Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities

Section 841.104. Tax Payment Required for Issuance of Certain Certificates of Authority - Sec. 841.104. TAX PAYMENT REQUIRED FOR ISSUANCE OF CERTAIN CERTIFICATES...

Subchapter D. Management of Company

Section 841.151. Conducting Shareholders' Meeting - Sec. 841.151. CONDUCTING SHAREHOLDERS' MEETING. (a) At a meeting of...

Section 841.153. Election of Directors - Sec. 841.153. ELECTION OF DIRECTORS. (a) After a domestic insurance...

Section 841.154. Staggered Terms for Directors - Sec. 841.154. STAGGERED TERMS FOR DIRECTORS. (a) Repealed by Acts...

Section 841.155. Officers - Sec. 841.155. OFFICERS. (a) A domestic insurance company's directors shall...

Section 841.156. Amendment of Charter or Articles - Sec. 841.156. AMENDMENT OF CHARTER OR ARTICLES. (a) The shareholders...

Subchapter E. Capital and Surplus

Section 841.201. Form of Required Capital and Surplus - Sec. 841.201. FORM OF REQUIRED CAPITAL AND SURPLUS. Notwithstanding any...

Section 841.202. Authorized Shares - Sec. 841.202. AUTHORIZED SHARES. (a) At any shareholders' meeting, shareholders...

Section 841.203. Company's Repurchase of Stock - Sec. 841.203. COMPANY'S REPURCHASE OF STOCK. (a) A legal reserve...

Section 841.204. Exemption From Required Increase of Capital and Surplus - Sec. 841.204. EXEMPTION FROM REQUIRED INCREASE OF CAPITAL AND SURPLUS....

Section 841.205. Commissioner May Require Larger Capital and Surplus Amounts - Sec. 841.205. COMMISSIONER MAY REQUIRE LARGER CAPITAL AND SURPLUS AMOUNTS....

Section 841.206. Impairment of Capital and Surplus - Sec. 841.206. IMPAIRMENT OF CAPITAL AND SURPLUS. (a) An insurance...

Section 841.207. Actions of Commissioner When Capital and Surplus Requirements Not Satisfied - Sec. 841.207. ACTIONS OF COMMISSIONER WHEN CAPITAL AND SURPLUS REQUIREMENTS...

Subchapter F. General Powers, Duties, and Limitations

Section 841.251. Evidence of Expenditures - Sec. 841.251. EVIDENCE OF EXPENDITURES. (a) A domestic insurance company...

Section 841.252. Payments to Officers, Directors, and Employees - Sec. 841.252. PAYMENTS TO OFFICERS, DIRECTORS, AND EMPLOYEES. (a) Unless...

Section 841.253. Life Insurance Company's Payment of Dividends - Sec. 841.253. LIFE INSURANCE COMPANY'S PAYMENT OF DIVIDENDS. (a) A...

Section 841.254. Transfer of Stock - Sec. 841.254. TRANSFER OF STOCK. (a) A domestic insurance company's...

Section 841.255. Annual Statement; Filing Fee - Sec. 841.255. ANNUAL STATEMENT; FILING FEE. (a) Not later than...

Section 841.256. Business in Separate Departments of Domestic Insurance Company - Sec. 841.256. BUSINESS IN SEPARATE DEPARTMENTS OF DOMESTIC INSURANCE COMPANY....

Section 841.257. Kinds of Business Limited - Sec. 841.257. KINDS OF BUSINESS LIMITED. An insurance company authorized...

Section 841.258. Agents for Company That Ceases Writing New Business - Sec. 841.258. AGENTS FOR COMPANY THAT CEASES WRITING NEW BUSINESS....

Section 841.259. Activities of Directors and Officers - Sec. 841.259. ACTIVITIES OF DIRECTORS AND OFFICERS. (a) A director...

Section 841.260. Prohibited Commissions - Sec. 841.260. PROHIBITED COMMISSIONS. (a) In this section, "contingent compensation"...

Section 841.261. Causes of Action - Sec. 841.261. CAUSES OF ACTION. (a) A domestic insurance company...

Subchapter G. Issuance of Policies

Section 841.301. Limits on Amount of Accident and Health Insurance Policies - Sec. 841.301. LIMITS ON AMOUNT OF ACCIDENT AND HEALTH INSURANCE...

Section 841.302. Limits on Life or Accidental Death Insurance - Sec. 841.302. LIMITS ON LIFE OR ACCIDENTAL DEATH INSURANCE. (a)...

Section 841.303. Entire Contract - Sec. 841.303. ENTIRE CONTRACT. Each policy of insurance issued or...

Subchapter H. Deposit of Securities

Section 841.351. Deposit With Comptroller - Sec. 841.351. DEPOSIT WITH COMPTROLLER. (a) A domestic insurance company...

Section 841.352. Issuance of Receipt for Deposit - Sec. 841.352. ISSUANCE OF RECEIPT FOR DEPOSIT. When a domestic...

Section 841.353. Advertisement of Deposit - Sec. 841.353. ADVERTISEMENT OF DEPOSIT. A domestic insurance company that...

Section 841.354. Access to Deposit - Sec. 841.354. ACCESS TO DEPOSIT. In accordance with reasonable rules...

Section 841.355. Withdrawal of Deposit After Merger, Consolidation, or Total Reinsurance - Sec. 841.355. WITHDRAWAL OF DEPOSIT AFTER MERGER, CONSOLIDATION, OR TOTAL...

Section 841.356. Situs of Deposit for Tax Purposes - Sec. 841.356. SITUS OF DEPOSIT FOR TAX PURPOSES. For purposes...

Section 841.357. Maintenance of Deposit - Sec. 841.357. MAINTENANCE OF DEPOSIT. A domestic insurance company must...

Subchapter I. Limited Purpose Subsidiary Life Insurance Companies

Section 841.401. Purpose - Sec. 841.401. PURPOSE. The purpose of this subchapter is to...

Section 841.402. Definitions - Sec. 841.402. DEFINITIONS. In this subchapter: (1) "Affiliated company" means:...

Section 841.403. Organizational Documents - Sec. 841.403. ORGANIZATIONAL DOCUMENTS. (a) A wholly owned domestic insurer...

Section 841.404. Certificate of Authority Required - Sec. 841.404. CERTIFICATE OF AUTHORITY REQUIRED. A limited purpose subsidiary...

Section 841.405. Application for Certificate of Authority - Sec. 841.405. APPLICATION FOR CERTIFICATE OF AUTHORITY. To obtain a...

Section 841.406. Investment of Certain Surplus by Organizing Company - Sec. 841.406. INVESTMENT OF CERTAIN SURPLUS BY ORGANIZING COMPANY. If...

Section 841.407. Officers and Directors - Sec. 841.407. OFFICERS AND DIRECTORS. The officers and directors of...

Section 841.408. Issuance of Certificate of Authority - Sec. 841.408. ISSUANCE OF CERTIFICATE OF AUTHORITY. (a) The commissioner...

Section 841.409. Scope of Certificate of Authority - Sec. 841.409. SCOPE OF CERTIFICATE OF AUTHORITY. (a) A limited...

Section 841.410. Capital and Surplus - Sec. 841.410. CAPITAL AND SURPLUS. (a) The commissioner may not...

Section 841.411. Foreclosure on Collateral - Sec. 841.411. FORECLOSURE ON COLLATERAL. A limited purpose subsidiary life...

Section 841.412. Minimum Authorized Investment Requirement After Credit for Reinsurance; Letters of Credit; Guaranties - Sec. 841.412. MINIMUM AUTHORIZED INVESTMENT REQUIREMENT AFTER CREDIT FOR REINSURANCE;...

Section 841.413. Permitted Reinsurance - Sec. 841.413. PERMITTED REINSURANCE. (a) A limited purpose subsidiary life...

Section 841.414. Reports on Reserves and Risk-Based Capital - Sec. 841.414. REPORTS ON RESERVES AND RISK-BASED CAPITAL. (a) A...

