reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.202. Reserve Requirements

Sec. 842.202.  RESERVE REQUIREMENTS.  (a)  Each group hospital service corporation shall maintain reserves sufficient to cover liability for claims incurred but not yet paid and the expenses incurred in settling those claims.
(b)  A group hospital service corporation shall estimate the amount necessary to satisfy the reserve requirements using a method submitted to the commissioner for approval.  The estimate method used by the corporation is considered approved on the 30th day after the date filed with the commissioner unless the commissioner affirmatively approves or disapproves the method before that date.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.203. Final Judgment Deposit

Sec. 842.203.  FINAL JUDGMENT DEPOSIT.  (a)  For each 1,000 members and fraction of 1,000 members, a group hospital service corporation shall deposit $100 with the comptroller through the commissioner.  The total deposit required under this subsection may not exceed $2,000.
(b)  The deposit required under Subsection (a) shall be used to pay any judgment entered against the group hospital service corporation and is subject to garnishment after a final judgment is entered.
(c)  The group hospital service corporation shall immediately replenish the amount on deposit if the amount is impounded or impaired.  If the amount is not replenished immediately on the demand of the commissioner, the corporation may be regarded as insolvent and treated accordingly.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.204. Investment Limitations

Sec. 842.204.  INVESTMENT LIMITATIONS.  The investment limitations that apply to a life, health, and accident insurance company apply to the investments of a group hospital service corporation.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.205. Incurred Expenses

Sec. 842.205.  INCURRED EXPENSES.  (a)  In this section, "general expenses" means expenses incurred by a group hospital service corporation in the operation of its business other than:
(1)  a tax;
(2)  a license fee;
(3)  a commission;  or
(4)  an expense incurred in the performance of a contract:
(A)  made directly or indirectly with this state or the United States;  and
(B)  under which the corporation does not assume an insurance risk.
(b)  Subject to Subsection (c), a group hospital service corporation may not incur during a calendar year general expenses that exceed 20 percent of the premiums earned in that calendar year.
(c)  For a group hospital service corporation earning $500 million or more in premiums in a calendar year, the maximum percentage of general expenses that may be incurred during a calendar year is reduced by one-half percent for each $50 million of premiums earned to a maximum percentage of 15 percent.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.206. Minimum Surplus Requirement

Sec. 842.206.  MINIMUM SURPLUS REQUIREMENT.  Each group hospital service corporation shall maintain a surplus of at least $100,000 to meet adverse contingencies.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.207. Contracts; Reinsurance; Other Agreements

Sec. 842.207.  CONTRACTS;  REINSURANCE;  OTHER AGREEMENTS.  (a)  Subject to Subsection (b), a group hospital service corporation may:
(1)  contract with another organization similar in character for joint participation through:
(A)  a mutualization contract agreement;
(B)  a reinsurance treaty;  or
(C)  another arrangement;  and
(2)  cede or accept risks from an insurer on all or part of a risk.
(b)  Each document used for a purpose described by Subsection (a) must be filed with the department and approved by the commissioner for use in that purpose.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.208. Books and Records

Sec. 842.208.  BOOKS AND RECORDS.  Each group hospital service corporation shall keep complete books and records.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.209. Examinations

Sec. 842.209.  EXAMINATIONS.  The following laws apply to a group hospital service corporation:
(1)  Subchapter A, Chapter 86; and
(2)  Sections 401.051, 401.052, 401.054-401.062, 401.151, 401.152, 401.155, and 401.156.
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.026, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter E. Regulation of Group Hospital Service Corporations › Section 842.210. Liquidation, Rehabilitation, or Conservation of Group Hospital Service Corporation

Sec. 842.210.  LIQUIDATION, REHABILITATION, OR CONSERVATION OF GROUP HOSPITAL SERVICE CORPORATION.  The dissolution, liquidation, rehabilitation, or conservation of a group hospital service corporation is subject to Chapters 441 and 443.
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.027, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.251. Plan of Operation

Sec. 842.251.  PLAN OF OPERATION.  (a)  Before accepting applications for membership in its hospital service plan, a group hospital service corporation must submit to the commissioner a plan of operation.  The plan of operation must be accompanied by a schedule of the dues to be charged to members and a statement of the amount of hospital services that the corporation contracts to provide.
(b)  The commissioner must approve the plan of operation as fair and reasonable before the corporation may engage in business.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.252. Membership Certificate; Contract

