reglab/housing_qa huggingface dataset:
TX Ins Code § 843.152 (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 E. Regulation of Health Maintenance Organizations|Section 843.152. Subpoena Authority

Sec. 843.152.  SUBPOENA AUTHORITY.  In implementing this chapter and the following provisions, the commissioner may exercise subpoena authority in accordance with Subchapter C, Chapter 36:(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.040, eff. April 1, 2009.|
TX Ins Code § 843.153 (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 E. Regulation of Health Maintenance Organizations|Section 843.153. Authority to Contract

Sec. 843.153.  AUTHORITY TO CONTRACT.  In performing duties under this chapter and the following provisions, the commissioner may contract with a state agency or, after notice and opportunity for hearing, with a qualified person to make recommendations concerning determinations to be made by the commissioner:(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.041, eff. April 1, 2009.|
TX Ins Code § 843.154 (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 E. Regulation of Health Maintenance Organizations|Section 843.154. Fees

Sec. 843.154.  FEES.  (a)  The commissioner shall, within the limits prescribed by this section, prescribe the fees to be charged under this section.(b)  Except for fees collected under Subsections (e) and (f), fees collected under this section shall be deposited to the credit of the Texas Department of Insurance operating account.(b-1)  A fee collected under Subsection (e) or (f) shall be deposited to the credit of the account described by Section 401.156(a).(c)  A health maintenance organization shall pay to the commissioner a fee in an amount not to exceed:(1)  $18,000 for filing and review of its original application for a certificate of authority;(2)  $200 for filing of an evidence of coverage that requires approval;  and(3)  $100 for a filing that is required by rule but does not require approval.(d)  A health maintenance organization shall pay to the comptroller a fee in an amount not to exceed $500 for filing of an annual report under Section 843.155.(e)  A health maintenance organization shall pay to the commissioner a fee, in an amount certified by the commissioner to be just and reasonable, for the expenses of all examinations of health maintenance organizations made on behalf of the state by the commissioner or under the commissioner's authority.(f)  A health maintenance organization shall pay to the commissioner a fee in an amount assessed by the commissioner and paid in accordance with rules adopted by the commissioner for the expenses of an examination under Section 843.156(a) that:(1)  are incurred by the commissioner or under the commissioner's authority;  and(2)  are directly attributable to that examination, including the actual salaries and expenses of the examiners directly attributable to that examination, as determined under rules adopted by the commissioner.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 659 (S.B. 1291), Sec. 5, eff. September 1, 2011.|
TX Ins Code § 843.157 (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 E. Regulation of Health Maintenance Organizations|Section 843.157. Rehabilitation, Liquidation, Supervision, or Conservation of Health Maintenance Organization

Sec. 843.157.  REHABILITATION, LIQUIDATION, SUPERVISION, OR CONSERVATION OF HEALTH MAINTENANCE ORGANIZATION.  (a)  The rehabilitation, liquidation, supervision, or conservation of a health maintenance organization shall be treated as the rehabilitation, liquidation, supervision, or conservation of an insurer and be conducted under the supervision of the commissioner under Chapter 441 or 443, as appropriate.(b)  The commissioner may also order the rehabilitation, liquidation, supervision, or conservation of a health maintenance organization if in the commissioner's opinion the continued operation of the health maintenance organization would be hazardous to the enrollees or to the people of this state.|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.044, eff. April 1, 2009.|
TX Ins Code § 843.201 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.201. Disclosure of Information About Health Care Plan Terms

Sec. 843.201.  DISCLOSURE OF INFORMATION ABOUT HEALTH CARE PLAN TERMS.  (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.(c)  If an enrollee designates a primary care physician who practices in a limited provider network or delegated entity, not later than the 30th day after the date of the enrollee's enrollment, the health maintenance organization shall provide the information required under this section to the enrollee with the enrollee's identification card or in a mailing separate from other information.(d)  A health maintenance organization shall provide to an enrollee on request information on:(1)  whether a physician or other health care provider is a participating provider in the health maintenance organization's network;(2)  whether proposed health care services are covered by the health plan; and(3)  what the enrollee's personal responsibility will be for payment of applicable copayment or deductible amounts.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 261, Sec. 2, eff. Sept. 1, 2003;  Acts 2003, 78th Leg., ch. 1276, Sec. 10A.208(a), eff. Sept. 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 12, eff. September 1, 2007.|
TX Ins Code § 843.2015 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.2015. Information Available Through Internet Site