Section 841.415. Other Laws Not Applicable - Sec. 841.415. OTHER LAWS NOT APPLICABLE. The deposit requirements in...

Section 841.416. Applicability of Other Law - Sec. 841.416. APPLICABILITY OF OTHER LAW. Except as specifically provided...

Section 841.417. Guaranty Requirements - Sec. 841.417. GUARANTY REQUIREMENTS. (a) A guaranty may not be...

Section 841.418. Sunset Provision - Sec. 841.418. SUNSET PROVISION. This subchapter is valid for business...

Section 841.419. Certification of Actuarial Officer - Sec. 841.419. CERTIFICATION OF ACTUARIAL OFFICER. (a) At the time...

Section 841.420. Accounting and Financial Reporting - Sec. 841.420. ACCOUNTING AND FINANCIAL REPORTING. The commissioner shall prescribe...

Subchapter O. Enforcement and Intervention

Section 841.701. Revocation of Certificate of Authority - Sec. 841.701. REVOCATION OF CERTIFICATE OF AUTHORITY. (a) If the...

Section 841.702. Appeal of Determination to Revoke Certificate - Sec. 841.702. APPEAL OF DETERMINATION TO REVOKE CERTIFICATE. An insurance...

Section 841.703. Certificate of Authority Void on Failure to Satisfy Judgment - Sec. 841.703. CERTIFICATE OF AUTHORITY VOID ON FAILURE TO SATISFY...

Section 841.704. False Statement, Report, or Other Document; Criminal Penalty - Sec. 841.704. FALSE STATEMENT, REPORT, OR OTHER DOCUMENT; CRIMINAL PENALTY....

Section 841.705. Penalty for Failure to Invest or Report - Sec. 841.705. PENALTY FOR FAILURE TO INVEST OR REPORT. (a)...

Chapter 842 - Group Hospital Service Corporations

Subchapter A. General Provisions

Section 842.001. Definitions - Sec. 842.001. DEFINITIONS. In this chapter: (1) "Group hospital service...

Section 842.002. Applicability of Other Laws - Sec. 842.002. APPLICABILITY OF OTHER LAWS. (a) Except as otherwise...

Section 842.003. Corporation Subject to Regulation by Commissioner and Department - Sec. 842.003. CORPORATION SUBJECT TO REGULATION BY COMMISSIONER AND DEPARTMENT....

Subchapter B. Formation and Structure of Group Hospital Service Corporation

Section 842.051. Application for Corporate Charter; Nonprofit Status Required - Sec. 842.051. APPLICATION FOR CORPORATE CHARTER; NONPROFIT STATUS REQUIRED. (a)...

Section 842.052. Minimum Membership Requirements - Sec. 842.052. MINIMUM MEMBERSHIP REQUIREMENTS. (a) Before a group hospital...

Subchapter C. Authority to Engage in Business

Section 842.101. Issuance of Certificate of Authority - Sec. 842.101. ISSUANCE OF CERTIFICATE OF AUTHORITY. (a) The department...

Subchapter D. Board of Directors; Personnel

Section 842.151. Board of Directors - Sec. 842.151. BOARD OF DIRECTORS. (a) Each group hospital service...

Section 842.152. Compensation of Directors - Sec. 842.152. COMPENSATION OF DIRECTORS. A director of a group...

Section 842.153. Board Meetings - Sec. 842.153. BOARD MEETINGS. The board of directors of a...

Section 842.154. Bond Requirements for Certain Officers and Employees - Sec. 842.154. BOND REQUIREMENTS FOR CERTAIN OFFICERS AND EMPLOYEES. (a)...

Section 842.155. Treasurer's Bond - Sec. 842.155. TREASURER'S BOND. The treasurer of each group hospital...

Section 842.156. Compensation of Certain Officers and Employees - Sec. 842.156. COMPENSATION OF CERTAIN OFFICERS AND EMPLOYEES. A paid...

Subchapter E. Regulation of Group Hospital Service Corporations

Section 842.201. Annual Statement; Filing Fee - Sec. 842.201. ANNUAL STATEMENT; FILING FEE. (a) Not later than...

Section 842.202. Reserve Requirements - Sec. 842.202. RESERVE REQUIREMENTS. (a) Each group hospital service corporation...

Section 842.203. Final Judgment Deposit - Sec. 842.203. FINAL JUDGMENT DEPOSIT. (a) For each 1,000 members...

Section 842.204. Investment Limitations - Sec. 842.204. INVESTMENT LIMITATIONS. The investment limitations that apply to...

Section 842.205. Incurred Expenses - Sec. 842.205. INCURRED EXPENSES. (a) In this section, "general expenses"...

Section 842.206. Minimum Surplus Requirement - Sec. 842.206. MINIMUM SURPLUS REQUIREMENT. Each group hospital service corporation...

Section 842.207. Contracts; Reinsurance; Other Agreements - Sec. 842.207. CONTRACTS; REINSURANCE; OTHER AGREEMENTS. (a) Subject to Subsection...

Section 842.208. Books and Records - Sec. 842.208. BOOKS AND RECORDS. Each group hospital service corporation...

Section 842.209. Examinations - Sec. 842.209. EXAMINATIONS. The following laws apply to a group...

Section 842.210. Liquidation, Rehabilitation, or Conservation of Group Hospital Service Corporation - Sec. 842.210. LIQUIDATION, REHABILITATION, OR CONSERVATION OF GROUP HOSPITAL SERVICE...

Subchapter F. Plan of Operation; Provision of Benefits to Members

Section 842.251. Plan of Operation - Sec. 842.251. PLAN OF OPERATION. (a) Before accepting applications for...

Section 842.252. Membership Certificate; Contract - Sec. 842.252. MEMBERSHIP CERTIFICATE; CONTRACT. (a) A group hospital service...

Section 842.253. Policy, Certificate, and Application Forms - Sec. 842.253. POLICY, CERTIFICATE, AND APPLICATION FORMS. A policy, certificate,...

Section 842.254. Deposit Requirements - Sec. 842.254. DEPOSIT REQUIREMENTS. A group hospital service corporation shall...

Section 842.255. Advance Payments to Hospital Prohibited - Sec. 842.255. ADVANCE PAYMENTS TO HOSPITAL PROHIBITED. A group hospital...

Section 842.256. Contracts With Health Care Providers - Sec. 842.256. CONTRACTS WITH HEALTH CARE PROVIDERS. (a) A group...

Section 842.257. May Limit Benefits - Sec. 842.257. MAY LIMIT BENEFITS. A policy or certificate issued...

Section 842.258. Limitations on Contracts for Medical Services - Sec. 842.258. LIMITATIONS ON CONTRACTS FOR MEDICAL SERVICES. (a) A...

Section 842.259. Use of Indemnity Plan Authorized - Sec. 842.259. USE OF INDEMNITY PLAN AUTHORIZED. A group hospital...

Section 842.260. Payment of Claim; Proof of Claim - Sec. 842.260. PAYMENT OF CLAIM; PROOF OF CLAIM. (a) After...

Section 842.261. Information Available Through Internet Site - Sec. 842.261. INFORMATION AVAILABLE THROUGH INTERNET SITE. (a) A group...

Subchapter G. Disciplinary Procedures

Section 842.301. Revocation of Certificate of Authority - Sec. 842.301. REVOCATION OF CERTIFICATE OF AUTHORITY. The commissioner shall...

Chapter 843 - Health Maintenance Organizations

Subchapter A. General Provisions

Section 843.001. Short Title - Sec. 843.001. SHORT TITLE. This chapter may be cited as...

Section 843.002. Definitions - Sec. 843.002. DEFINITIONS. In this chapter: (1) "Adverse determination" means...

Section 843.003. Powers of Insurers and Group Hospital Service Corporations - Sec. 843.003. POWERS OF INSURERS AND GROUP HOSPITAL SERVICE CORPORATIONS....

Section 843.004. Governing Body of Health Maintenance Organization - Sec. 843.004. GOVERNING BODY OF HEALTH MAINTENANCE ORGANIZATION. The governing...

