 |
Texas Administrative Code (Last Updated: March 27,2024) |
 |
TITLE 28. INSURANCE |
|
|
PART 1. TEXAS DEPARTMENT OF INSURANCE |
|
|
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES |
| SUBCHAPTER A. SUBMISSION REQUIREMENTS FOR FILINGS AND DEPARTMENTAL ACTIONS RELATED TO SUCH FILINGS |
| § 3.1. Scope |
| § 3.2. Definitions |
| § 3.3. Transmittal Information |
| § 3.4. General Submission Requirements |
| § 3.5. Filing Authorities and Categories |
| § 3.6. Certifications, Attachments, and Additional Information Requirements |
| § 3.7. Form Acceptance and Procedures |
| § 3.8. Effective Date |
| SUBCHAPTER C. APPROVAL, DISAPPROVAL, AND WITHDRAWAL OF APPROVAL OF CERTAIN PARTICIPATING POLICY FORMS |
| § 3.201. Definition of Certain Participating Policies |
| § 3.202. Specification of Certain Participating Policies |
| § 3.203. Instructions to Commissioner |
| § 3.204. Material and Information for the Commissioner To Consider |
| § 3.205. Construction of Rules |
| SUBCHAPTER E. GROUP LIFE, AND/OR GROUP ACCIDENT AND HEALTH INSURANCE POLICIES AND CERTIFICATES |
| § 3.408. Mandatory Policy Provisions |
| SUBCHAPTER F. RATE REVIEW FOR HEALTH BENEFIT PLANS |
| § 3.501. Purpose and Applicability |
| § 3.502. Definitions |
| § 3.503. Rating Standards |
| § 3.504. Geographic Rating Areas |
| § 3.505. Required Rate Filings |
| § 3.506. Review of Rate Filings |
| § 3.507. Public Disclosure and Input |
| SUBCHAPTER G. PLAIN LANGUAGE REQUIREMENTS FOR HEALTH BENEFIT POLICIES |
| § 3.601. Purpose and Scope, Applicability, and Definitions Used in This Subchapter |
| § 3.602. Plain Language Requirements |
| SUBCHAPTER K. MAXIMUM GUARANTEED INTEREST RATES FOR ANNUITIES, PURE ENDOWMENT CONTRACTS, AND MISCELLANEOUS FUNDS |
| § 3.1001. Authority |
| § 3.1002. Purpose |
| § 3.1003. Unallocated Group Annuity |
| § 3.1004. Policy Form Review |
| § 3.1005. Reserve Requirements |
| § 3.1006. Early Warning Requirements |
| § 3.1007. Disclosure Requirements |
| § 3.1008. Application |
| § 3.1009. Effective Date |
| SUBCHAPTER M. DISCRETIONARY CLAUSES |
| § 3.1201. Applicability, Effective Dates, and Severability |
| § 3.1202. Discretionary Clauses Defined |
| § 3.1203. Discretionary Clauses Prohibited |
| SUBCHAPTER R. LIFE SETTLEMENT |
| DIVISION 1. GENERAL PROVISIONS |
| § 3.1701. Purpose and Severability |
| § 3.1702. Applicability and Scope |
| § 3.1703. Definitions |
| DIVISION 2. LICENSE APPLICATION AND RENEWAL; COURSE AND TRAINING REQUIREMENTS; MAINTENANCE OF RECORDS |
| § 3.1720. Forms |
| § 3.1721. License Application; Fees |
| § 3.1722. Renewal; Nonrenewal; Surrender; Change of Information; and Fees |
| § 3.1723. Course and Training Requirements for Brokers |
| § 3.1724. Continuing Education Providers |
| § 3.1725. Life Insurance Agent Notification |
| § 3.1726. Life Expectancy Estimators |
| § 3.1727. Unauthorized Insurance |
| § 3.1728. Life Settlement Broker Fiduciary Duty |
| § 3.1729. Maintenance of Records |
| § 3.1730. Health Status Verification |
| DIVISION 3. FORM FILING AND USAGE REQUIREMENTS |
| § 3.1740. Form Filing Requirements and Approval, Disapproval, or Withdrawal of Forms; Fees |
| § 3.1741. Required Form Provisions |
| § 3.1742. Shopper's Guide |
| § 3.1743. Prohibited Life Settlements |
| § 3.1744. Advertising, Sales, and Solicitation Materials; Filing Prior to Use |
| DIVISION 4. ANNUAL REPORTING |
| § 3.1760. Reporting Requirements |
| SUBCHAPTER S. MINIMUM STANDARDS AND BENEFITS AND READABILITY FOR INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES |
| § 3.3001. Applicability and Scope |
| § 3.3002. Definitions |
| § 3.3005. Definitions in Policies |