Sec. 842.252.  MEMBERSHIP CERTIFICATE;  CONTRACT.  (a)  A group hospital service corporation shall issue to each member a membership certificate that states the benefits to which the member is or may become entitled.
(b)  The department must approve the form of:
(1)  the membership certificate;  and
(2)  any contract made between the group hospital service corporation and the member's employer or group representative.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.253. Policy, Certificate, and Application Forms

Sec. 842.253.  POLICY, CERTIFICATE, AND APPLICATION FORMS.  A policy, certificate, or application form used by a group hospital service corporation is subject to Chapter 1701.
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.028, eff. April 1, 2009.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.254. Deposit Requirements

Sec. 842.254.  DEPOSIT REQUIREMENTS.  A group hospital service corporation shall deposit in the account of the corporation in a bank money collected by the corporation from a member or subscriber.  The bank must be a state depository.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.255. Advance Payments to Hospital Prohibited

Sec. 842.255.  ADVANCE PAYMENTS TO HOSPITAL PROHIBITED.  A group hospital service corporation may not pay to a hospital any money collected by the corporation from a member or subscriber before the hospital provides necessary care to that member or subscriber.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.256. Contracts With Health Care Providers

Sec. 842.256.  CONTRACTS WITH HEALTH CARE PROVIDERS.  (a)  A group hospital service corporation may contract with health care providers as necessary to ensure to each member or subscriber the provision of services and supplies covered by the membership certificate or policy of the corporation.
(b)  A group hospital service corporation may not be required to contract with any particular health care provider.
(c)  This section does not authorize a group hospital service corporation to contract with a health care provider in a manner prohibited by a licensing law of this state under which that health care provider operates.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.257. May Limit Benefits

Sec. 842.257.  MAY LIMIT BENEFITS.  A policy or certificate issued by a group hospital service corporation may limit the types of disease for which benefits are provided.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.258. Limitations on Contracts for Medical Services

Sec. 842.258.  LIMITATIONS ON CONTRACTS FOR MEDICAL SERVICES.  (a)  A group hospital service corporation may not:
(1)  contract to provide to a member a physician or any medical services;
(2)  contract to practice medicine in any manner;
(3)  control or attempt to control the relations existing between a member and the member's physician;  or
(4)  restrict the right of a patient to obtain the services of any licensed physician.
(b)  This section does not prohibit a group hospital service corporation from contracting with:
(1)  a health organization certified under Chapter 162, Occupations Code;  or
(2)  a physician or other health care provider under rules adopted for preferred provider plans.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.259. Use of Indemnity Plan Authorized

Sec. 842.259.  USE OF INDEMNITY PLAN AUTHORIZED.  A group hospital service corporation may provide benefits for medical care, surgical care, or both medical and surgical care on the basis of indemnity payments for incurred expenses.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.260. Payment of Claim; Proof of Claim

Sec. 842.260.  PAYMENT OF CLAIM;  PROOF OF CLAIM.  (a)  After receipt of due proof of claim, a group hospital service corporation shall pay each claim presented under a membership certificate in full not later than the 60th day after the date on which the applicable services prescribed in the certificate have been provided.
(b)  Written notice of a claim given to a group hospital service corporation is considered due proof of claim under this section if the corporation does not provide the claimant with the forms usually provided by the corporation for filing a claim before the 16th day after the date notice is received.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter F. Plan of Operation; Provision of Benefits to Members › Section 842.261. Information Available Through Internet Site

Sec. 842.261.  INFORMATION AVAILABLE THROUGH INTERNET SITE.  (a)  A group hospital service corporation that maintains an Internet site shall list on the Internet site the physicians and health care providers, including, if appropriate, mental health providers and substance abuse treatment providers, that may be used by members in accordance with the terms of the policy or certificate applicable to the member.  The listing must identify those physicians and health care providers who continue to be available to provide services to new patients or clients.
(b)  The group hospital service corporation 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. 2, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle C - Life, Health, and Accident Insurers and Related Entities › Chapter 842 - Group Hospital Service Corporations › Subchapter G. Disciplinary Procedures › Section 842.301. Revocation of Certificate of Authority

Sec. 842.301.  REVOCATION OF CERTIFICATE OF AUTHORITY.  The commissioner shall revoke the certificate of authority of a group hospital service corporation that:
(1)  is determined to be:
(A)  operating fraudulently;  or
(B)  improperly contesting claims;  or
(2)  fails to pay valid claims in accordance with this chapter.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 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 843.001. Short Title

