reglab/housing_qa huggingface dataset:
TX Ins Code § 843.009 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter A. General Provisions|Section 843.009. Appeals; Judicial Review

Sec. 843.009.  APPEALS;  JUDICIAL REVIEW.  (a)  A person who is affected by a rule, ruling, or decision of the department or the commissioner is entitled to have the rule, ruling, or decision reviewed by the commissioner by applying to the commissioner.(b)  An application must identify:(1)  the applicant;(2)  the rule, ruling, or decision affecting the applicant;(3)  the interest of the applicant in the rule, ruling, or decision;(4)  the grounds of the applicant's objection;(5)  the action sought of the commissioner;  and(6)  the reasons and grounds for the commissioner to take the action.(c)  An applicant shall file the original application with the chief clerk of the department with a certification that a true and correct copy of the application has been filed with the commissioner.(d)  Not later than the 30th day after the date the application is filed, and after 10 days' written notice to each party of record, the commissioner shall review the action in a hearing.  In the hearing, any evidence and any matter pertinent to the application may be submitted to the commissioner regardless of whether it was included in the application.(e)  After the hearing, the commissioner shall render a decision at the earliest possible date.  The application has precedence over all other business of a different nature pending before the commissioner.(f)  The commissioner shall adopt rules, consistent with this section, relating to applications under this section and consideration of those applications that the commissioner considers advisable.(g)  A person who is affected by a rule, ruling, or decision of the commissioner and is dissatisfied with the rule, ruling, or decision may, after failing to get relief from the commissioner, file a petition seeking judicial review of the rule, ruling, or decision under Subchapter D, Chapter 36.  The action has precedence over all other causes on the docket of a different nature.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.010 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter A. General Provisions|Section 843.010. Applicability of Certain Provisions to Governmental Health Benefit Plans

Sec. 843.010.  APPLICABILITY OF CERTAIN PROVISIONS TO GOVERNMENTAL HEALTH BENEFIT PLANS.  Sections 843.306(f) and 843.363(a)(4) do not apply to coverage under:(1)  the child health plan program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code; or(2)  a Medicaid program, including a Medicaid managed care program operated under Chapter 533, Government Code.|Added by Acts 2015, 84th Leg., R.S., Ch. 275 (H.B. 574), Sec. 1, eff. September 1, 2015.|
TX Ins Code § 843.051 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter B. Applicability of and Construction With Other Laws|Section 843.051. Applicability of Insurance and Group Hospital Service Corporation Laws

Sec. 843.051.  APPLICABILITY OF INSURANCE AND GROUP HOSPITAL SERVICE CORPORATION LAWS.  (a)  Except to the extent that the commissioner determines that the nature of health maintenance organizations, health care plans, or evidences of coverage renders a provision of the following laws clearly inappropriate, Subchapter A, Chapter 542, Subchapters D and E, Chapter 544, and Chapters 541, 543, and 547 apply to:(1)  health maintenance organizations that offer basic, limited, and single health care coverages;(2)  basic, limited, and single health care plans; and(3)  evidences of coverage under basic, limited, and single health care plans.(b)  A health maintenance organization is subject to:(1)  Chapter 402;(2)  Chapter 827 and is an authorized insurer for purposes of that chapter; and(3)  Subchapter G, Chapter 1251, and Section 1551.064.(c)  Except as otherwise provided by this chapter or other law, insurance laws and group hospital service corporation laws do not apply to a health maintenance organization that holds a certificate of authority under this chapter.  This subsection applies to an insurer or a group hospital service corporation only with respect to the health maintenance organization activities of the insurer or corporation.(d)  Activities permitted under other chapters of this code are not subject to this chapter.(e)  Except for Chapter 251, as applicable to a third-party administrator, and Chapters 259, 4151, and 4201, insurance laws and group hospital service corporation laws do not apply to a physician or provider.  Notwithstanding this subsection, a physician or provider who conducts a utilization review during the ordinary course of treatment of patients under a joint or delegated review agreement with a health maintenance organization on services provided by the physician or provider is not required to obtain certification under Subchapter C, Chapter 4201.(f)  A health maintenance organization is subject to Chapter 823 as if the health maintenance organization were an insurer under that chapter.(g)  The merger of a health maintenance organization with another health maintenance organization is subject to Chapter 824 as if the health maintenance organizations were insurance corporations under that chapter.  The commissioner may adopt rules as necessary to implement this subsection in a way that reflects the nature of health maintenance organizations, health care plans, or evidences of coverage.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2005, 79th Leg., Ch. 364 (S.B. 1284), Sec. 1, eff. September 1, 2005.Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.033, eff. April 1, 2009.|
TX Ins Code § 843.052 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter B. Applicability of and Construction With Other Laws|Section 843.052. Laws Relating to Solicitation or Advertising