| § 3.3006. Policy Definition of Hospital |
| § 3.3007. Policy Definition of Convalescent Nursing Home or Extended Care Facility |
| § 3.3008. Policy Definitions of Accident, Accidental Injury, Injury |
| § 3.3009. Policy Definitions of Sickness |
| § 3.3010. Policy Definition of Physician |
| § 3.3011. Policy Definition of Nurse |
| § 3.3012. Policy Definition of Total Disability |
| § 3.3013. Policy Definition of Partial Disability |
| § 3.3014. Policy Definition of Residual Disability |
| § 3.3015. Policy Definition of Medicare |
| § 3.3016. Policy Definition of Mental or Nervous Disorders |
| § 3.3017. Policy Definition of One Period of Confinement--Continuous Hospital Confinement |
| § 3.3018. Policy Definition of Preexisting Condition |
| § 3.3019. Policy Definition of Noncancellable |
| § 3.3020. Policy Definition of Guaranteed Renewable and Limited Guarantee of Renewability |
| § 3.3021. Policy Definition of Complication of Pregnancy |
| § 3.3038. Mandatory Guaranteed Renewability Provisions for Individual Hospital, Medical or Surgical Coverage; Exceptions |
| § 3.3039. Other Mandatory Policy Provisions |
| § 3.3040. Prohibited Policy Provisions |
| § 3.3050. Standards for Renewability Provisions |
| § 3.3051. Initial and Subsequent Conditions of Eligibility Provision |
| § 3.3052. Standards for Termination of Insurance Provision |
| § 3.3054. Preexisting Conditions Provisions |
| § 3.3055. Standards for Probationary or Waiting Period Provision |
| § 3.3056. Standards for Limitations Provision |
| § 3.3057. Standards for Exceptions, Exclusions, and Reductions Provision |
| § 3.3058. Standards for Elimination Period Provision |
| § 3.3059. Standards for Recurrent Disabilities Provision |
| § 3.3060. Standards for Conversion Privileges Provision |
| § 3.3061. Standards for Requirements for Replacement Provision |
| § 3.3062. Conditional Receipts |
| § 3.3070. Minimum Standards for Benefits Generally |
| § 3.3071. Minimum Standards for Basic Hospital Expense Coverage |
| § 3.3072. Minimum Standards for Basic Medical-Surgical Expense Coverage |
| § 3.3073. Minimum Standards for Hospital Confinement Indemnity Coverage |
| § 3.3074. Minimum Standards for Major Medical Expense Coverage |
| § 3.3075. Minimum Standards for Disability Income Protection Coverage |
| § 3.3076. Minimum Standards for Accident Only Coverage |
| § 3.3077. Minimum Standards for Specified Disease and Specified Accident Coverage |
| § 3.3079. Minimum Standards for Limited Benefit Coverage |
| § 3.3080. Supplemental Coverage |
| § 3.3081. Nonconventional Coverage |
| § 3.3090. Outline of Coverage Generally |
| § 3.3091. Notice Requirements for Outline of Coverage of Limited Benefit, Supplemental and Non-conventional Coverages |
| § 3.3092. Format, Content, and Readability for Outline of Coverage |
| § 3.3093. Prescribed Outlines of Coverage |
| § 3.3100. Policy Readability Generally |
| § 3.3101. Organization of Policy Format for Readability |
| § 3.3102. Language Readability |
| § 3.3110. Effective Date; Applicability of Certain Provisions to Policies Deemed Continuous under Insurance Code |
| § 3.3111. Severability Clause |
| SUBCHAPTER T. MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES |
| § 3.3301. Purpose |
| § 3.3302. Applicability and Scope |
| § 3.3303. Definitions |
| § 3.3304. Policy Definitions and Terms |
| § 3.3305. Policy Provisions |
| § 3.3306. Minimum Benefit Standards |
| § 3.3307. Loss Ratio Standards and Refund or Credit of Premiums |
| § 3.3308. Required Disclosure Provisions |
| § 3.3309. Requirements for Application Forms and Replacement Coverage |