Sec. 843.001.  SHORT TITLE.  This chapter may be cited as the Texas Health Maintenance Organization Act.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 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 843.003. Powers of Insurers and Group Hospital Service Corporations

Sec. 843.003.  POWERS OF INSURERS AND GROUP HOSPITAL SERVICE CORPORATIONS.  (a)  An insurer authorized to engage in the business of insurance in this state under Chapter 822, 841, or 883, an accident insurance company, health insurance company, or life insurance company authorized to engage in the business of insurance in this state under Chapter 982, or a group hospital service corporation may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under this chapter.
(b)  Any two or more insurers or group hospital service corporations described by Subsection (a), or their subsidiaries or affiliates, may jointly organize and operate a health maintenance organization under this chapter.
(c)  An insurer or group hospital service corporation may contract with a health maintenance organization to provide:
(1)  insurance or similar protection against the cost of care provided by the health maintenance organization;  and
(2)  coverage if the health maintenance organization does not meet its obligations.
(d)  The authority of an insurer or group hospital service corporation under a contract described by Subsection (c) may include the authority to make benefit payments to a health maintenance organization for health care services provided by physicians or providers under a health care plan.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 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 843.004. Governing Body of Health Maintenance Organization

Sec. 843.004.  GOVERNING BODY OF HEALTH MAINTENANCE ORGANIZATION.  The governing body of a health maintenance organization may include physicians, providers, or other individuals, or any combination of physicians, providers, and other individuals.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 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 843.005. Use of Insurance-Related Terms by Health Maintenance Organization

Sec. 843.005.  USE OF INSURANCE-RELATED TERMS BY HEALTH MAINTENANCE ORGANIZATION.  A health maintenance organization that is not authorized as an insurer may not use in its name, contracts, or literature the word "insurance," "casualty," "surety," or "mutual," or any other words that are:
(1)  descriptive of the insurance, casualty, or surety business;  or
(2)  deceptively similar to the name or description of an insurer or surety corporation engaging in business in this state.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 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 843.006. Public Documents

Sec. 843.006.  PUBLIC DOCUMENTS.  (a)  Except as provided by Subsection (b), each application, filing, and report required under this chapter, Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapter 222, 251, or 258, as applicable to a health maintenance organization, or Chapter 1271 or 1272 is a public document.
(b)  An examination report is confidential but may be released if, in the opinion of the commissioner, the release is in the public interest.
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.030, eff. April 1, 2009.
2023 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 843.007. Confidentiality of Medical and Health Information

Sec. 843.007.  CONFIDENTIALITY OF MEDICAL AND HEALTH INFORMATION.  (a)  Any information relating to the diagnosis, treatment, or health of an enrollee or applicant obtained by a health maintenance organization from the enrollee or applicant or from a physician or provider shall be held in confidence and may not be disclosed to any person except:
(1)  to the extent necessary to accomplish the purposes of this chapter or:
(A)  Section 1367.053;
(B)  Subchapter A, Chapter 1452;
(C)  Subchapter B, Chapter 1507;
(D)  Chapter 222, 251, or 258, as applicable to a health maintenance organization; or
(E)  Chapter 1271 or 1272;
(2)  with the express consent of the enrollee or applicant;
(3)  in compliance with a statute or court order for the production or discovery of evidence; or
(4)  in the event of a claim or litigation between the enrollee or applicant and the health maintenance organization in which the information is pertinent.
(b)  A health maintenance organization is entitled to claim the statutory privilege against disclosure that the physician or provider who provides the information to the health maintenance organization is entitled to claim.
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.031, eff. April 1, 2009.
2023 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 843.008. Costs of Administering Health Maintenance Organization Laws

Sec. 843.008.  COSTS OF ADMINISTERING HEALTH MAINTENANCE ORGANIZATION LAWS.  Money collected under this chapter and Chapters 222, 251, and 258, as applicable to a health maintenance organization, must be sufficient to administer this chapter and:
(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.032, eff. April 1, 2009.
2023 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.
2023 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

Text of section effective until April 01, 2025
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.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.119, eff. April 1, 2025.
2023 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

Text of section effective on April 01, 2025
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 540 or 540A, Government Code, as applicable.
Added by Acts 2015, 84th Leg., R.S., Ch. 275 (H.B. 574), Sec. 1, eff. September 1, 2015.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.119, eff. April 1, 2025.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.