards relating to basic health care services.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter D. Certain Benefits Required|Section 1271.153. Periodic Health Evaluations

Sec. 1271.153.  PERIODIC HEALTH EVALUATIONS.  (a)  The basic health care services provided under an evidence of coverage must include periodic health evaluations for each adult enrollee.(b)  The services provided under this section must include a health risk assessment at least once every three years and, for a female enrollee, an annual well-woman examination provided in accordance with Subchapter F, Chapter 1451.(c)  This section does not apply to an evidence of coverage for a limited health care service plan or a single health care service plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter D. Certain Benefits Required|Section 1271.154. Well-Child Care From Birth

Sec. 1271.154.  WELL-CHILD CARE FROM BIRTH.  (a)  In this section, "well-child care from birth" has the meaning used under Section 1302, Public Health Service Act (42 U.S.C. Section 300e-1), and its subsequent amendments.  The term includes administration of newborn screening required by the Department of State Health Services and the cost of the newborn screening test kit described by Section 33.019, Health and Safety Code.(b)  A health maintenance organization shall ensure that each health care plan provided by the health maintenance organization includes well-child care from birth that complies with:(1)  federal requirements adopted under Chapter XI, Public Health Service Act (42 U.S.C. Section 300e et seq.), and its subsequent amendments; and(2)  the rules adopted by the executive commissioner of the Health and Human Services Commission to implement those requirements, including rules on the cost of the newborn screening test kit described by Section 33.019, Health and Safety Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2019, 86th Leg., R.S., Ch. 599 (S.B. 747), Sec. 4, eff. September 1, 2019.|
TX Ins Code § 1271.156 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter D. Certain Benefits Required|Section 1271.156. Benefits for Rehabilitation Services and Therapies

Sec. 1271.156.  BENEFITS FOR REHABILITATION SERVICES AND THERAPIES.  (a)  If benefits are provided for rehabilitation services and therapies under an evidence of coverage, the provision of a rehabilitation service or therapy that, in the opinion of a physician, is medically necessary may not be denied, limited, or terminated if the service or therapy meets or exceeds treatment goals for the enrollee.(b)  For an enrollee with a physical disability, treatment goals may include maintenance of functioning or prevention of or slowing of further deterioration.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter E. Choice of Primary Care Physician for Certain Enrollees|Section 1271.201. Designation of Specialist as Primary Care Physician

Sec. 1271.201.  DESIGNATION OF SPECIALIST AS PRIMARY CARE PHYSICIAN.  (a)  An evidence of coverage must provide that an enrollee with a chronic, disabling, or life-threatening illness may apply to the health maintenance organization's medical director to use a nonprimary care physician specialist as the enrollee's primary care physician.(b)  The application must:(1)  include information specified by the health maintenance organization, including certification of the medical need;  and(2)  be signed by the enrollee and the nonprimary care physician specialist interested in serving as the enrollee's primary care physician.(c)  To be eligible to serve as the enrollee's primary care physician, a physician specialist must:(1)  meet the health maintenance organization's requirements for primary care physician participation;  and(2)  agree to accept the responsibility to coordinate all of the enrollee's health care needs.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.202 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter E. Choice of Primary Care Physician for Certain Enrollees|Section 1271.202. Appeal

Sec. 1271.202.  APPEAL.  If a health maintenance organization denies a request under Section 1271.201, the enrollee may appeal the decision through the health maintenance organization's established complaint and appeals process.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.203 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter E. Choice of Primary Care Physician for Certain Enrollees|Section 1271.203. Effective Date of Designation

Sec. 1271.203.  EFFECTIVE DATE OF DESIGNATION.  (a)  The effective date of the designation of a nonprimary care physician specialist as an enrollee's primary care physician under Section 1271.201 may not be applied retroactively.(b)  A health maintenance organization may not reduce the amount of compensation owed to the original primary care physician for services provided before the date of the new designation.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.251 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter F. Schedule of Charges|Section 1271.251. Approval of Formula or Method for Computing Schedule of Charges

Sec. 1271.251.  APPROVAL OF FORMULA OR METHOD FOR COMPUTING SCHEDULE OF CHARGES.  (a)  The formula or method for computing the schedule of charges for enrollee coverage for health care services must be filed with the commissioner before the formula or method is used in conjunction with a health care plan.(b)  The formula or method must be established in accordance with actuarial principles for the various categories of enrollees.  The filing of the method or formula must contain:(1)  a statement by a qualified actuary that certifies that the formula or method is appropriate;  and(2)  supporting information that the commissioner considers adequate.(c)  The formula or method must produce charges that are not excessive, inadequate, or unfairly discriminatory.  Benefits must be reasonable with respect to the rates produced by the formula or method.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.252 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter F. Schedule of Charges|Section 1271.252. Consideration of Individual Health Status Prohibited