Section 843.005. Use of Insurance-Related Terms by Health Maintenance Organization - Sec. 843.005. USE OF INSURANCE-RELATED TERMS BY HEALTH MAINTENANCE ORGANIZATION....

Section 843.006. Public Documents - Sec. 843.006. PUBLIC DOCUMENTS. (a) Except as provided by Subsection...

Section 843.007. Confidentiality of Medical and Health Information - Sec. 843.007. CONFIDENTIALITY OF MEDICAL AND HEALTH INFORMATION. (a) Any...

Section 843.008. Costs of Administering Health Maintenance Organization Laws - Sec. 843.008. COSTS OF ADMINISTERING HEALTH MAINTENANCE ORGANIZATION LAWS. Money...

Section 843.009. Appeals; Judicial Review - Sec. 843.009. APPEALS; JUDICIAL REVIEW. (a) A person who is...

Section 843.010. Applicability of Certain Provisions to Governmental Health Benefit Plans - Sec. 843.010. APPLICABILITY OF CERTAIN PROVISIONS TO GOVERNMENTAL HEALTH BENEFIT...

Subchapter B. Applicability of and Construction With Other Laws

Section 843.051. Applicability of Insurance and Group Hospital Service Corporation Laws - Sec. 843.051. APPLICABILITY OF INSURANCE AND GROUP HOSPITAL SERVICE CORPORATION...

Section 843.052. Laws Relating to Solicitation or Advertising - Sec. 843.052. LAWS RELATING TO SOLICITATION OR ADVERTISING. (a) Solicitation...

Section 843.053. Laws Relating to Restraint of Trade - Sec. 843.053. LAWS RELATING TO RESTRAINT OF TRADE. (a) A...

Section 843.054. Laws Requiring Certificate of Need for Health Care Facility or Service - Sec. 843.054. LAWS REQUIRING CERTIFICATE OF NEED FOR HEALTH CARE...

Section 843.055. Laws Relating to Practice of Medicine - Sec. 843.055. LAWS RELATING TO PRACTICE OF MEDICINE. (a) This...

Section 843.056. Inapplicability of Bankruptcy Law - Sec. 843.056. INAPPLICABILITY OF BANKRUPTCY LAW. By applying for and...

Subchapter C. Authority to Engage in Business

Section 843.071. Certificate of Authority Required; Use of "Health Maintenance Organization" or "Hmo" - Sec. 843.071. CERTIFICATE OF AUTHORITY REQUIRED; USE OF "HEALTH MAINTENANCE...

Section 843.072. Authorization Required to Act as Health Maintenance Organization - Sec. 843.072. AUTHORIZATION REQUIRED TO ACT AS HEALTH MAINTENANCE ORGANIZATION....

Section 843.073. Certificate of Authority Requirement: Applicability to Physicians and Providers - Sec. 843.073. CERTIFICATE OF AUTHORITY REQUIREMENT: APPLICABILITY TO PHYSICIANS AND...

Section 843.074. Certificate of Authority Requirement: Applicability to Medical School and Medical and Dental Unit - Sec. 843.074. CERTIFICATE OF AUTHORITY REQUIREMENT: APPLICABILITY TO MEDICAL SCHOOL...

Section 843.075. Certificate of Authority for Single Health Care Service Plan - Sec. 843.075. CERTIFICATE OF AUTHORITY FOR SINGLE HEALTH CARE SERVICE...

Section 843.076. Application - Sec. 843.076. APPLICATION. (a) Any person may apply to the...

Section 843.077. Eligibility of Foreign Corporation - Sec. 843.077. ELIGIBILITY OF FOREIGN CORPORATION. A foreign corporation may...

Section 843.078. Contents of Application - Sec. 843.078. CONTENTS OF APPLICATION. (a) An application for a...

Section 843.079. Contents of Application: Limited Health Care Service Plan - Sec. 843.079. CONTENTS OF APPLICATION: LIMITED HEALTH CARE SERVICE PLAN....

Section 843.080. Modification or Amendment of Application Information - Sec. 843.080. MODIFICATION OR AMENDMENT OF APPLICATION INFORMATION. (a) The...

Section 843.082. Requirements for Approval of Application - Sec. 843.082. REQUIREMENTS FOR APPROVAL OF APPLICATION. The commissioner shall...

Section 843.083. Denial of Certificate of Authority - Sec. 843.083. DENIAL OF CERTIFICATE OF AUTHORITY. (a) If the...

Section 843.084. Duration of Certificate of Authority - Sec. 843.084. DURATION OF CERTIFICATE OF AUTHORITY. A certificate of...

Section 843.085. Change in Control: Commissioner Approval - Sec. 843.085. CHANGE IN CONTROL: COMMISSIONER APPROVAL. Any change in...

Subchapter D. General Powers and Duties of Health Maintenance Organizations

Section 843.101. Providing or Arranging for Care - Sec. 843.101. PROVIDING OR ARRANGING FOR CARE. (a) A health...

Section 843.102. Health Maintenance Organization Quality Assurance - Sec. 843.102. HEALTH MAINTENANCE ORGANIZATION QUALITY ASSURANCE. (a) A health...

Section 843.103. Acquisition and Operation of Facilities; Certain Loans; Commissioner Approval of Affiliate Transactions - Sec. 843.103. ACQUISITION AND OPERATION OF FACILITIES; CERTAIN LOANS; COMMISSIONER...

Section 843.104. Contracts for Certain Administrative Functions - Sec. 843.104. CONTRACTS FOR CERTAIN ADMINISTRATIVE FUNCTIONS. A health maintenance...

Section 843.105. Management and Exclusive Agency Contracts - Sec. 843.105. MANAGEMENT AND EXCLUSIVE AGENCY CONTRACTS. (a) A health...

Section 843.106. Insurance, Reinsurance, Indemnity, and Reimbursement - Sec. 843.106. INSURANCE, REINSURANCE, INDEMNITY, AND REIMBURSEMENT. A health maintenance...

Section 843.107. Indemnity Benefits; Point-of-Service Provisions - Sec. 843.107. INDEMNITY BENEFITS; POINT-OF-SERVICE PROVISIONS. A health maintenance organization...

Section 843.108. Point-of-Service Rider - Sec. 843.108. POINT-OF-SERVICE RIDER. (a) In this section, "point-of-service rider"...

Section 843.109. Payment by Governmental or Private Entity - Sec. 843.109. PAYMENT BY GOVERNMENTAL OR PRIVATE ENTITY. A health...

Section 843.110. Corporation, Partnership, or Association Powers - Sec. 843.110. CORPORATION, PARTNERSHIP, OR ASSOCIATION POWERS. A health maintenance...

Section 843.111. Group Model Health Maintenance Organizations - Sec. 843.111. GROUP MODEL HEALTH MAINTENANCE ORGANIZATIONS. (a) In this...

Section 843.112. Dental Point-of-Service Option - Sec. 843.112. DENTAL POINT-OF-SERVICE OPTION. (a) In this section: (1)...

Section 843.113. Specified Powers Not Exclusive - Sec. 843.113. SPECIFIED POWERS NOT EXCLUSIVE. The powers of a...

Subchapter E. Regulation of Health Maintenance Organizations

Section 843.151. Rules - Sec. 843.151. RULES. The commissioner may adopt reasonable rules as...

Section 843.152. Subpoena Authority - Sec. 843.152. SUBPOENA AUTHORITY. In implementing this chapter and the...

Section 843.153. Authority to Contract - Sec. 843.153. AUTHORITY TO CONTRACT. In performing duties under this...

Section 843.154. Fees - Sec. 843.154. FEES. (a) The commissioner shall, within the limits...

Section 843.155. Annual Report - Sec. 843.155. ANNUAL REPORT. (a) Not later than March 1...

Section 843.156. Examinations - Sec. 843.156. EXAMINATIONS. (a) The commissioner may examine the quality...

