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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle C. MANAGED CARE |
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Chapter 1271. BENEFITS PROVIDED BY HEALTH MAINTENANCE ORGANIZATIONS; EVIDENCE OF COVERAGE; CHARGES |
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Subchapter A. GENERAL PROVISIONS |
Sec. 1271.004. INDIVIDUAL HEALTH CARE PLAN
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(a) In this section, "individual health care plan" means a health care plan:
(1) that provides health care services for individuals and their dependents;
(2) under which an enrollee:
(A) pays the premium; and
(B) is not covered under the contract in accordance with a continuation of services or continuation of benefits requirement applicable under federal or state law; and
(3) in which the evidence of coverage meets the requirements of the definition of "basic health care services" provided by Section 843.002.
(b) A health maintenance organization may provide an individual health care plan in accordance with this section and Section 1271.307.
(c) A health maintenance organization may limit enrollment in an individual health care plan to individuals who reside or work within the service area for the plan's network.
(d) The commissioner may adopt rules necessary to implement this section and to meet the minimum requirements of federal law, including regulations.