Sec. 1271.252.  CONSIDERATION OF INDIVIDUAL HEALTH STATUS PROHIBITED.  The charges resulting from the application of a formula or method described by Section 1271.251 may not be altered for an individual enrollee based on the status of that enrollee's health.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.253 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter F. Schedule of Charges|Section 1271.253. Information Required by Commissioner

Sec. 1271.253.  INFORMATION REQUIRED BY COMMISSIONER.  The commissioner may require the submission of any relevant information the commissioner considers necessary in determining whether to approve or disapprove a filing under this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.301 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal|Section 1271.301. Entitlement to Continuation of Group Coverage

Sec. 1271.301.  ENTITLEMENT TO CONTINUATION OF GROUP COVERAGE.  (a)  In this section, "involuntary termination for cause" does not include termination for any health-related reason.(b)  A health maintenance organization shall provide a group coverage continuation privilege as required by and subject to the eligibility provisions of this subchapter.(c)  An enrollee is entitled to continue group coverage as provided by this subchapter if:(1)  the enrollee's coverage under a group contract is terminated for any reason except involuntary termination for cause;  and(2)  the enrollee for at least three consecutive months immediately before the termination of coverage has been continuously covered under the group contract and under any previous group contract providing similar services and benefits that the current group contract replaced.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.302 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal|Section 1271.302. Request for Continued Coverage; Deadline

Sec. 1271.302.  REQUEST FOR CONTINUED COVERAGE; DEADLINE.  An enrollee must provide to the employer or group contract holder a written notice of election to continue group coverage under this subchapter not later than the 60th day after the later of:(1)  the date the group coverage would otherwise terminate; or(2)  the date the enrollee is given notice of the right of continuation by the employer or group contract holder.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 550 (S.B. 1771), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 1271.303 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal|Section 1271.303. Payment for Continued Coverage

Sec. 1271.303.  PAYMENT FOR CONTINUED COVERAGE.  (a)  An enrollee electing continuation of group coverage must pay to the employer or group contract holder the amount of contribution required by the employer or group contract holder, plus an amount equal to two percent of the group rate for the coverage being continued under the group contract.(b)  The enrollee must make the payment not later than the 45th day after the initial election for coverage and on the due date of each payment thereafter.  Following the first payment made after the initial election for coverage, the payment of any other premium shall be considered timely if made by the 30th day after the date on which payment is due.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 550 (S.B. 1771), Sec. 6, eff. June 19, 2009.|
TX Ins Code § 1271.304 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal|Section 1271.304. Termination of Continued Coverage

Sec. 1271.304.  TERMINATION OF CONTINUED COVERAGE.  Group continued coverage under this subchapter may not terminate until the earliest of:(1)  the date the maximum continuation period provided by law would end, which is:(A)  for any enrollee not eligible for continuation coverage under Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) (COBRA), the end of the nine-month period after the date the election to continue coverage is made; or(B)  for any enrollee eligible for continuation coverage under COBRA, six additional months following any period of continuation provided under that statute;(2)  the date on which failure to make timely payments terminates coverage;(3)  the date on which the enrollee is covered for similar services and benefits by any other plan or program, including a hospital, surgical, medical, or major medical expense insurance policy, hospital or medical service subscriber contract, or medical practice or other prepayment plan; or(4)  the date on which the group coverage terminates in its entirety.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 550 (S.B. 1771), Sec. 7, eff. June 19, 2009.|
TX Ins Code § 1271.306 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal|Section 1271.306. Conversion Contracts

Sec. 1271.306.  CONVERSION CONTRACTS.  (a)  A health maintenance organization may offer to each enrollee a conversion contract.(b)  A health maintenance organization shall issue the conversion contract without evidence of insurability if written application for the contract and payment of the first premium are made not later than the 31st day after the date of termination of coverage.(c)  A conversion contract must meet the minimum standards for services and benefits for conversion contracts.  The commissioner shall adopt rules to prescribe the minimum standards for services and benefits applicable to conversion contracts.(d)  The premium for a conversion contract shall be determined in accordance with the health maintenance organization's premium rates for coverage provided under the group contract or plan.  The premium may be based on the geographic location of each person to be covered and must be based on the type of conversion contract and the coverage provided by the contract.  The premium may not exceed 200 percent of the premium rates for the same coverage provided under a group contract or plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1271.307 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges|Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal|Section 1271.307. Renewability of Coverage: Individual Health Care Plans and Conversion Contracts

