Sec. 1301.154. OBLIGATION FOR CONTINUITY OF CARE OF INSURER. (a) Except as provided by Subsection (b), Sections 1301.152 and 1301.153 do not extend an insurer's obligation to reimburse the terminated physician or provider or, if applicable, the insured at the preferred provider level of coverage for ongoing treatment of an insured after:
(1) the 90th day after the effective date of the termination; or
(2) if the insured has been diagnosed as having a terminal illness at the time of the termination, the expiration of the nine-month period after the effective date of the termination.
(b) If an insured is past the 24th week of pregnancy at the time of termination, an insurer's obligation to reimburse, at the preferred provider level of coverage, the physician or provider or, if applicable, the insured, extends through delivery of the child, immediate postpartum care, and the follow-up checkup within the six-week period after delivery.
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