Sec. 843.2015.  INFORMATION AVAILABLE THROUGH INTERNET SITE.  (a)  A health maintenance organization that maintains an Internet site shall list on the Internet site the physicians and providers, including, if appropriate, mental health providers and substance abuse treatment providers, that may be used by enrollees in accordance with the terms of the enrollee's health care plan.  The listing must identify those physicians and providers who continue to be available to provide services to new patients or clients.(b)  The health maintenance organization shall update at least quarterly an Internet site subject to this section.(c)  The commissioner may adopt rules as necessary to implement this section.  The rules may govern the form and content of the information required to be provided under Subsection (a).|Acts 2003, 78th Leg., ch. 1177, Sec. 3, eff. Sept. 1, 2003.|
TX Ins Code § 843.202 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.202. Disclosure of Information to Medicare Recipients

Sec. 843.202.  DISCLOSURE OF INFORMATION TO MEDICARE RECIPIENTS.  (a)  Before a prospective enrollee is enrolled in a health care plan offered to Medicare recipients by a Medicare-contracting health maintenance organization, the health maintenance organization must provide the prospective enrollee with a disclosure form adopted by the commissioner under Subsection (b).(b)  The commissioner shall adopt a disclosure form informing a prospective enrollee in a Medicare-contracting health maintenance organization of:(1)  the effect of enrollment in the health maintenance organization on the prospective enrollee's opportunity to purchase Medicare supplement insurance;  and(2)  any differences in the benefits and costs between the health care plan offered to Medicare recipients and Medicare supplement insurance.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.203 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.203. Selection of Primary Care Physician or Provider

Sec. 843.203.  SELECTION OF PRIMARY CARE PHYSICIAN OR PROVIDER.  (a)  Each plan application form shall prominently include a space in which the enrollee at the time of application or enrollment shall select a primary care physician or primary care provider.(b)  An enrollee shall at all times have the right to select or change a primary care physician or primary care provider within the health maintenance organization network of available primary care physicians and primary care providers, except that a health maintenance organization may limit an enrollee's request to change physicians or providers to not more than four changes in a 12-month period.(c)  For purposes of this subchapter, an applicant physician, as defined by Chapter 1452, may not be considered to be an available primary care physician or primary care provider within the  health maintenance organization delivery network for selection by an enrollee.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.Amended by: Acts 2007, 80th Leg., R.S., Ch. 1203 (H.B. 1594), Sec. 2, eff. September 1, 2007.|
TX Ins Code § 843.204 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.204. Untrue or Misleading Information

Sec. 843.204.  UNTRUE OR MISLEADING INFORMATION.  (a)  A health maintenance organization or a representative of a health maintenance organization may not:(1)  use or distribute or knowingly permit the use or distribution of prospective enrollee information that is untrue or misleading;  or(2)  use or knowingly permit the use of:(A)  advertising that is untrue or misleading;(B)  solicitation that is untrue or misleading;  or(C)  any form of evidence of coverage that is deceptive.(b)  In this chapter, Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapters 222, 251, and 258, as applicable to a health maintenance organization, and Chapters 1271 and 1272, a statement or item of information is:(1)  considered to be untrue if the statement or item does not conform to fact in any respect that is or may be significant to an enrollee of, or person considering enrollment in, a health care plan; and(2)  considered to be misleading, whether or not the statement or item is literally untrue, if, in the total context in which the statement is made or the item is communicated, the statement or item may be reasonably understood by a reasonable person who does not possess special knowledge regarding health care coverage as indicating:(A)  the inclusion of a benefit or advantage that does not exist and that is of possible significance to an enrollee of, or person considering enrollment in, a health care plan; or(B)  the absence of an exclusion, limitation, or disadvantage that does exist and that is of possible significance to an enrollee of, or person considering enrollment in, a health care plan.(c)  In this chapter, Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapters 222, 251, and 258, as applicable to a health maintenance organization, and Chapters 1271 and 1272, an evidence of coverage is considered to be deceptive if the evidence of coverage, taken as a whole and with consideration given to typography and format as well as language, would cause a reasonable person who does not possess special knowledge regarding health care plans and evidences of coverage for health care plans to expect charges or benefits, services, or other advantages that the evidence of coverage does not provide or that the health care plan issuing the evidence of coverage does not regularly make available for enrollees covered under the evidence of coverage.|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.045, eff. April 1, 2009.|
TX Ins Code § 843.205 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.205. Member's Handbook; Information About Complaints and Appeals

Sec. 843.205.  MEMBER'S HANDBOOK;  INFORMATION ABOUT COMPLAINTS AND APPEALS.  (a)  In this section, "major population" means a group constituting 10 percent or more of the enrolled population of the health maintenance organization.(b)  A health maintenance organization shall establish procedures to:(1)  provide to an enrollee a member handbook and materials relating to the complaint and appeals process in the languages of the major populations of the enrolled population;  and(2)  provide access to a member handbook and the complaint and appeals process to an enrollee who has a disability that affects the enrollee's ability to communicate or read.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.206 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.206. Notice of Change in Payment Arrangements

