Sec. 1301.160. NOTIFICATION OF TERMINATION OF PARTICIPATION OF PREFERRED PROVIDER. (a) If a practitioner's participation in a preferred provider benefit plan is terminated for a reason other than at the practitioner's request, an insurer may not notify insureds of the termination until the later of:
(1) the effective date of the termination; or
(2) the time at which a review panel makes a formal recommendation regarding the termination.
(b) A physician or health care provider that voluntarily terminates the physician's or provider's participation in a preferred provider benefit plan shall provide reasonable notice to each insured under the physician's or provider's care. The insurer shall provide assistance to the physician or provider in ensuring that the notice requirements of this subsection are met.
(c) If a practitioner's participation in a preferred provider benefit plan is terminated for reasons related to imminent harm, an insurer may notify insureds immediately.
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