tx-May82026-44: 28 TAC §11.2503 — Health Maintenance Organizations
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STATUTORY AUTHORITY. TDI proposes to amend §11.2503 under Insurance Code§1702.006 and §36.001. Insurance Code §1702.006 authorizes the commissioner to adopt reasonable rules necessary to implement Insurance Code Chapter 1702. Insurance Code §36.001 provides that the commissioner may adopt any rules necessary and appropriate to implement the powers and duties of TDI under the Insurance Code and other laws of this state. CROSS-REFERENCE TO STATUTE. The amendments to §11.2503 implement Insurance Code Chapter 1702, as added by HB 2221. §11.2503. Coverage Relating to Point-of-Service Rider Plans. (a) An HMO may not consider an in-plan covered service to be a benefit provided under the point-of-service rider. (b) An HMO may not require an enrollee to use either the point-of-service rider benefits or in-plan covered services first. (c) An HMO that includes limited provider networks: (1) may not limit the access, under the point-of-service rider, of an enrollee whose in-plan covered services are restricted to the limited provider network, to either participating physicians and providers or nonparticipating physicians and providers; (2) may not impose cost-sharing arrangements for an...
The agency’s own summary, as published.
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