| (a) A health carrier may provide coverage to only one
health group cooperative in any county, except that a health carrier
may provide coverage to additional health group cooperatives if it
is providing coverage in an expanded service area.
(b) A health carrier may provide health group cooperative
coverage to an expanded service area that includes the entire state
on providing certification to TDI, signed by an officer of the health
carrier, that the health carrier intends to provide health group cooperative
coverage to an expanded service area that includes the entire state.
(c) A health carrier may apply for an expanded service
area that includes less than the entire state by submitting an application
for approval to TDI. The health carrier may begin using the expanded
service area on approval or 60 days after the day the application
is received by TDI, unless the application is disapproved by TDI within
that time. The application must include, in a nondiscriminatory manner
and in compliance with Insurance Code Chapter 544 (concerning Prohibited
Discrimination):
(1) the geographic service areas, defined in terms
of counties or ZIP codes, to the extent possible; and
(2) if the service area cannot be defined by counties
or ZIP codes, a map that clearly shows the geographic service areas.
(d) A filing under this section does not affect any
service areas that have been established in accordance with Insurance
Code Chapter 843 (concerning Health Maintenance Organizations) or
Chapter 1301 (concerning Preferred Provider Benefit Plans). A health
carrier may not issue coverage to a health group cooperative in a
service area that is not also contained entirely within the health
carrier's service area established under Insurance Code Chapter 843
or 1301.
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| Source Note: The provisions of this §26.411 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 |