Section 843.157. Rehabilitation, Liquidation, Supervision, or Conservation of Health Maintenance Organization - Sec. 843.157. REHABILITATION, LIQUIDATION, SUPERVISION, OR CONSERVATION OF HEALTH MAINTENANCE...

Subchapter F. Relations With Enrollees and Group Contract Holders

Section 843.201. Disclosure of Information About Health Care Plan Terms - Sec. 843.201. DISCLOSURE OF INFORMATION ABOUT HEALTH CARE PLAN TERMS....

Section 843.2015. Information Available Through Internet Site - Sec. 843.2015. INFORMATION AVAILABLE THROUGH INTERNET SITE. (a) A health...

Section 843.202. Disclosure of Information to Medicare Recipients - Sec. 843.202. DISCLOSURE OF INFORMATION TO MEDICARE RECIPIENTS. (a) Before...

Section 843.203. Selection of Primary Care Physician or Provider - Sec. 843.203. SELECTION OF PRIMARY CARE PHYSICIAN OR PROVIDER. (a)...

Section 843.204. Untrue or Misleading Information - Sec. 843.204. UNTRUE OR MISLEADING INFORMATION. (a) A health maintenance...

Section 843.205. Member's Handbook; Information About Complaints and Appeals - Sec. 843.205. MEMBER'S HANDBOOK; INFORMATION ABOUT COMPLAINTS AND APPEALS. (a)...

Section 843.206. Notice of Change in Payment Arrangements - Sec. 843.206. NOTICE OF CHANGE IN PAYMENT ARRANGEMENTS. A health...

Section 843.207. Notice of Change in Operations - Sec. 843.207. NOTICE OF CHANGE IN OPERATIONS. A health maintenance...

Section 843.2071. Notice of Increase in Charge for Coverage - Sec. 843.2071. NOTICE OF INCREASE IN CHARGE FOR COVERAGE. (a)...

Section 843.208. Cancellation or Nonrenewal of Coverage - Sec. 843.208. CANCELLATION OR NONRENEWAL OF COVERAGE. A health maintenance...

Section 843.209. Identification Card - Sec. 843.209. IDENTIFICATION CARD. An identification card or other similar...

Section 843.210. Terms of Enrollee Eligibility - Sec. 843.210. TERMS OF ENROLLEE ELIGIBILITY. (a) A contract between...

Section 843.211. Applicability of Subchapter to Entities Contracting With Health Maintenance Organization - Sec. 843.211. APPLICABILITY OF SUBCHAPTER TO ENTITIES CONTRACTING WITH HEALTH...

Subchapter G. Dispute Resolution

Section 843.251. Complaint System Required; Commissioner Rules and Examination - Sec. 843.251. COMPLAINT SYSTEM REQUIRED; COMMISSIONER RULES AND EXAMINATION. (a)...

Section 843.252. Complaint Initiation and Initial Response; Deadlines for Response and Resolution - Sec. 843.252. COMPLAINT INITIATION AND INITIAL RESPONSE; DEADLINES FOR RESPONSE...

Section 843.253. Complaint Investigation and Resolution - Sec. 843.253. COMPLAINT INVESTIGATION AND RESOLUTION. (a) A health maintenance...

Section 843.254. Appeal to Complaint Appeal Panel; Deadlines - Sec. 843.254. APPEAL TO COMPLAINT APPEAL PANEL; DEADLINES. (a) A...

Section 843.255. Composition of Complaint Appeal Panel - Sec. 843.255. COMPOSITION OF COMPLAINT APPEAL PANEL. (a) A health...

Section 843.256. Information Provided to Complainant Relating to Complaint Appeal Panel - Sec. 843.256. INFORMATION PROVIDED TO COMPLAINANT RELATING TO COMPLAINT APPEAL...

Section 843.257. Rights of Complainant at Complaint Appeal Panel Meeting - Sec. 843.257. RIGHTS OF COMPLAINANT AT COMPLAINT APPEAL PANEL MEETING....

Section 843.258. Appeal Involving Ongoing Emergency or Continued Hospitalization - Sec. 843.258. APPEAL INVOLVING ONGOING EMERGENCY OR CONTINUED HOSPITALIZATION. (a)...

Section 843.259. Notice of Decision on Appeal - Sec. 843.259. NOTICE OF DECISION ON APPEAL. (a) A health...

Section 843.260. Record of Complaints - Sec. 843.260. RECORD OF COMPLAINTS. (a) A health maintenance organization...

Section 843.261. Special Provisions for Appeals of Adverse Determinations - Sec. 843.261. SPECIAL PROVISIONS FOR APPEALS OF ADVERSE DETERMINATIONS. (a)...

Section 843.262. Certain Decisions Binding - Sec. 843.262. CERTAIN DECISIONS BINDING. (a) If an enrollee, a...

Subchapter H. General Provisions Regarding Complaints

Section 843.281. Retaliatory Action Prohibited - Sec. 843.281. RETALIATORY ACTION PROHIBITED. (a) A health maintenance organization...

Section 843.282. Submitting Complaints to Department - Sec. 843.282. SUBMITTING COMPLAINTS TO DEPARTMENT. (a) Any person, including...

Section 843.283. Posting of Information on Complaint Process Required - Sec. 843.283. POSTING OF INFORMATION ON COMPLAINT PROCESS REQUIRED. A...

Subchapter I. Relations With Physicians and Providers

Section 843.301. Practice of Medicine Not Affected - Sec. 843.301. PRACTICE OF MEDICINE NOT AFFECTED. This chapter, Section...

Section 843.302. Disclosure of Application Procedures and Qualification Requirements to Physician or Provider - Sec. 843.302. DISCLOSURE OF APPLICATION PROCEDURES AND QUALIFICATION REQUIREMENTS TO...

Section 843.303. Denial of Initial Contract to Physician or Provider - Sec. 843.303. DENIAL OF INITIAL CONTRACT TO PHYSICIAN OR PROVIDER....

Section 843.304. Exclusion of Provider Based on Type of License Prohibited - Sec. 843.304. EXCLUSION OF PROVIDER BASED ON TYPE OF LICENSE...

Section 843.3041. Acupuncturist Services - Sec. 843.3041. ACUPUNCTURIST SERVICES. (a) A health maintenance organization that...

Section 843.3042. Chiropractic Services - Sec. 843.3042. CHIROPRACTIC SERVICES. (a) A health maintenance organization offering...

Section 843.3045. Nurse First Assistant - Sec. 843.3045. NURSE FIRST ASSISTANT. A health maintenance organization may...

Section 843.305. Annual Application Period for Physicians and Providers to Contract - Sec. 843.305. ANNUAL APPLICATION PERIOD FOR PHYSICIANS AND PROVIDERS TO...

Section 843.306. Termination of Participation; Advisory Review Panel - Sec. 843.306. TERMINATION OF PARTICIPATION; ADVISORY REVIEW PANEL. (a) Before...

Section 843.307. Expedited Review Process on Termination or Deselection - Sec. 843.307. EXPEDITED REVIEW PROCESS ON TERMINATION OR DESELECTION. On...

Section 843.308. Notification of Patients of Deselected Physician or Provider - Sec. 843.308. NOTIFICATION OF PATIENTS OF DESELECTED PHYSICIAN OR PROVIDER....

Section 843.309. Contracts With Physicians or Providers: Notice to Certain Enrollees of Termination of Physician or Provider Participation in Plan - Sec. 843.309. CONTRACTS WITH PHYSICIANS OR PROVIDERS: NOTICE TO CERTAIN...

Section 843.310. Contracts With Physicians or Providers: Certain Indemnity Clauses Prohibited - Sec. 843.310. CONTRACTS WITH PHYSICIANS OR PROVIDERS: CERTAIN INDEMNITY CLAUSES...

Section 843.311. Contracts With Podiatrists - Sec. 843.311. CONTRACTS WITH PODIATRISTS. A contract between a health...

Section 843.3115. Contracts With Dentists - Sec. 843.3115. CONTRACTS WITH DENTISTS. (a) In this section, "covered...

