SECTION 11.2201. General Provisions

(a) Each single service HMO must provide uniquely described services with any corresponding copayments for each covered service and benefit and must provide a single health care service plan as defined in Insurance Code §843.002 (concerning Definitions). Each single service HMO must comply with all requirements for a single health care service plan specified in this subchapter.

(b) Each single service HMO schedule of enrollee copayments must specify an appropriate description of covered services and benefits, as required by §11.506 of this title (relating to Mandatory Contractual Provisions: Group, Individual, and Conversion Agreement and Group Certificate), and may specify recognized procedures or other information used for the purpose of maintaining a statistical reporting system.

(c) Each single service HMO evidence of coverage must include a glossary of terminology, including the terms used in the evidence of coverage required by §11.501 of this title (relating to Contents of the Evidence of Coverage). The glossary must be included in the information to prospective and current group contract holders and enrollees, as required by Insurance Code §843.201 (concerning Disclosure of Information About Health Care Plan Terms).

(d) In the event of a conflict between the provisions of this subchapter and other provisions of this chapter, this subchapter prevails with regard to single service HMOs. It is not considered a conflict if a topic that is not addressed in this subchapter appears elsewhere in this chapter.

Source Note: The provisions of this §11.2201 adopted to be effective August 1, 2017, 42 TexReg 2169