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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 G. CONTINUATION OF COVERAGE, CONVERSION CONTRACTS, AND RENEWAL |
Sec. 1271.307. RENEWABILITY OF COVERAGE: INDIVIDUAL HEALTH CARE PLANS AND CONVERSION CONTRACTS
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(a) In this section, "individual health care plan" has the meaning assigned by Section 1271.004.
(b) An individual health care plan or a conversion contract that provides health care services to an enrollee is renewable at the option of the enrollee. A health maintenance organization may decline to renew an individual health care plan or conversion contract only:
(1) for failure to pay premiums or contributions in accordance with the terms of the plan or because the issuer of the plan has not received timely premium payments;
(2) for fraud or intentional misrepresentation;
(3) because the health maintenance organization ceases to offer coverage in the individual market in accordance with rules established by the commissioner;
(4) because the enrollee no longer resides or works in the area in which the health maintenance organization is authorized to provide coverage, if coverage under the plan is terminated uniformly for this reason without regard to any factor related to the health status of a covered enrollee; or
(5) in accordance with applicable federal law, including regulations.
(c) The commissioner may adopt rules necessary to implement this section and to meet the minimum requirements of federal law, including regulations.