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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 E. CHOICE OF PRIMARY CARE PHYSICIAN FOR CERTAIN ENROLLEES |
Sec. 1271.201. DESIGNATION OF SPECIALIST AS PRIMARY CARE PHYSICIAN
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(a) An evidence of coverage must provide that an enrollee with a chronic, disabling, or life-threatening illness may apply to the health maintenance organization's medical director to use a nonprimary care physician specialist as the enrollee's primary care physician.
(b) The application must:
(1) include information specified by the health maintenance organization, including certification of the medical need; and
(2) be signed by the enrollee and the nonprimary care physician specialist interested in serving as the enrollee's primary care physician.
(c) To be eligible to serve as the enrollee's primary care physician, a physician specialist must:
(1) meet the health maintenance organization's requirements for primary care physician participation; and
(2) agree to accept the responsibility to coordinate all of the enrollee's health care needs.