Tex. Ins. Code Section 1271.005
Applicability of Other Law


(a)

Chapters 1368 (Availability of Chemical Dependency Coverage) and 1652 (Medicare Supplement Benefit Plans) apply to a health maintenance organization other than a health maintenance organization that offers only a single health care service plan.

(b)

Subchapter B (Definitions), Chapter 1355 (Benefits for Certain Mental Disorders), applies to a health maintenance organization providing benefits for mental health treatment in a residential treatment center for children and adolescents or crisis stabilization unit to the extent that:

(1)

Subchapter B (Definitions), Chapter 1355 (Benefits for Certain Mental Disorders), does not conflict with this chapter, Chapter 843 (Health Maintenance Organizations), Subchapter A (Short Title), Chapter 1452 (Physician and Provider Credentials), or Subchapter B, Chapter 1507 (Consumer Choice of Benefits Plans); and

(2)

the residential treatment center for children and adolescents or crisis stabilization unit is located within the service area of the health maintenance organization and is subject to inspection and review as required by this chapter, Chapter 843 (Health Maintenance Organizations), Subchapter A (Short Title), Chapter 1452 (Physician and Provider Credentials), or Subchapter B, Chapter 1507 (Consumer Choice of Benefits Plans), or rules adopted under this chapter, Chapter 843 (Health Maintenance Organizations), Subchapter A (Short Title), Chapter 1452 (Physician and Provider Credentials), or Subchapter B, Chapter 1507 (Consumer Choice of Benefits Plans).

(c)

A health maintenance organization shall comply with Subchapter B (Definitions), Chapter 542 (Processing and Settlement of Claims), with respect to prompt payment to an enrollee.

(d)

Notwithstanding any other law, Subchapter C (Definition), Chapter 1355 (Benefits for Certain Mental Disorders), applies to a group contract issued by a health maintenance organization.

(e)

Notwithstanding any other law, Section 1201.062 (Coverage for Certain Children in Individual or Group Policy or in Plan or Program) applies to an evidence of coverage issued by a health maintenance organization.
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. 11.074(b), eff. September 1, 2005.

Source: Section 1271.005 — Applicability of Other Law, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1271.­htm#1271.­005 (accessed May 11, 2024).

1271.001
Applicability of Definitions
1271.002
Right to Evidence of Coverage
1271.003
Evidence of Coverage Not Health Insurance Policy
1271.004
Individual Health Care Plan
1271.005
Applicability of Other Law
1271.006
Benefits to Dependent Child and Grandchild
1271.007
Religious Convictions
1271.008
Balance Billing Prohibition Notice
1271.051
Evidence of Coverage: Contract and Certificate Requirements
1271.052
Information About Benefits and Limitations
1271.053
Information About Obtaining Services
1271.054
Information About Complaints and Appeals
1271.055
Out-of-network Services
1271.056
Unfair or Deceptive Provisions and Statements Prohibited
1271.057
Discretionary Clauses Prohibited
1271.101
Approval of Form of Evidence of Coverage or Group Contract
1271.102
Procedures for Approval of Form of Evidence of Coverage or Group Contract
1271.103
Withdrawal of Approval of Form
1271.104
Information Required by Commissioner
1271.151
Provision of Basic Health Care Services
1271.152
Standards for Basic Health Care Services
1271.153
Periodic Health Evaluations
1271.154
Well-child Care from Birth
1271.155
Emergency Care
1271.156
Benefits for Rehabilitation Services and Therapies
1271.157
Non-network Facility-based Providers
1271.158
Non-network Diagnostic Imaging Provider or Laboratory Service Provider
1271.159
Non-network Emergency Medical Services Provider
1271.201
Designation of Specialist as Primary Care Physician
1271.202
Appeal
1271.203
Effective Date of Designation
1271.251
Approval of Formula or Method for Computing Schedule of Charges
1271.252
Consideration of Individual Health Status Prohibited
1271.253
Information Required by Commissioner
1271.301
Entitlement to Continuation of Group Coverage
1271.302
Request for Continued Coverage
1271.303
Payment for Continued Coverage
1271.304
Termination of Continued Coverage
1271.306
Conversion Contracts
1271.307
Renewability of Coverage: Individual Health Care Plans and Conversion Contracts

Accessed:
May 11, 2024

§ 1271.005’s source at texas​.gov