Tex. Ins. Code Section 1271.054
Information About Complaints and Appeals

(a)

An evidence of coverage must contain a clear and understandable description of the health maintenance organization’s methods for resolving enrollee complaints, including:

(1)

the enrollee’s right to appeal denial of an adverse determination to an independent review organization; and

(2)

the procedures for appealing to an independent review organization.

(b)

A health maintenance organization may indicate a subsequent change to the methods for resolving enrollee complaints in a separate document issued to the enrollee.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1271.054 — Information About Complaints and Appeals, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1271.­htm#1271.­054 (accessed Jun. 5, 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
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 1271.054’s source at texas​.gov