| § 3.3310. Severability |
| § 3.3312. Guaranteed Issue for Eligible Persons |
| § 3.3313. Filing Requirements for Advertising |
| § 3.3315. Standards for Claims Payment |
| § 3.3316. Filing Requirements for Out-of-State Group Policies |
| § 3.3317. Permitted Compensation Arrangements |
| § 3.3319. Standards for Marketing |
| § 3.3320. Appropriateness of Recommended Purchase and Excessive Insurance |
| § 3.3321. Reporting of Multiple Policies |
| § 3.3322. Filing and Approval of Policies, Certificates and Premium Rates; Discontinuance of Forms |
| § 3.3323. Increases to Premium Rates |
| § 3.3324. Open Enrollment |
| § 3.3325. Medicare Select Policies, Certificates and Plans of Operation |
| § 3.3326. Prohibition Against Use of Genetic Information and Requests for Genetic Testing in Medicare Supplement Policies |
| SUBCHAPTER U. NEWBORN CHILDREN COVERAGE |
| § 3.3401. Purpose |
| § 3.3402. Applicability and Scope |
| § 3.3403. General Rules of Application |
| SUBCHAPTER V. COORDINATION OF BENEFITS |
| § 3.3501. Purpose |
| § 3.3502. Applicability |
| § 3.3503. Definitions |
| § 3.3504. General Prohibition |
| § 3.3505. Allowable Expenses |
| § 3.3506. Use of the Term "Plan" in Contracts |
| § 3.3507. Rules for COB and Order of Benefits |
| § 3.3508. Procedure to be Followed by Secondary Plan |
| § 3.3509. Miscellaneous Provisions |
| § 3.3510. Model COB Contract Provisions |
| SUBCHAPTER W. MISCELLANEOUS RULES FOR GROUP AND INDIVIDUAL ACCIDENT AND HEALTH INSURANCE |
| § 3.3601. Orthodontic Coverages |
| § 3.3602. Requirements for Short-Term Limited-Duration Coverage |
| § 3.3603. Purpose and Scope |
| § 3.3604. Notice for Policies That Provide Benefits for Expenses Incurred for an Accidental Injury Only |
| § 3.3605. Policies That Provide Benefits for Specified Limited Services |
| § 3.3606. Policies That Reimburse Expenses Incurred for Specified Diseases or Impairments |
| § 3.3607. Policies That Pay Fixed Dollar Amounts for Specified Diseases or Impairments |
| § 3.3608. Indemnity or Other Policies That Pay a Fixed Dollar Amount Per Day |
| § 3.3609. Policies That Provide Benefits upon Both an Expense-Incurred and Fixed Indemnity Basis |
| § 3.3613. Other Health Insurance Policies |
| § 3.3614. Notice Regarding Policies or Certificates Which Are Not Medicare Supplement Policies |
| SUBCHAPTER X. PREFERRED AND EXCLUSIVE PROVIDER PLANS |
| DIVISION 1. GENERAL REQUIREMENTS |
| § 3.3701. Applicability and Scope |
| § 3.3702. Definitions |
| § 3.3703. Contracting Requirements |
| § 3.3704. Freedom of Choice; Availability of Preferred Providers |
| § 3.3705. Nature of Communications with Insureds; Readability, Mandatory Disclosure Requirements, and Plan Designations |
| § 3.3706. Designation as a Preferred Provider, Decision to Withhold Designation, Termination of a Preferred Provider, Review of Process |
| § 3.3707. Waiver Due to Failure to Contract in Local Markets |
| § 3.3708. Payment of Certain Basic Benefit Claims and Related Disclosures |
| § 3.3709. Annual Network Adequacy Report |
| § 3.3710. Failure to Provide an Adequate Network |
| § 3.3711. Geographic Regions |
| DIVISION 2. EXCLUSIVE PROVIDER BENEFIT PLAN REQUIREMENTS |
| § 3.3720. Preferred and Exclusive Provider Benefit Plan Requirements |
| § 3.3721. Preferred and Exclusive Provider Benefit Plan Network Approval Required |
| § 3.3722. Application for Preferred and Exclusive Provider Benefit Plan Approval; Qualifying Examination; Network Modifications |
| § 3.3723. Examinations |
| § 3.3724. Quality Improvement Program |
| § 3.3725. Payment of Certain Out-of-Network Claims |
| DIVISION 1. GENERAL PROVISIONS |
