Texas Statutes
Subtitle C - Managed Care
Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges

Subchapter A. General Provisions

Section 1271.001. Applicability of Definitions - Sec. 1271.001. APPLICABILITY OF DEFINITIONS. In this chapter, terms defined...

Section 1271.002. Right to Evidence of Coverage; Issuance - Sec. 1271.002. RIGHT TO EVIDENCE OF COVERAGE; ISSUANCE. (a) Each...

Section 1271.003. Evidence of Coverage Not Health Insurance Policy - Sec. 1271.003. EVIDENCE OF COVERAGE NOT HEALTH INSURANCE POLICY. An...

Section 1271.004. Individual Health Care Plan - Sec. 1271.004. INDIVIDUAL HEALTH CARE PLAN. (a) In this section,...

Section 1271.005. Applicability of Other Law - Sec. 1271.005. APPLICABILITY OF OTHER LAW. (a) Chapters 1368 and...

Section 1271.006. Benefits to Dependent Child and Grandchild - Sec. 1271.006. BENEFITS TO DEPENDENT CHILD AND GRANDCHILD. (a) If...

Section 1271.007. Religious Convictions - Sec. 1271.007. RELIGIOUS CONVICTIONS. (a) This chapter, Chapters 843, 1272,...

Section 1271.008. Balance Billing Prohibition Notice - Sec. 1271.008. BALANCE BILLING PROHIBITION NOTICE. (a) A health maintenance...

Subchapter B. Contents of Evidence of Coverage

Section 1271.051. Evidence of Coverage: Contract and Certificate Requirements - Sec. 1271.051. EVIDENCE OF COVERAGE: CONTRACT AND CERTIFICATE REQUIREMENTS. (a)...

Section 1271.052. Information About Benefits and Limitations - Sec. 1271.052. INFORMATION ABOUT BENEFITS AND LIMITATIONS. An evidence of...

Section 1271.053. Information About Obtaining Services - Sec. 1271.053. INFORMATION ABOUT OBTAINING SERVICES. An evidence of coverage...

Section 1271.054. Information About Complaints and Appeals - Sec. 1271.054. INFORMATION ABOUT COMPLAINTS AND APPEALS. (a) An evidence...

Section 1271.055. Out-of-Network Services - Sec. 1271.055. OUT-OF-NETWORK SERVICES. (a) An evidence of coverage must...

Section 1271.056. Unfair or Deceptive Provisions and Statements Prohibited - Sec. 1271.056. UNFAIR OR DECEPTIVE PROVISIONS AND STATEMENTS PROHIBITED. An...

Section 1271.057. Discretionary Clauses Prohibited - Sec. 1271.057. DISCRETIONARY CLAUSES PROHIBITED. (a) An evidence of coverage...

Subchapter C. Commissioner Approval

Section 1271.101. Approval of Form of Evidence of Coverage or Group Contract - Sec. 1271.101. APPROVAL OF FORM OF EVIDENCE OF COVERAGE OR...

Section 1271.102. Procedures for Approval of Form of Evidence of Coverage or Group Contract; Withdrawal of Approval - Sec. 1271.102. PROCEDURES FOR APPROVAL OF FORM OF EVIDENCE OF...

Section 1271.103. Withdrawal of Approval of Form - Sec. 1271.103. WITHDRAWAL OF APPROVAL OF FORM. (a) After notice...

Section 1271.104. Information Required by Commissioner - Sec. 1271.104. INFORMATION REQUIRED BY COMMISSIONER. The commissioner may require...

Subchapter D. Certain Benefits Required

Section 1271.151. Provision of Basic Health Care Services - Sec. 1271.151. PROVISION OF BASIC HEALTH CARE SERVICES. A health...

Section 1271.152. Standards for Basic Health Care Services - Sec. 1271.152. STANDARDS FOR BASIC HEALTH CARE SERVICES. The commissioner...

Section 1271.153. Periodic Health Evaluations - Sec. 1271.153. PERIODIC HEALTH EVALUATIONS. (a) The basic health care...

Section 1271.154. Well-Child Care From Birth - Sec. 1271.154. WELL-CHILD CARE FROM BIRTH. (a) In this section,...

Section 1271.155. Emergency Care - Sec. 1271.155. EMERGENCY CARE. (a) A health maintenance organization shall...

Section 1271.156. Benefits for Rehabilitation Services and Therapies - Sec. 1271.156. BENEFITS FOR REHABILITATION SERVICES AND THERAPIES. (a) If...

Section 1271.157. Non-Network Facility-Based Providers - Sec. 1271.157. NON-NETWORK FACILITY-BASED PROVIDERS. (a) In this section, "facility-based...

Section 1271.158. Non-Network Diagnostic Imaging Provider or Laboratory Service Provider - Sec. 1271.158. NON-NETWORK DIAGNOSTIC IMAGING PROVIDER OR LABORATORY SERVICE PROVIDER....

Subchapter E. Choice of Primary Care Physician for Certain Enrollees

Section 1271.201. Designation of Specialist as Primary Care Physician - Sec. 1271.201. DESIGNATION OF SPECIALIST AS PRIMARY CARE PHYSICIAN. (a)...

Section 1271.202. Appeal - Sec. 1271.202. APPEAL. If a health maintenance organization denies a...

Section 1271.203. Effective Date of Designation - Sec. 1271.203. EFFECTIVE DATE OF DESIGNATION. (a) The effective date...

Subchapter F. Schedule of Charges

Section 1271.251. Approval of Formula or Method for Computing Schedule of Charges - Sec. 1271.251. APPROVAL OF FORMULA OR METHOD FOR COMPUTING SCHEDULE...

Section 1271.252. Consideration of Individual Health Status Prohibited - Sec. 1271.252. CONSIDERATION OF INDIVIDUAL HEALTH STATUS PROHIBITED. The charges...

Section 1271.253. Information Required by Commissioner - Sec. 1271.253. INFORMATION REQUIRED BY COMMISSIONER. The commissioner may require...

Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal

Section 1271.301. Entitlement to Continuation of Group Coverage - Sec. 1271.301. ENTITLEMENT TO CONTINUATION OF GROUP COVERAGE. (a) In...

Section 1271.302. Request for Continued Coverage; Deadline - Sec. 1271.302. REQUEST FOR CONTINUED COVERAGE; DEADLINE. An enrollee must...

Section 1271.303. Payment for Continued Coverage - Sec. 1271.303. PAYMENT FOR CONTINUED COVERAGE. (a) An enrollee electing...

Section 1271.304. Termination of Continued Coverage - Sec. 1271.304. TERMINATION OF CONTINUED COVERAGE. Group continued coverage under...

Section 1271.306. Conversion Contracts - Sec. 1271.306. CONVERSION CONTRACTS. (a) A health maintenance organization may...

Section 1271.307. Renewability of Coverage: Individual Health Care Plans and Conversion Contracts - Sec. 1271.307. RENEWABILITY OF COVERAGE: INDIVIDUAL HEALTH CARE PLANS AND...