Sec. 1271.052. INFORMATION ABOUT BENEFITS AND LIMITATIONS. An evidence of coverage must state:
(1) the health care services, limited health care services, or single health care service to which the enrollee is entitled under the health care plan, limited health care service plan, or single health care service plan;
(2) the issuance of other benefits, if any, to which the enrollee is entitled under the health care plan, limited health care service plan, or single health care service plan; and
(3) any limitation on the services, kinds of services, benefits, or kinds of benefits to be provided, including any deductible or copayment feature.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1271 - Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges
Subchapter B. Contents of Evidence of Coverage
Section 1271.051. Evidence of Coverage: Contract and Certificate Requirements
Section 1271.052. Information About Benefits and Limitations
Section 1271.053. Information About Obtaining Services
Section 1271.054. Information About Complaints and Appeals
Section 1271.055. Out-of-Network Services
Section 1271.056. Unfair or Deceptive Provisions and Statements Prohibited