Sec. 1301.054. NOTICE TO PRACTITIONERS OF PREFERRED PROVIDER BENEFIT PLAN. (a) When sponsoring a preferred provider benefit plan, an insurer shall immediately notify each practitioner in the plan's service area of the insurer's intent to offer the plan and of the opportunity to participate. The notification must be made by publication or in writing to each practitioner.
(b) After establishing a preferred provider benefit plan, an insurer shall annually provide notice of and an opportunity to participate in the plan to practitioners in the plan's service area who do not participate in the plan.
(c) On request, an insurer shall provide to any physician or health care provider information concerning the application process and qualification requirements for participation as a preferred provider in the plan.
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 1301 - Preferred Provider Benefit Plans
Subchapter B. Relations With Physicians or Health Care Providers
Section 1301.051. Designation as Preferred Provider
Section 1301.0515. Acupuncturist Services
Section 1301.0516. Chiropractic Services
Section 1301.0521. Designation of Certain Podiatrists as Preferred Providers
Section 1301.053. Appeal Relating to Designation as Preferred Provider
Section 1301.054. Notice to Practitioners of Preferred Provider Benefit Plan
Section 1301.055. Complaint Resolution
Section 1301.056. Restrictions on Payment and Reimbursement
Section 1301.057. Termination of Participation; Expedited Review Process
Section 1301.058. Economic Profiling
Section 1301.059. Quality Assessment
Section 1301.060. Compensation on Discounted Fee Basis
Section 1301.061. Preferred Provider Networks
Section 1301.062. Preferred Provider Contracts Between Insurers and Podiatrists
Section 1301.0625. Health Care Collaboratives
Section 1301.063. Contract Provisions Relating to Use of Hospitalist
Section 1301.064. Contract Provisions Relating to Payment of Claims
Section 1301.0641. Contract Provisions Prohibiting Rejection of Batched Claims
Section 1301.065. Shifting of Insurer's Tort Liability Prohibited
Section 1301.066. Retaliation Against Preferred Provider Prohibited
Section 1301.068. Inducement to Limit Medically Necessary Services Prohibited
Section 1301.069. Services Provided by Certain Physicians and Health Care Providers