Texas Administrative Code

Texas Administrative Code

TITLE 28	INSURANCE
PART 1	TEXAS DEPARTMENT OF INSURANCE
CHAPTER 11	HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER Y	LIMITED SERVICE HMOS
RULE §11.2403	Prohibited Practices

A limited service HMO may not:

(1) exclude services required for preexisting conditions which would otherwise be covered under the plan;

(2) establish waiting periods for coverage of preexisting conditions;

(3) impose a lifetime coverage maximum for any covered service or benefit;

(4) limit or otherwise interfere with an enrollee's right to terminate his or her membership in the plan before the end of the enrollment year;

(5) limit coverage for emergency services under a limited health care service plan;

(6) charge an emergency fee in addition to a copayment for emergency services; or

(7) count medication-related services and services provided by telephone toward the annual outpatient visit total for either serious or nonserious mental illness.

Source Note: The provisions of this §11.2403 adopted to be effective August 1, 2017, 42 TexReg 2169