Sec. 1271.251. APPROVAL OF FORMULA OR METHOD FOR COMPUTING SCHEDULE OF CHARGES. (a) The formula or method for computing the schedule of charges for enrollee coverage for health care services must be filed with the commissioner before the formula or method is used in conjunction with a health care plan.
(b) The formula or method must be established in accordance with actuarial principles for the various categories of enrollees. The filing of the method or formula must contain:
(1) a statement by a qualified actuary that certifies that the formula or method is appropriate; and
(2) supporting information that the commissioner considers adequate.
(c) The formula or method must produce charges that are not excessive, inadequate, or unfairly discriminatory. Benefits must be reasonable with respect to the rates produced by the formula or method.
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 F. Schedule of Charges
Section 1271.251. Approval of Formula or Method for Computing Schedule of Charges
Section 1271.252. Consideration of Individual Health Status Prohibited