Texas Statutes
Subchapter B. Coalitions and Cooperatives
Section 1501.061. Requirements Applicable to Health Benefit Plan Issuers With Which Cooperative May Contract

Sec. 1501.061. REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY CONTRACT. A cooperative may contract only with a small or large employer health benefit plan issuer that demonstrates that the issuer:
(1) is in good standing with the department;
(2) has the capacity to administer health benefit plans;
(3) is able to monitor and evaluate the quality and cost-effectiveness of care and applicable procedures;
(4) is able to conduct utilization management and establish applicable procedures and policies;
(5) is able to ensure that enrollees have adequate access to health care providers, including adequate numbers and types of providers;
(6) has a satisfactory grievance procedure and is able to respond to enrollees' calls, questions, and complaints; and
(7) has financial capacity, either through satisfying financial solvency standards, as applied by the commissioner, or through appropriate reinsurance or other risk-sharing mechanisms.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.053(b), eff. September 1, 2005.

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