Section 843.312. Physician Assistants and Advanced Practice Nurses - Sec. 843.312. PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE NURSES. (a) A...

Section 843.313. Economic Profiling - Sec. 843.313. ECONOMIC PROFILING. (a) A health maintenance organization that...

Section 843.314. Inducement to Limit Medically Necessary Services Prohibited - Sec. 843.314. INDUCEMENT TO LIMIT MEDICALLY NECESSARY SERVICES PROHIBITED. (a)...

Section 843.315. Payment of Capitation; Assignment of Primary Care Physician or Provider - Sec. 843.315. PAYMENT OF CAPITATION; ASSIGNMENT OF PRIMARY CARE PHYSICIAN...

Section 843.316. Alternative Capitation System - Sec. 843.316. ALTERNATIVE CAPITATION SYSTEM. As an alternative to the...

Section 843.317. Exclusion of Physician or Provider Based on Affiliation With Health Maintenance Organization Prohibited - Sec. 843.317. EXCLUSION OF PHYSICIAN OR PROVIDER BASED ON AFFILIATION...

Section 843.318. Certain Contracts of Participating Physician or Provider Not Prohibited - Sec. 843.318. CERTAIN CONTRACTS OF PARTICIPATING PHYSICIAN OR PROVIDER NOT...

Section 843.319. Certain Required Contracts - Sec. 843.319. CERTAIN REQUIRED CONTRACTS. Notwithstanding Section 843.304, a health...

Section 843.320. Use of Hospitalist - Sec. 843.320. USE OF HOSPITALIST. (a) In this section, "hospitalist"...

Section 843.321. Availability of Coding Guidelines - Sec. 843.321. AVAILABILITY OF CODING GUIDELINES. (a) A contract between...

Section 843.323. Contract Provisions Prohibiting Rejection of Batched Claims - Sec. 843.323. CONTRACT PROVISIONS PROHIBITING REJECTION OF BATCHED CLAIMS. (a)...

Subchapter J. Payment of Claims to Physicians and Providers

Section 843.336. Definition - Sec. 843.336. DEFINITION. (a) In this subchapter, "clean claim" means...

Section 843.337. Time for Submission of Claim; Duplicate Claims; Acknowledgment of Receipt of Claim - Sec. 843.337. TIME FOR SUBMISSION OF CLAIM; DUPLICATE CLAIMS; ACKNOWLEDGMENT...

Section 843.338. Deadline for Action on Clean Claims - Sec. 843.338. DEADLINE FOR ACTION ON CLEAN CLAIMS. Except as...

Section 843.3385. Additional Information - Sec. 843.3385. ADDITIONAL INFORMATION. (a) If a health maintenance organization...

Section 843.339. Deadline for Action on Prescription Claims; Payment - Sec. 843.339. DEADLINE FOR ACTION ON PRESCRIPTION CLAIMS; PAYMENT. (a)...

Section 843.340. Audited Claims - Sec. 843.340. AUDITED CLAIMS. (a) Except as provided by Section...

Section 843.3405. Investigation and Determination of Payment - Sec. 843.3405. INVESTIGATION AND DETERMINATION OF PAYMENT. The investigation and...

Section 843.341. Claims Processing Procedures - Sec. 843.341. CLAIMS PROCESSING PROCEDURES. (a) A health maintenance organization...

Section 843.342. Violation of Certain Claims Payment Provisions; Penalties - Sec. 843.342. VIOLATION OF CERTAIN CLAIMS PAYMENT PROVISIONS; PENALTIES. (a)...

Section 843.343. Attorney's Fees - Sec. 843.343. ATTORNEY'S FEES. A physician or provider may recover...

Section 843.344. Applicability of Subchapter to Entities Contracting With Health Maintenance Organization - Sec. 843.344. APPLICABILITY OF SUBCHAPTER TO ENTITIES CONTRACTING WITH HEALTH...

Section 843.345. Exception - Sec. 843.345. EXCEPTION. This subchapter does not apply to a...

Section 843.346. Payment of Claims - Sec. 843.346. PAYMENT OF CLAIMS. Except as provided by this...

Section 843.347. Verification - Sec. 843.347. VERIFICATION. (a) In this section, "verification" means a...

Section 843.348. Preauthorization of Health Care Services - Sec. 843.348. PREAUTHORIZATION OF HEALTH CARE SERVICES. (a) In this...

Section 843.3481. Posting of Preauthorization Requirements - Sec. 843.3481. POSTING OF PREAUTHORIZATION REQUIREMENTS. (a) A health maintenance...

Section 843.3483. Remedy for Noncompliance - Sec. 843.3483. REMEDY FOR NONCOMPLIANCE. In addition to any other...

Section 843.349. Coordination of Payment - Sec. 843.349. COORDINATION OF PAYMENT. (a) A health maintenance organization...

Section 843.350. Overpayment - Sec. 843.350. OVERPAYMENT. (a) A health maintenance organization may recover...

Section 843.351. Services Provided by Certain Physicians and Providers - Sec. 843.351. SERVICES PROVIDED BY CERTAIN PHYSICIANS AND PROVIDERS. The...

Section 843.352. Conflict With Other Law - Sec. 843.352. CONFLICT WITH OTHER LAW. To the extent of...

Section 843.353. Waiver Prohibited - Sec. 843.353. WAIVER PROHIBITED. Except as provided by Sections 843.336(f)...

Section 843.354. Legislative Declaration - Sec. 843.354. LEGISLATIVE DECLARATION. It is the intent of the...

Subchapter K. Relations Between Enrollee and Physician or Provider

Section 843.361. Enrollees Held Harmless - Sec. 843.361. ENROLLEES HELD HARMLESS. A contract or other agreement...

Section 843.362. Continuity of Care; Obligation of Health Maintenance Organization - Sec. 843.362. CONTINUITY OF CARE; OBLIGATION OF HEALTH MAINTENANCE ORGANIZATION....

Section 843.363. Protected Physician or Provider Communications With Patients - Sec. 843.363. PROTECTED PHYSICIAN OR PROVIDER COMMUNICATIONS WITH PATIENTS. (a)...

Subchapter L. Financial Regulation of Health Maintenance Organizations

Section 843.401. Fiduciary Responsibility - Sec. 843.401. FIDUCIARY RESPONSIBILITY. A director, officer, member, employee, or...

Section 843.402. Officers' and Employees' Bond - Sec. 843.402. OFFICERS' AND EMPLOYEES' BOND. (a) A health maintenance...

Section 843.403. Minimum Net Worth - Sec. 843.403. MINIMUM NET WORTH. (a) A health maintenance organization...

Section 843.404. Additional Net Worth Requirements - Sec. 843.404. ADDITIONAL NET WORTH REQUIREMENTS. (a) The commissioner may...

Section 843.405. Deposit With Comptroller - Sec. 843.405. DEPOSIT WITH COMPTROLLER. (a) Unless otherwise provided by...

Section 843.406. Hazardous Financial Condition - Sec. 843.406. HAZARDOUS FINANCIAL CONDITION. (a) If the financial condition...

Section 843.407. Receivership and Delinquency Proceedings - Sec. 843.407. RECEIVERSHIP AND DELINQUENCY PROCEEDINGS. (a) In addition to...

Section 843.408. Insolvency and Allocation to Other Health Maintenance Organizations - Sec. 843.408. INSOLVENCY AND ALLOCATION TO OTHER HEALTH MAINTENANCE ORGANIZATIONS....

Section 843.409. Examination Expenses - Sec. 843.409. EXAMINATION EXPENSES. (a) A credit against the amount...

Section 843.410. Assessments - Sec. 843.410. ASSESSMENTS. (a) To provide funds for the administrative...

Subchapter N. Enforcement

Section 843.461. Enforcement Actions - Sec. 843.461. ENFORCEMENT ACTIONS. (a) After notice and opportunity for...