Sec. 843.206.  NOTICE OF CHANGE IN PAYMENT ARRANGEMENTS.  A health maintenance organization shall notify a group contract holder within 30 days of any substantive change to the payment arrangements between the health maintenance organization and physicians or providers.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.207 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.207. Notice of Change in Operations

Sec. 843.207.  NOTICE OF CHANGE IN OPERATIONS.  A health maintenance organization shall provide to its enrollees reasonable notice of any material adverse change in the operation of the health maintenance organization that will directly affect the enrollees.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.2071 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.2071. Notice of Increase in Charge for Coverage

Sec. 843.2071.  NOTICE OF INCREASE IN CHARGE FOR COVERAGE.  (a)  Not less than 60 days before the date on which an increase in a charge for coverage under this chapter takes effect, a health maintenance organization shall:(1)  give to each enrollee under an individual evidence of coverage written notice of the effective date of the increase; and(2)  provide the enrollee a table that clearly lists:(A)  the actual dollar amount of the charge for coverage on the date of the notice;(B)  the actual dollar amount of the charge for coverage after the charge increase; and(C)  the percentage change between the amounts described by Paragraphs (A) and (B).(b)  The notice required by this section must be based on coverage in effect on the date of the notice.(c)  This section may not be construed to prevent a health maintenance organization, at the request of an enrollee, from negotiating a change in benefits or rates after delivery of the notice required by this section.(d)  A health maintenance organization may not require an enrollee entitled to notice under this section to respond to the health maintenance organization to renew the coverage or take other action relating to the renewal or extension of the coverage before the 45th day after the date the notice described by Subsection (a) is given.(e)  The notice required by this section must include:(1)  contact information for the department, including information concerning how to file a complaint with the department;(2)  contact information for the Texas Consumer Health Assistance Program, including information concerning how to request from the program consumer protection information or assistance with filing a complaint; and(3)  the addresses of Internet websites that provide consumer information related to rate increase justifications, including the websites of the department and the United States Department of Health and Human Services.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 3.001, eff. September 1, 2011.|
TX Ins Code § 843.208 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.208. Cancellation or Nonrenewal of Coverage

Sec. 843.208.  CANCELLATION OR NONRENEWAL OF COVERAGE.  A health maintenance organization may cancel or refuse to renew the coverage of an enrollee only for:(1)  failure to pay the charges for the coverage;  or(2)  another reason prescribed by rules adopted by the commissioner.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 843.209 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.209. Identification Card

Sec. 843.209.  IDENTIFICATION CARD.  An identification card or other similar document issued by a health maintenance organization to an enrollee must:(1)  indicate that the health maintenance organization is regulated under this code and subject to the provisions of Subchapter J;  and(2)  display:(A)  the first date on which the enrollee became enrolled;  or(B)  a toll-free number a physician or provider may use to obtain that date.|Added by Acts 2003, 78th Leg., ch. 214, Sec. 4, eff. June 17, 2003.|
TX Ins Code § 843.210 (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 F. Relations With Enrollees and Group Contract Holders|Section 843.210. Terms of Enrollee Eligibility

Sec. 843.210.  TERMS OF ENROLLEE ELIGIBILITY.  (a)  A contract between a health maintenance organization and a group contract holder must provide that:(1)  in addition to any other premiums for which the group contract holder is liable, the group contract holder is liable for an enrollee's premiums from the time the enrollee is no longer part of the group eligible for coverage under the contract until the end of the month in which the contract holder notifies the health maintenance organization that the enrollee is no longer part of the group eligible for coverage by the contract; and(2)  the enrollee remains covered by the contract until the end of that period.(b)  Each health maintenance organization that enters into a contract described by Subsection (a) shall notify the group contract holder periodically as provided by this section that the contract holder is liable for premiums on an enrollee who is no longer part of the group eligible for coverage under the contract until the health maintenance organization receives notification of termination of the enrollee's eligibility for that coverage.(c)  If the health maintenance organization charges the group contract holder on a monthly basis for the coverage premiums, the health maintenance organization shall include the notice required by Subsection (b) in each monthly statement sent to the group contract holder.  If the health maintenance organization charges the group contract holder on other than a monthly basis for the premiums, the health maintenance organization shall notify the group contract holder periodically in the manner prescribed by the commissioner by rule.(d)  The notice required by Subsection (b) must include a description of methods preferred by the health maintenance organization for notification by a group contract holder of an enrollee's termination from coverage eligibility.|Added by Acts 2005, 79th Leg., Ch. 669 (S.B. 51), Sec. 2, eff. September 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1217 (S.B. 1143), Sec. 1, eff. September 1, 2009.|