| (a) Unless a health carrier has identified a previously
approved health benefit plan in the filing required by §26.407
of this title (relating to Health Carrier Filing Before Issuance of
Coverage to a Health Group Cooperative), the health carrier must file
each health benefit plan that will be offered to a health group cooperative
for approval and must clearly indicate in the filing that the health
benefit plan is to be offered to a health group cooperative and is
subject to review under this section.
(b) A health benefit plan subject to review under this
section may be filed as a file-and-use form consistent with Insurance
Code Chapter 1701, Subchapter B (concerning Filing Requirement) and
Subchapter C (concerning Sanctions; Applicability of Other Laws),
and §3.5(a)(2) of this title (relating to Filing Authorities
and Categories).
(c) An insurer that does not elect to file for approval
under subsection (b) of this section must file for approval consistent
with Insurance Code §1701.051 (concerning Filing Required), and
§1701.054 (concerning Approval of Form), and §3.5(a)(1)
of this title. TDI will approve or disapprove the filing within 40
calendar days of receipt of the complete filing.
(d) An HMO must file for approval an HMO evidence of
coverage that is to be offered solely to a health group cooperative
and must indicate that review of the evidence of coverage is subject
to the expedited process available under this section. The HMO must
file the evidence of coverage as required by Chapter 11 of this title
(relating to Health Maintenance Organizations), and TDI will approve
or disapprove the evidence of coverage within 20 calendar days of
receipt of a complete filing.
|
| Source Note: The provisions of this §26.410 adopted to be effective August 31, 2004, 29 TexReg 8360; amended to be effective January 31, 2006, 31 TexReg 512; amended to be effective May 17, 2017, 42 TexReg 2539 |