Section 843.462. Operations During Suspension or After Revocation of Certificate of Authority - Sec. 843.462. OPERATIONS DURING SUSPENSION OR AFTER REVOCATION OF CERTIFICATE...

Section 843.463. Injunctions - Sec. 843.463. INJUNCTIONS. If the commissioner believes that a health...

Section 843.464. Criminal Penalty - Sec. 843.464. CRIMINAL PENALTY. (a) A person, including an agent...

Chapter 844 - Certification of Certain Nonprofit Health Corporations

Subchapter A. General Provisions

Section 844.001. Definitions - Sec. 844.001. DEFINITIONS. In this chapter: (1) "Approved nonprofit health...

Section 844.002. Exceptions - Sec. 844.002. EXCEPTIONS. This chapter does not apply to: (1)...

Section 844.003. Exceptions to Texas Health Maintenance Organization Act - Sec. 844.003. EXCEPTIONS TO TEXAS HEALTH MAINTENANCE ORGANIZATION ACT. This...

Section 844.004. Rules - Sec. 844.004. RULES. Except as provided by Section 844.101(b), the...

Section 844.005. Provision of Certain Services on Behalf of Health Maintenance Organizations - Sec. 844.005. PROVISION OF CERTAIN SERVICES ON BEHALF OF HEALTH...

Subchapter B. Authority to Engage in Business

Section 844.051. Certificate of Authority Required - Sec. 844.051. CERTIFICATE OF AUTHORITY REQUIRED. An approved nonprofit health...

Section 844.052. Certificate Application; Eligibility Requirements - Sec. 844.052. CERTIFICATE APPLICATION; ELIGIBILITY REQUIREMENTS. (a) An approved nonprofit...

Section 844.053. Provisional Certificate of Authority - Sec. 844.053. PROVISIONAL CERTIFICATE OF AUTHORITY. The commissioner shall grant...

Section 844.054. Powers and Duties of Certificate Holder - Sec. 844.054. POWERS AND DUTIES OF CERTIFICATE HOLDER. (a) A...

Subchapter C. Prohibited Conduct

Section 844.101. Unfair Competition - Sec. 844.101. UNFAIR COMPETITION. (a) A certificate holder may not...

Chapter 845 - Statewide Rural Health Care System

Subchapter A. General Provisions

Section 845.001. Short Title - Sec. 845.001. SHORT TITLE. This chapter may be cited as...

Section 845.002. Definitions - Sec. 845.002. DEFINITIONS. In this chapter: (1) "Board" means the...

Section 845.003. Rural Area Designation - Sec. 845.003. RURAL AREA DESIGNATION. In determining whether to designate...

Section 845.004. Rules - Sec. 845.004. RULES. The commissioner shall adopt rules as necessary...

Subchapter B. System

Section 845.051. Statewide Rural Health Care System - Sec. 845.051. STATEWIDE RURAL HEALTH CARE SYSTEM. The commissioner shall...

Section 845.052. Organization Requirements - Sec. 845.052. ORGANIZATION REQUIREMENTS. The system must: (1) be a...

Section 845.053. Requirements Applicable to Certain Plans - Sec. 845.053. REQUIREMENTS APPLICABLE TO CERTAIN PLANS. (a) Except as...

Section 845.054. Local Government - Sec. 845.054. LOCAL GOVERNMENT. (a) The system is: (1) a...

Section 845.055. Provision of Administrative and Health Care Services - Sec. 845.055. PROVISION OF ADMINISTRATIVE AND HEALTH CARE SERVICES. (a)...

Section 845.056. Gifts and Grants - Sec. 845.056. GIFTS AND GRANTS. The system may accept gifts...

Section 845.057. Limitation on Authority of Participating Hospital Providers - Sec. 845.057. LIMITATION ON AUTHORITY OF PARTICIPATING HOSPITAL PROVIDERS. The...

Section 845.058. Sale or Dissolution of System - Sec. 845.058. SALE OR DISSOLUTION OF SYSTEM. (a) The participating...

Subchapter C. Board of Directors

Section 845.101. Appointment of Board - Sec. 845.101. APPOINTMENT OF BOARD. (a) The system is governed...

Section 845.102. Terms; Vacancy - Sec. 845.102. TERMS; VACANCY. (a) Members of the board serve...

Section 845.103. Removal of Certain Board Members - Sec. 845.103. REMOVAL OF CERTAIN BOARD MEMBERS. The participating hospital...

Section 845.104. Board Duties - Sec. 845.104. BOARD DUTIES. The board shall: (1) administer the...

Section 845.105. Rules Relating to Administrative and Health Care Services - Sec. 845.105. RULES RELATING TO ADMINISTRATIVE AND HEALTH CARE SERVICES....

Section 845.106. Officers - Sec. 845.106. OFFICERS. The board may elect officers as it...

Section 845.107. Executive Committee - Sec. 845.107. EXECUTIVE COMMITTEE. (a) The board may appoint an...

Section 845.108. Administrative Services; Personnel - Sec. 845.108. ADMINISTRATIVE SERVICES; PERSONNEL. (a) The board may, by...

Section 845.109. Advisory Committees - Sec. 845.109. ADVISORY COMMITTEES. (a) The board may appoint a...

Section 845.110. Open Meetings and Records Requirements - Sec. 845.110. OPEN MEETINGS AND RECORDS REQUIREMENTS. (a) Meetings of...

Subchapter D. State Managed Care Contracts

Section 845.151. Contract Award - Sec. 845.151. CONTRACT AWARD. To the extent consistent with federal...

Section 845.152. Participation Requirement - Sec. 845.152. PARTICIPATION REQUIREMENT. As a requirement of participation in...

Section 845.153. Reimbursement at State-Defined Capitation Rate - Sec. 845.153. REIMBURSEMENT AT STATE-DEFINED CAPITATION RATE. (a) To the...

Section 845.154. Right of State to Cancel Contract on Sale or Dissolution - Sec. 845.154. RIGHT OF STATE TO CANCEL CONTRACT ON SALE...

Section 845.155. Use of System as Pilot Program, Demonstration Project, or Study - Sec. 845.155. USE OF SYSTEM AS PILOT PROGRAM, DEMONSTRATION PROJECT,...

Subchapter E. Goals of System

Section 845.201. Rural Health Care Delivery System - Sec. 845.201. RURAL HEALTH CARE DELIVERY SYSTEM. (a) The system...

Section 845.202. Patient Rights Policies - Sec. 845.202. PATIENT RIGHTS POLICIES. It is intended that the...

Section 845.203. Patient-Physician Relationship - Sec. 845.203. PATIENT-PHYSICIAN RELATIONSHIP. It is intended that the system...

Section 845.204. Public Health and Prevention - Sec. 845.204. PUBLIC HEALTH AND PREVENTION. It is intended that...

Section 845.205. Credentials and Peer Review - Sec. 845.205. CREDENTIALS AND PEER REVIEW. To ensure that enrollees...

Section 845.206. Quality Improvement and Management - Sec. 845.206. QUALITY IMPROVEMENT AND MANAGEMENT. It is intended that...

Chapter 846 - Multiple Employer Welfare Arrangements

Subchapter A. General Provisions

Section 846.001. Definitions - Sec. 846.001. DEFINITIONS. In this chapter: (1) "Board" means the...

Section 846.002. Applicability of Chapter - Sec. 846.002. APPLICABILITY OF CHAPTER. (a) In this section, "fully...

Section 846.003. Limited Exemption From Insurance Laws; Applicability of Certain Laws - Sec. 846.003. LIMITED EXEMPTION FROM INSURANCE LAWS; APPLICABILITY OF CERTAIN...

Section 846.004. Late-Participating Employee or Dependent - Sec. 846.004. LATE-PARTICIPATING EMPLOYEE OR DEPENDENT. (a) For purposes of...

Section 846.005. Rules; Orders - Sec. 846.005. RULES; ORDERS. (a) The commissioner may, on notice...

Section 846.006. Appeal of Orders - Sec. 846.006. APPEAL OF ORDERS. A person affected by an...

