Sec. 1301.0056. EXAMINATIONS AND FEES. (a) The commissioner shall examine an insurer to determine the quality and adequacy of a network used by a preferred provider benefit plan or an exclusive provider benefit plan offered by the insurer under this chapter. An insurer is subject to a qualifying examination of the insurer's preferred provider benefit plans and exclusive provider benefit plans and subsequent quality of care and network adequacy examinations by the commissioner at least once every three years and whenever the commissioner considers an examination necessary. Documentation provided to the commissioner during an examination conducted under this section is confidential and is not subject to disclosure as public information under Chapter 552, Government Code.
(b) An insurer examined under this section shall pay the cost of the examination in an amount determined by the commissioner.
(c) The department shall collect an assessment in an amount determined by the commissioner from the insurer at the time of the examination to cover all expenses attributable directly to the examination, including the salaries and expenses of department employees and all reasonable expenses of the department necessary for the administration of this chapter.
(d) The department shall deposit an assessment collected under this section to the credit of the account described by Section 401.156(a). Money deposited under this subsection shall be used to pay the salaries and expenses of examiners and all other expenses relating to the examination of insurers under this section.
Added by Acts 2011, 82nd Leg., R.S., Ch. 288 (H.B. 1772), Sec. 9, eff. September 1, 2011.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 1316 (H.B. 3911), Sec. 1, eff. September 1, 2019.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Chapter 1301 - Preferred Provider Benefit Plans
Subchapter A. General Provisions
Section 1301.002. Nonapplicability to Dental Care Benefits
Section 1301.003. Preferred Provider Benefit Plans and Exclusive Provider Benefit Plans Permitted
Section 1301.0041. Applicability
Section 1301.0042. Applicability of Insurance Law
Section 1301.0045. Construction of Chapter
Section 1301.0046. Coinsurance Requirements for Services of Nonpreferred Providers
Section 1301.005. Availability of Preferred Providers
Section 1301.0051. Exclusive Provider Benefit Plans: Quality Improvement and Utilization Management
Section 1301.0052. Exclusive Provider Benefit Plans: Referrals for Medically Necessary Services
Section 1301.0053. Exclusive Provider Benefit Plans: Emergency Care
Section 1301.0055. Network Adequacy Standards
Section 1301.0056. Examinations and Fees
Section 1301.0057. Access to Out-of-Network Providers
Section 1301.0058. Protected Communications by Preferred Providers
Section 1301.006. Availability of and Accessibility to Health Care Services
Section 1301.0061. Terms of Enrollee Eligibility
Section 1301.008. Conflict With Other Law