Sec. 843.052.  LAWS RELATING TO SOLICITATION OR ADVERTISING.  (a)  Solicitation of enrollees by a health maintenance organization or its representative or agent does not violate a law relating to solicitation or advertising by a physician or provider.(b)  The provision of factually accurate information by a health maintenance organization or its personnel to prospective enrollees regarding coverage, rates, location and hours of service, and names of affiliated institutions, physicians, and providers does not violate any law relating to solicitation or advertising by a physician or provider.  The provision of that information with respect to a physician or provider may not be contrary to or in conflict with any law or ethical provision regulating the practice of a practitioner of any professional service provided through or in connection with the physician or provider.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.053 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter B. Applicability of and Construction With Other Laws|Section 843.053. Laws Relating to Restraint of Trade

Sec. 843.053.  LAWS RELATING TO RESTRAINT OF TRADE.  (a)  A health maintenance organization that contracts with a health facility or enters into an independent contractual arrangement with physicians or providers practicing individually or as a group is not, because of the contract or arrangement, considered to have entered into a conspiracy in restraint of trade in violation of Sections 15.01-15.26, Business & Commerce Code.(b)  Notwithstanding any other law, a physician who contracts with one or more physicians in the process of conducting activities that are permitted by law but that do not require a certificate of authority under this chapter is not, because of the contract, considered to have entered into a conspiracy in restraint of trade in violation of Sections 15.01-15.26, Business & Commerce Code.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.054 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter B. Applicability of and Construction With Other Laws|Section 843.054. Laws Requiring Certificate of Need for Health Care Facility or Service

Sec. 843.054.  LAWS REQUIRING CERTIFICATE OF NEED FOR HEALTH CARE FACILITY OR SERVICE.  (a)  A health maintenance organization is not exempt from any statute that provides for the regulation and certification of need of health care facility construction, expansion, or other modification, or the institution of a health care service through the issuance of a certificate of need, if at the time of establishment of operation or during the course of operation of the health maintenance organization it becomes subject to the provisions of that statute.(b)  If the proposed plan of operation of a health maintenance organization includes providing a health care facility or service that makes the health maintenance organization subject to a statute described by Subsection (a), the commissioner may not issue a certificate of authority until the commissioner has received a certified copy of the certificate of need granted to the health maintenance organization by the appropriate agency.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.055 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter B. Applicability of and Construction With Other Laws|Section 843.055. Laws Relating to Practice of Medicine

Sec. 843.055.  LAWS RELATING TO PRACTICE OF MEDICINE.  (a)  This chapter does not authorize the practice of medicine as defined by state law.(b)  This chapter does not repeal, modify, or amend Section 164.051, 164.052, 164.053, 164.054, or 164.056, Occupations Code, and a health maintenance organization is not exempt from those sections.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.056 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter B. Applicability of and Construction With Other Laws|Section 843.056. Inapplicability of Bankruptcy Law

Sec. 843.056.  INAPPLICABILITY OF BANKRUPTCY LAW.  By applying for and receiving a certificate of authority to engage in business in this state, a health maintenance organization agrees and admits that it is not subject to and is not eligible to proceed under the United States Bankruptcy Code.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.071 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.071. Certificate of Authority Required; Use of "Health Maintenance Organization" or "Hmo"

Sec. 843.071.  CERTIFICATE OF AUTHORITY REQUIRED;  USE OF "HEALTH MAINTENANCE ORGANIZATION" OR "HMO".  (a)  A person may not organize or operate a health maintenance organization in this state, or sell or offer to sell or solicit offers to purchase or receive advance or periodic consideration in conjunction with a health maintenance organization, without obtaining a certificate of authority under this chapter.(b)  A person may not use "health maintenance organization" or "HMO" in the course of operation unless the person:(1)  complies with this chapter and:(A)  Section 1367.053;(B)  Subchapter A, Chapter 1452;(C)  Subchapter B, Chapter 1507;(D)  Chapters 222, 251, and 258, as applicable to a health maintenance organization; and(E)  Chapters 1271 and 1272; and(2)  holds a certificate of authority under this chapter.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.034, eff. April 1, 2009.|
TX Ins Code § 843.072 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.072. Authorization Required to Act as Health Maintenance Organization

