Sec. 1301.152. CONTINUING CARE IN GENERAL. (a) An insurer shall establish reasonable procedures for ensuring a transition of insureds to physicians or health care providers and for continuity of treatment.
(b) An insurer shall:
(1) provide, subject to Section 1301.160, reasonable advance notice to an insured of the impending termination of the participation in the plan of a physician or health care provider who is currently treating the insured; and
(2) in the event of termination of a preferred provider's participation in the plan, make available to the insured a current listing of preferred providers.
(c) A contract between an insurer and a physician or health care provider must include a procedure for resolving disputes regarding the necessity for continued treatment by the physician or provider.
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 D. Relations Between Insureds and Preferred Providers
Section 1301.151. Insured's Right to Treatment
Section 1301.152. Continuing Care in General
Section 1301.153. Continuity of Care
Section 1301.154. Obligation for Continuity of Care of Insurer
Section 1301.155. Emergency Care
Section 1301.156. Payment of Claims to Insured
Section 1301.157. Plain Language Requirements
Section 1301.158. Information Concerning Preferred Provider Benefit Plans
Section 1301.1581. Information Concerning Exclusive Provider Benefit Plans
Section 1301.159. Annual List of Preferred Providers
Section 1301.1591. Preferred Provider Information on Internet
Section 1301.160. Notification of Termination of Participation of Preferred Provider
Section 1301.161. Retaliation Against Insured Prohibited
Section 1301.162. Identification Card
Section 1301.163. Applicability of Subchapter to Entities Contracting With Insurer
Section 1301.164. Out-of-Network Facility-Based Providers
Section 1301.165. Out-of-Network Diagnostic Imaging Provider or Laboratory Service Provider