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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 G. HEALTH COVERAGE AVAILABILITY |
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Chapter 1501. HEALTH INSURANCE PORTABILITY AND AVAILABILITY ACT |
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Subchapter B. COALITIONS AND COOPERATIVES |
Sec. 1501.061. REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY CONTRACT
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A cooperative may contract only with a small or large employer health benefit plan issuer that demonstrates that the issuer:
(1) is in good standing with the department;
(2) has the capacity to administer health benefit plans;
(3) is able to monitor and evaluate the quality and cost-effectiveness of care and applicable procedures;
(4) is able to conduct utilization management and establish applicable procedures and policies;
(5) is able to ensure that enrollees have adequate access to health care providers, including adequate numbers and types of providers;
(6) has a satisfactory grievance procedure and is able to respond to enrollees' calls, questions, and complaints; and
(7) has financial capacity, either through satisfying financial solvency standards, as applied by the commissioner, or through appropriate reinsurance or other risk-sharing mechanisms.