Tex.
Ins. Code Section 1501.255
Health Maintenance Organization Plans
(a)
In this section, “point-of-service contract” means a health benefit plan offered through a health maintenance organization that:(1)
includes corresponding indemnity benefits in addition to benefits relating to out-of-area or emergency services provided through insurers or group hospital service corporations; and(2)
permits the covered individual to obtain coverage under either the health maintenance organization conventional plan or the indemnity plan as determined in accordance with the terms of the contract.(b)
A health maintenance organization:(1)
shall offer at least one state-approved basic health care plan that complies with this chapter, Chapters 843 (Health Maintenance Organizations), 1271 (Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges), 1272 (Delegation of Certain Functions by Health Maintenance Organization), and 1367 (Coverage of Children), Subchapter A (Short Title), Chapter 1452 (Physician and Provider Credentials), Subchapter B, Chapter 1507 (Consumer Choice of Benefits Plans), Title XIII, Public Health Service Act (42 U.S.C. Section 300e et seq.), and its subsequent amendments, and rules adopted under those laws and may offer additional such plans;(2)
shall offer a standard health benefit plan under Subchapter B (Purpose), Chapter 1507 (Consumer Choice of Benefits Plans), and may offer additional benefit riders to the standard health benefit plan or offer standard health benefit plans with additional mandatory benefits; and(3)
may offer a point-of-service contract in connection with an insurer that includes optional coverage for out-of-area services, emergency care, or out-of-network care.(c)
A point-of-service contract offered under Subsection (b)(3) is subject to this chapter unless specifically exempted. The insurer with which the health maintenance organization offers a point-of-service contract is not required to otherwise make available the health benefit plans adopted under this subchapter if the insurer’s small employer products are limited to the point-of-service contract.
Source:
Section 1501.255 — Health Maintenance Organization Plans, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1501.htm#1501.255 (accessed Jun. 5, 2024).
