| (B) notify the insurer that surgery has been scheduled.
(29) A contract between an insurer and a preferred
provider must comply with Insurance Code §1458.101, concerning
Contract Requirements, to the extent applicable.
(30) A contract between an insurer and a preferred
provider that is an optometrist or therapeutic optometrist must comply
with Insurance Code Chapter 1451, Subchapter D, concerning Access
to Optometrists Used Under Managed Care Plan.
(b) In addition to all other contract rights, violations
of these rules will be treated for purposes of complaint and action
in accordance with Insurance Code Chapter 542, Subchapter A, concerning
Unfair Claim Settlement Practices, and the provisions of that subchapter
will be employed to the extent practicable, as it relates to the power
of the department, hearings, orders, enforcement, and penalties.
(c) An insurer may enter into an agreement with a preferred
provider organization, an exclusive provider network, or a health
care collaborative for the purpose of offering a network of preferred
providers, provided that it remains the insurer's responsibility to:
(1) meet the requirements of Insurance Code Chapter
1301, concerning Preferred Provider Benefit Plans, and this subchapter;
(2) ensure that the requirements of Insurance Code
Chapter 1301 and this subchapter are met; and
(3) provide all documentation to demonstrate compliance
with all applicable rules on request by the department.
|
| Source Note: The provisions of this §3.3703 adopted to be effective July 1, 1986, 11 TexReg 2810; amended to be effective December 6, 1995, 20 TexReg 9697; amended to be effective July 15, 1999, 24 TexReg 5204; amended to be effective October 8, 2002, 27 TexReg 9328; amended to be effective October 5, 2003, 28 TexReg 8623; amended to be effective January 19, 2006, 31 TexReg 289; amended to be effective December 6, 2011, 36 TexReg 3411; amended to be effective February 21, 2013, 38 TexReg 827; amended to be effective April 25, 2024, 49 TexReg 2497 |
