| (a) A limited service HMO must develop and maintain
an ongoing quality improvement structure and program that complies
with Chapter 11, Subchapter T, of this title (relating to Quality
of Care).
(b) Each limited service HMO must provide uniquely
described services with any corresponding copayments for each covered
service and benefit, and provide a limited health care service plan
as defined in Insurance Code §843.002 (concerning Definitions).
Each limited service HMO must comply with all requirements for a limited
health care service plan specified in this subchapter.
(c) Each limited service HMO schedule of enrollee copayments
must specify an appropriate description of covered services and benefits,
as required by §11.506 of this title (relating to Mandatory Contractual
Provisions: Group, Individual, and Conversion Agreement and Group
Certificate), and may specify recognized procedure codes or other
information used for maintaining a statistical reporting system.
(d) Each limited service HMO evidence of coverage must
include a glossary of terms, including the terms used in the evidence
of coverage required by §11.501 of this title (relating to Contents
of the Evidence of Coverage). The glossary must be included in the
information to prospective and current group contract holders and
enrollees, as required by Insurance Code §843.201 (concerning
Disclosure of Information about Health Care Plan Terms).
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