Sec. 1271.307.  RENEWABILITY OF COVERAGE:  INDIVIDUAL HEALTH CARE PLANS AND CONVERSION CONTRACTS.  (a)  In this section, "individual health care plan" has the meaning assigned by Section 1271.004.(b)  An individual health care plan or a conversion contract that provides health care services to an enrollee is renewable at the option of the enrollee.  A health maintenance organization may decline to renew an individual health care plan or conversion contract only:(1)  for failure to pay premiums or contributions in accordance with the terms of the plan or because the issuer of the plan has not received timely premium payments;(2)  for fraud or intentional misrepresentation;(3)  because the health maintenance organization ceases to offer coverage in the individual market in accordance with rules established by the commissioner;(4)  because the enrollee no longer resides or works in the area in which the health maintenance organization is authorized to provide coverage, if coverage under the plan is terminated uniformly for this reason without regard to any factor related to the health status of a covered enrollee;  or(5)  in accordance with applicable federal law, including regulations.(c)  The commissioner may adopt rules necessary to implement this section and to meet the minimum requirements of federal law, including regulations.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1272.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization|Subchapter A. General Provisions|Section 1272.002. Compliance of Limited Provider Network or Delegated Entity With Certain Legal Requirements

Sec. 1272.002.  COMPLIANCE OF LIMITED PROVIDER NETWORK OR DELEGATED ENTITY WITH CERTAIN LEGAL REQUIREMENTS.  A limited provider network or delegated entity shall comply with each statutory or regulatory requirement that relates to a function assumed by or carried out by the network or entity under this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1272.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization|Subchapter B. Delegation Agreements|Section 1272.051. Applicability of Subchapter

Sec. 1272.051.  APPLICABILITY OF SUBCHAPTER.  This subchapter does not apply to a group model health maintenance organization, as defined by Section 843.111.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1272.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization|Subchapter B. Delegation Agreements|Section 1272.052. Delegation Agreement Required

Sec. 1272.052.  DELEGATION AGREEMENT REQUIRED.  (a)  A health maintenance organization that delegates a function required by this chapter, Chapter 843, 1271, or 1367, Subchapter A, Chapter 1452, or Subchapter B, Chapter 1507, shall execute a written delegation agreement with the entity to which the function is delegated.(b)  The health maintenance organization shall file the delegation agreement with the department not later than the 30th day after the date the agreement is executed.(c)  The parties to the delegation agreement shall determine which party bears the expense of complying with a requirement of this subchapter, including the cost of an examination required by the department under Subchapter B, Chapter 401, if applicable.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(f), eff. September 1, 2005.Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.002, eff. April 1, 2009.|
TX Ins Code § 1272.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization|Subchapter B. Delegation Agreements|Section 1272.053. Monitoring Plan

Sec. 1272.053.  MONITORING PLAN.  A delegation agreement required by Section 1272.052 must establish a monitoring plan that:(1)  allows the health maintenance organization to monitor compliance with the minimum solvency requirements established under Subchapter D, if applicable;  and(2)  includes:(A)  a description of financial practices that will ensure that the delegated entity tracks and reports liabilities that have been incurred but not reported;(B)  a summary of the total amount paid by the entity to physicians and providers on a monthly basis;  and(C)  a summary of complaints from physicians, providers, and enrollees regarding delays in payment or nonpayment of claims, including the status of each complaint, on a monthly basis.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1272.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization|Subchapter B. Delegation Agreements|Section 1272.054. Requirements for Termination Without Cause

Sec. 1272.054.  REQUIREMENTS FOR TERMINATION WITHOUT CAUSE.  A delegation agreement required by Section 1272.052 must provide that the agreement cannot be terminated without cause by the delegated entity or the health maintenance organization unless the party terminating the agreement provides written notice before the 90th day before the termination date.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1272.055 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1272 - Delegation of Certain Functions by Health Maintenance Organization|Subchapter B. Delegation Agreements|Section 1272.055. Collection of Payments

Sec. 1272.055.  COLLECTION OF PAYMENTS.  A delegation agreement required by Section 1272.052 must prohibit the delegated entity and the physicians and providers with whom the entity has contracted from billing or attempting to collect from an enrollee under any circumstance, including the insolvency of the health maintenance organization or entity, payments for covered services other than authorized copayments and deductibles.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|