Section 846.007. Premium Rates; Adjustments - Sec. 846.007. PREMIUM RATES; ADJUSTMENTS. (a) A multiple employer welfare...

Subchapter B. Formation and Structure of Multiple Employer Welfare Arrangements

Section 846.051. Certificate of Authority Required - Sec. 846.051. CERTIFICATE OF AUTHORITY REQUIRED. A person may not...

Section 846.052. Application for Initial Certificate of Authority - Sec. 846.052. APPLICATION FOR INITIAL CERTIFICATE OF AUTHORITY. (a) A...

Section 846.053. Eligibility Requirements for Initial Certificate of Authority - Sec. 846.053. ELIGIBILITY REQUIREMENTS FOR INITIAL CERTIFICATE OF AUTHORITY. (a)...

Section 846.054. Issuance of Initial Certificate of Authority - Sec. 846.054. ISSUANCE OF INITIAL CERTIFICATE OF AUTHORITY. (a) The...

Section 846.055. Extension of Term of Initial Certificate of Authority - Sec. 846.055. EXTENSION OF TERM OF INITIAL CERTIFICATE OF AUTHORITY....

Section 846.056. Final Certificate of Authority - Sec. 846.056. FINAL CERTIFICATE OF AUTHORITY. (a) A multiple employer...

Section 846.057. Denial of Final Certificate of Authority - Sec. 846.057. DENIAL OF FINAL CERTIFICATE OF AUTHORITY. (a) The...

Section 846.058. Disqualification - Sec. 846.058. DISQUALIFICATION. (a) A multiple employer welfare arrangement, each...

Section 846.059. Fees; Service of Process - Sec. 846.059. FEES; SERVICE OF PROCESS. (a) Each multiple employer...

Section 846.060. Suspension, Revocation, or Limitation of Certificate of Authority - Sec. 846.060. SUSPENSION, REVOCATION, OR LIMITATION OF CERTIFICATE OF AUTHORITY....

Section 846.061. Action by Attorney General - Sec. 846.061. ACTION BY ATTORNEY GENERAL. (a) The commissioner may...

Subchapter C. Board Members; Other Officers and Personnel

Section 846.101. Board Members; Notice of Elections - Sec. 846.101. BOARD MEMBERS; NOTICE OF ELECTIONS. (a) Except as...

Section 846.102. Duties of Board Members - Sec. 846.102. DUTIES OF BOARD MEMBERS. (a) The board members...

Section 846.103. Limitation on Action Against Board Member - Sec. 846.103. LIMITATION ON ACTION AGAINST BOARD MEMBER. A board...

Section 846.104. Compensation of Board Members - Sec. 846.104. COMPENSATION OF BOARD MEMBERS. A board member serves...

Section 846.105. Officers; Agents - Sec. 846.105. OFFICERS; AGENTS. (a) The board shall select officers...

Section 846.106. Compensation of Officers, Agents, and Employees - Sec. 846.106. COMPENSATION OF OFFICERS, AGENTS, AND EMPLOYEES. (a) A...

Section 846.107. Receipt of Thing of Value; Criminal Penalty - Sec. 846.107. RECEIPT OF THING OF VALUE; CRIMINAL PENALTY. (a)...

Subchapter D. Powers and Duties of Multiple Employer Welfare Arrangements

Section 846.151. General Powers - Sec. 846.151. GENERAL POWERS. (a) Unless otherwise provided by or...

Section 846.152. Filing of Organizational Documents - Sec. 846.152. FILING OF ORGANIZATIONAL DOCUMENTS. A multiple employer welfare...

Section 846.153. Required Filings - Sec. 846.153. REQUIRED FILINGS. (a) A multiple employer welfare arrangement...

Section 846.154. Cash Reserve Requirements - Sec. 846.154. CASH RESERVE REQUIREMENTS. (a) The amount of cash...

Section 846.155. Adjustment of Contributions - Sec. 846.155. ADJUSTMENT OF CONTRIBUTIONS. If the recommended cash reserves...

Section 846.156. Waiver or Reduction of Required Stop-Loss Insurance or Cash Reserves - Sec. 846.156. WAIVER OR REDUCTION OF REQUIRED STOP-LOSS INSURANCE OR...

Section 846.157. Renewal of Certificate; Additional Actuarial Review - Sec. 846.157. RENEWAL OF CERTIFICATE; ADDITIONAL ACTUARIAL REVIEW. (a) The...

Section 846.158. Examination of Multiple Employer Welfare Arrangements - Sec. 846.158. EXAMINATION OF MULTIPLE EMPLOYER WELFARE ARRANGEMENTS. (a) The...

Section 846.159. Name of Multiple Employer Welfare Arrangement - Sec. 846.159. NAME OF MULTIPLE EMPLOYER WELFARE ARRANGEMENT. (a) A...

Section 846.160. Evidence of Existence - Sec. 846.160. EVIDENCE OF EXISTENCE. A certified copy of the...

Subchapter E. Provision of Coverage

Section 846.201. Benefits Allowed - Sec. 846.201. BENEFITS ALLOWED. (a) A multiple employer welfare arrangement...

Section 846.202. Preexisting Condition Provision - Sec. 846.202. PREEXISTING CONDITION PROVISION. (a) In this section, "creditable...

Section 846.203. Treatment of Certain Conditions as Preexisting Prohibited - Sec. 846.203. TREATMENT OF CERTAIN CONDITIONS AS PREEXISTING PROHIBITED. (a)...

Section 846.204. Waiting Period Permitted - Sec. 846.204. WAITING PERIOD PERMITTED. Sections 846.202 and 846.203 do...

Section 846.205. Certain Limitations or Exclusions of Coverage Prohibited - Sec. 846.205. CERTAIN LIMITATIONS OR EXCLUSIONS OF COVERAGE PROHIBITED. (a)...

Section 846.206. Renewability of Coverage; Cancellation - Sec. 846.206. RENEWABILITY OF COVERAGE; CANCELLATION. (a) Except as provided...

Section 846.207. Refusal to Renew - Sec. 846.207. REFUSAL TO RENEW. (a) A multiple employer welfare...

Section 846.208. Notice to Covered Persons - Sec. 846.208. NOTICE TO COVERED PERSONS. (a) A multiple employer...

Section 846.209. Written Statement of Denial, Cancellation, or Refusal to Renew - Sec. 846.209. WRITTEN STATEMENT OF DENIAL, CANCELLATION, OR REFUSAL TO...

Subchapter F. Participation in Coverage

Section 846.251. Participation Criteria - Sec. 846.251. PARTICIPATION CRITERIA. Participation criteria may not be based...

Section 846.252. Coverage Requirements - Sec. 846.252. COVERAGE REQUIREMENTS. (a) A multiple employer welfare arrangement:...

Section 846.253. Prohibition on Exclusion of Eligible Employee or Dependent - Sec. 846.253. PROHIBITION ON EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT....

Section 846.254. Written Notice to Employees Covered - Sec. 846.254. WRITTEN NOTICE TO EMPLOYEES COVERED. A multiple employer...

Section 846.255. Declining Coverage - Sec. 846.255. DECLINING COVERAGE. (a) A multiple employer welfare arrangement...

Section 846.256. Minimum Contribution or Participation Requirements - Sec. 846.256. MINIMUM CONTRIBUTION OR PARTICIPATION REQUIREMENTS. (a) A multiple...

Section 846.257. Enrollment; Waiting Period - Sec. 846.257. ENROLLMENT; WAITING PERIOD. (a) The initial enrollment period...

Section 846.258. Coverage for Newborn Children - Sec. 846.258. COVERAGE FOR NEWBORN CHILDREN. (a) A multiple employer...

Section 846.259. Coverage for Adopted Children - Sec. 846.259. COVERAGE FOR ADOPTED CHILDREN. (a) This section applies...

Section 846.260. Limiting Age Applicable to Unmarried Child - Sec. 846.260. LIMITING AGE APPLICABLE TO UNMARRIED CHILD. If children...

