(a) TDI adopts the Provider Network Contracting Entity
Exemption of Affiliates Form by reference.
(b) Unless the commissioner has granted an affiliate
exemption to the contracting entity under this section, each contracting
entity that is a health maintenance organization or other entity holding
a certificate of authority issued by TDI to engage in the business
of insurance in this state must submit to TDI a fully completed Provider
Network Contracting Entity Exemption of Affiliates Form and the required
fee established under §3.9804 of this title before the later
of:
(1) the 30th day after the date on which the submitting
person begins acting as a contracting entity in this state; or
(2) December 1, 2014.
(c) The person submitting the Provider Network Contracting
Entity Exemption of Affiliates Form must:
(1) list each affiliate of the contracting entity that
will access the provider networks disclosed in the submission or state
that the contracting entity has no affiliates;
(2) disclose the provider network contracting relationships
between the person who holds a certificate of authority and all affiliates
of the person, including:
(A) primary provider networks and the affiliates that
have access to the primary provider networks;
(B) subsidiary provider networks and the affiliates
that have access to the subsidiary provider networks; and
(C) other provider networks and the affiliates that
have access to the other provider networks;
(3) disclose if the contracting entity or an affiliate
allows a nonaffiliate to access any network of the contracting entity
or affiliate and the name of the contracting entity or affiliate allowing
such access.
(d) An affiliate exemption under this section is not
effective until the commissioner grants the exemption in writing.
The commissioner may grant the requested exemption to all listed affiliates,
grant the exemption to some listed affiliates, or deny the requested
exemption for one or more affiliates.
(e) Not later than August 1 of each year, a contracting
entity that has submitted the Provider Network Contracting Entity
Exemption of Affiliates Form under this section must report to the
commissioner any changes to the information the contracting entity
provided in its Provider Network Contracting Entity Exemption of Affiliates
Form or subsequent annual reports, including the addition or removal
of any affiliates.
(f) A contracting entity must submit the Provider Network
Contracting Entity Exemption of Affiliates Form and subsequent annual
reports in a written or electronic format to the address TDI will
provide on the Provider Network Contracting Entity Exemption of Affiliates
Form.
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