Sec. 843.072.  AUTHORIZATION REQUIRED TO ACT AS HEALTH MAINTENANCE ORGANIZATION.  (a)  A person, including a physician or provider, may not perform any act of a health maintenance organization except in accordance with the specific authorization of this chapter or other law.(b)  A person, including a physician or provider, who performs an act of a health maintenance organization that requires a certificate of authority under this chapter without first obtaining the certificate is subject to all enforcement processes and procedures available against an unauthorized insurer under Chapter 101 and Subchapter C, Chapter 36.(c)  This section does not apply to an activity exempt from regulation under Section 843.051(e), 843.053, 843.073, or 843.318.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.073 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.073. Certificate of Authority Requirement: Applicability to Physicians and Providers

Sec. 843.073.  CERTIFICATE OF AUTHORITY REQUIREMENT:  APPLICABILITY TO PHYSICIANS AND PROVIDERS.  (a)  A person is not required to obtain a certificate of authority under this chapter to the extent that the person is:(1)  a physician engaged in the delivery of medical care;  or(2)  a provider engaged in the delivery of health care services other than medical care as part of a health maintenance organization delivery network.(b)  Except as provided by Section 843.101 or 843.318(a), a physician or provider that employs or enters into a contractual arrangement with a provider or group of providers to provide basic or limited health care services or a single health care service is subject to this chapter and the following provisions and is required to obtain a certificate of authority under this chapter:(1)  Section 1367.053;(2)  Subchapter A, Chapter 1452;(3)  Subchapter B, Chapter 1507;(4)  Chapters 222, 251, and 258, as applicable to a health maintenance organization; and(5)  Chapters 1271 and 1272.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.035, eff. April 1, 2009.|
TX Ins Code § 843.074 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.074. Certificate of Authority Requirement: Applicability to Medical School and Medical and Dental Unit

Sec. 843.074.  CERTIFICATE OF AUTHORITY REQUIREMENT:  APPLICABILITY TO MEDICAL SCHOOL AND MEDICAL AND DENTAL UNIT.  A medical school or medical and dental unit, as defined or described by Section 61.003, 61.501, or 74.601, Education Code, is not required to obtain a certificate of authority under this chapter to the extent that the medical school or medical and dental unit contracts to deliver medical care within a health maintenance organization delivery network.  This chapter is otherwise applicable to the medical school or medical and dental unit.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.075 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.075. Certificate of Authority for Single Health Care Service Plan

Sec. 843.075.  CERTIFICATE OF AUTHORITY FOR SINGLE HEALTH CARE SERVICE PLAN.  The commissioner may issue a certificate of authority to a health maintenance organization organized and operated solely to provide a single health care service plan.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.076 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.076. Application

Sec. 843.076.  APPLICATION.  (a)  Any person may apply to the commissioner for and obtain a certificate of authority to organize and operate a health maintenance organization.(b)  An application for a certificate of authority must:(1)  be on a form prescribed by rules adopted by the commissioner;  and(2)  be verified by the applicant or an officer or other authorized representative of the applicant.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.077 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.077. Eligibility of Foreign Corporation

Sec. 843.077.  ELIGIBILITY OF FOREIGN CORPORATION.  A foreign corporation may qualify for a certificate of authority under this chapter, including a certificate of authority for a single health care service plan, subject to the corporation's:(1)  registration to engage in business in this state as a foreign corporation under the Texas Business Corporation Act;  and(2)  compliance with this chapter and other applicable state laws.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.079 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.079. Contents of Application: Limited Health Care Service Plan

Sec. 843.079.  CONTENTS OF APPLICATION:  LIMITED HEALTH CARE SERVICE PLAN.  In addition to the items required under Section 843.078, an application for a certificate of authority for a limited health care service plan must include a specific description of the health care services to be provided by the applicant.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.080 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 843 - Health Maintenance Organizations|Subchapter C. Authority to Engage in Business|Section 843.080. Modification or Amendment of Application Information

Sec. 843.080.  MODIFICATION OR AMENDMENT OF APPLICATION INFORMATION.  (a)  The commissioner may adopt reasonable rules that the commissioner considers necessary for the proper administration of this chapter to require a health maintenance organization, after receiving its certificate of authority, to submit modifications or amendments to the operations or documents described in Sections 843.078 and 843.079 to the commissioner, for the commissioner's approval or only to provide information, before implementing the modification or amendment or to require the health maintenance organization to indicate the modifications to the commissioner at the time of the next site visit or examination.(b)  As soon as reasonably possible after any filing for approval required under this section is made, the commissioner shall approve or disapprove the filing in writing.  If, before the 31st day after the date a modification or amendment for which the commissioner's approval is required is filed, the commissioner does not disapprove the modification or amendment, it is considered approved.  The commissioner may delay action as necessary for proper consideration for not more than an additional 30 days.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|