Subchapter G. Marketing

Section 846.301. Marketing Requirements - Sec. 846.301. MARKETING REQUIREMENTS. On request, each employer purchasing a...

Section 846.302. Additional Reporting Requirements - Sec. 846.302. ADDITIONAL REPORTING REQUIREMENTS. The department may require periodic...

Section 846.303. Applicability to Third-Party Administrator - Sec. 846.303. APPLICABILITY TO THIRD-PARTY ADMINISTRATOR. If a multiple employer...

Chapter 847 - Health Care Quality Assurance

Section 847.001. Short Title - Sec. 847.001. SHORT TITLE. This chapter may be cited as...

Section 847.002. Legislative Findings; Purposes - Sec. 847.002. LEGISLATIVE FINDINGS; PURPOSES. The legislature finds that to...

Section 847.003. Definitions - Sec. 847.003. DEFINITIONS. In this chapter: (1) "Commission" means the...

Section 847.004. Applicability of Chapter - Sec. 847.004. APPLICABILITY OF CHAPTER. This chapter applies only to...

Section 847.005. Presumed Compliance With Certain Statutory and Regulatory Requirements - Sec. 847.005. PRESUMED COMPLIANCE WITH CERTAIN STATUTORY AND REGULATORY REQUIREMENTS....

Section 847.006. Filing of Accreditation Report; Confidentiality Requirements - Sec. 847.006. FILING OF ACCREDITATION REPORT; CONFIDENTIALITY REQUIREMENTS. (a) The...

Section 847.007. Duties of Commissioner of Insurance - Sec. 847.007. DUTIES OF COMMISSIONER OF INSURANCE. (a) In conducting...

Section 847.008. Commission Duties - Sec. 847.008. COMMISSION DUTIES. (a) The commission may require the...

Section 847.009. Memorandum of Understanding - Sec. 847.009. MEMORANDUM OF UNDERSTANDING. The commissioner and the commission...

Section 847.010. Enforcement - Sec. 847.010. ENFORCEMENT. This chapter may not be construed to...

Chapter 848 - Health Care Collaboratives

Subchapter A. General Provisions

Section 848.001. Definitions - Sec. 848.001. DEFINITIONS. In this chapter: (1) "Affiliate" means a...

Section 848.002. Exception: Delegated Entities - Sec. 848.002. EXCEPTION: DELEGATED ENTITIES. (a) This section applies only...

Section 848.003. Use of Insurance-Related Terms by Health Care Collaborative - Sec. 848.003. USE OF INSURANCE-RELATED TERMS BY HEALTH CARE COLLABORATIVE....

Section 848.004. Applicability of Insurance Laws - Sec. 848.004. APPLICABILITY OF INSURANCE LAWS. (a) An organization may...

Section 848.005. Certain Information Confidential - Sec. 848.005. CERTAIN INFORMATION CONFIDENTIAL. (a) Except as provided by...

Section 848.006. Coverage by Health Care Collaborative Not Required - Sec. 848.006. COVERAGE BY HEALTH CARE COLLABORATIVE NOT REQUIRED. (a)...

Subchapter B. Authority to Engage in Business

Section 848.051. Operation of Health Care Collaborative - Sec. 848.051. OPERATION OF HEALTH CARE COLLABORATIVE. A health care...

Section 848.052. Formation and Governance of Health Care Collaborative - Sec. 848.052. FORMATION AND GOVERNANCE OF HEALTH CARE COLLABORATIVE. (a)...

Section 848.053. Compensation Advisory Committee; Sharing of Certain Data - Sec. 848.053. COMPENSATION ADVISORY COMMITTEE; SHARING OF CERTAIN DATA. (a)...

Section 848.054. Certificate of Authority and Determination of Approval Required - Sec. 848.054. CERTIFICATE OF AUTHORITY AND DETERMINATION OF APPROVAL REQUIRED....

Section 848.055. Exceptions - Sec. 848.055. EXCEPTIONS. (a) An organization is not required to...

Section 848.056. Application for Certificate of Authority - Sec. 848.056. APPLICATION FOR CERTIFICATE OF AUTHORITY. (a) An organization...

Section 848.057. Requirements for Approval of Application - Sec. 848.057. REQUIREMENTS FOR APPROVAL OF APPLICATION. (a) The commissioner...

Section 848.058. Denial of Certificate of Authority - Sec. 848.058. DENIAL OF CERTIFICATE OF AUTHORITY. (a) The commissioner...

Section 848.059. Concurrence of Attorney General - Sec. 848.059. CONCURRENCE OF ATTORNEY GENERAL. (a) If the commissioner...

Section 848.060. Renewal of Certificate of Authority and Determination of Approval - Sec. 848.060. RENEWAL OF CERTIFICATE OF AUTHORITY AND DETERMINATION OF...

Subchapter C. General Powers and Duties of Health Care Collaborative

Section 848.101. Providing or Arranging for Services - Sec. 848.101. PROVIDING OR ARRANGING FOR SERVICES. (a) A health...

Section 848.102. Insurance, Reinsurance, Indemnity, and Reimbursement - Sec. 848.102. INSURANCE, REINSURANCE, INDEMNITY, AND REIMBURSEMENT. A health care...

Section 848.103. Payment by Governmental or Private Entity - Sec. 848.103. PAYMENT BY GOVERNMENTAL OR PRIVATE ENTITY. (a) A...

Section 848.104. Contracts for Administrative or Management Services - Sec. 848.104. CONTRACTS FOR ADMINISTRATIVE OR MANAGEMENT SERVICES. A health...

Section 848.105. Corporation, Partnership, or Association Powers - Sec. 848.105. CORPORATION, PARTNERSHIP, OR ASSOCIATION POWERS. A health care...

Section 848.106. Quality and Cost of Health Care Services - Sec. 848.106. QUALITY AND COST OF HEALTH CARE SERVICES. (a)...

Section 848.107. Complaint Systems - Sec. 848.107. COMPLAINT SYSTEMS. (a) A health care collaborative shall...

Section 848.108. Delegation Agreements - Sec. 848.108. DELEGATION AGREEMENTS. (a) Except as provided by Subsection...

Section 848.109. Validity of Operations and Trade Practices of Health Care Collaboratives - Sec. 848.109. VALIDITY OF OPERATIONS AND TRADE PRACTICES OF HEALTH...

Section 848.110. Rights of Physicians; Limitations on Participation - Sec. 848.110. RIGHTS OF PHYSICIANS; LIMITATIONS ON PARTICIPATION. (a) Before...

Subchapter D. Regulation of Health Care Collaboratives

Section 848.151. Rules - Sec. 848.151. RULES. The commissioner and the attorney general may...

Section 848.152. Fees and Assessments - Sec. 848.152. FEES AND ASSESSMENTS. (a) The commissioner shall, within...

Section 848.153. Examinations - Sec. 848.153. EXAMINATIONS. (a) The commissioner may examine the financial...

Subchapter E. Enforcement

Section 848.201. Enforcement Actions - Sec. 848.201. ENFORCEMENT ACTIONS. (a) After notice and opportunity for...

Section 848.202. Operations During Suspension or After Revocation of Certificate of Authority - Sec. 848.202. OPERATIONS DURING SUSPENSION OR AFTER REVOCATION OF CERTIFICATE...

Section 848.203. Injunctions - Sec. 848.203. INJUNCTIONS. If the commissioner believes that a health...

Section 848.204. Notice - Sec. 848.204. NOTICE. The commissioner shall: (1) report any action...

Section 848.205. Independent Authority of Attorney General - Sec. 848.205. INDEPENDENT AUTHORITY OF ATTORNEY GENERAL. (a) The attorney...

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Texas Statutes Title 6 - Organization of Insurers and Related Entities Subtitle C - Life, Health, and Accident Insurers and Related Entities

Texas Statutes
Title 6 - Organization of Insurers and Related Entities
Subtitle C - Life, Health, and Accident Insurers and Related Entities