| § 3.3801. Authority |
| § 3.3802. Purpose |
| § 3.3803. Applicability and Severability |
| § 3.3804. Definitions |
| DIVISION 2. NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE |
| § 3.3805. Standards in Policies |
| § 3.3806. Initial and Subsequent Conditions of Eligibility |
| § 3.3807. Policy or Certificate Standards for Guaranteed Renewability |
| § 3.3810. Policy or Certificate Standards for Noncancellability |
| § 3.3812. Policy Standards for Provider |
| § 3.3815. Standards for Home Health and Adult Day Care Benefits |
| § 3.3818. Standards for Eligibility for Benefits |
| § 3.3819. Requirement for Reserve |
| § 3.3820. Requirement To Offer Inflation Protection |
| § 3.3821. Limits on Group Long-Term Care Insurance |
| § 3.3822. Minimum Standard for Renewability of Long-term Care Coverage |
| § 3.3823. Prohibited Policy Provisions; Required Disclosures |
| § 3.3824. Preexisting Conditions Provisions |
| § 3.3825. Prior Hospitalization or Institutionalization |
| § 3.3826. Limitations and Exclusions |
| § 3.3827. Extension of Benefits |
| § 3.3828. Continuation or Conversion; Discontinuance and Replacement |
| § 3.3829. Required Disclosures |
| § 3.3830. Requirements for Application Forms and Replacement Coverage |
| § 3.3831. Standards and Rates |
| § 3.3832. Outline of Coverage |
| § 3.3833. Group Certificates; Outline of Coverage Required |
| § 3.3834. Organization of Policy Format for Readability |
| § 3.3835. Language Readability |
| § 3.3836. Standards for Policy Certificates Submitted for Approval |
| § 3.3837. Reporting Requirements |
| § 3.3838. Filing Requirements for Advertising |
| § 3.3839. Standards for Marketing |
| § 3.3840. Requirements To Deliver Shopper's Guide |
| § 3.3841. Unintentional Lapse and Reinstatement |
| § 3.3842. Appropriateness of Recommended Purchase |
| § 3.3843. Premium Rate Restrictions |
| § 3.3844. Nonforfeiture and Contingent Nonforfeiture Benefits |
| § 3.3845. Permitted Refunds of Premium Provisions |
| § 3.3846. Incontestability Period |
| § 3.3847. Qualified Long-Term Care Insurance Contracts: Prohibited Representations |
| § 3.3848. Requirements for Limited Premium Payment Options in Long-Term Care Policies, Certificates, and Riders |
| § 3.3849. Requirements for Insurers that Issue Long-Term Care Policies to Associations and Marketing Standards for Associations that Market the Policies |
| DIVISION 3. NON-PARTNERSHIP LONG-TERM CARE INSURANCE ONLY |
| § 3.3860. Policy Summary Requirements for Non-Partnership Life Insurance Policies and Annuity Contracts that Provide Long-Term Care Benefits |
| DIVISION 4. PARTNERSHIP LONG-TERM CARE INSURANCE ONLY |
| § 3.3870. Exchange Requirements for Long-Term Care Partnership Policies |
| § 3.3871. Standards and Reporting Requirements for Approved Long-Term Care Partnership Policies and Certificates |
| § 3.3872. Inflation Protection Requirements for Long-Term Care Partnership Policies and Certificates |
| § 3.3873. Filing Requirements for Long-Term Care Partnership Policies |
| § 3.3874. Insurer Requirements for Agents That Market Partnership Policies and Certificates |
| SUBCHAPTER Z. EXEMPTION FROM REVIEW AND APPROVAL OF CERTAIN LIFE, ACCIDENT, HEALTH AND ANNUITY FORMS AND EXPEDITION OF REVIEW |
| § 3.4001. Purpose |
| § 3.4002. All Forms To Be Filed for Review Unless Specifically Exempted |
| § 3.4004. Exempt Forms |
| § 3.4005. General Information |
| § 3.4006. New, Uncommon, and Unusual Forms |
| § 3.4007. Newly Licensed Insurers |
| § 3.4008. Procedures for Corrections to Non-Compliant Exempt Forms |
| § 3.4009. Sanctions |
| § 3.4020. Appendix |
| SUBCHAPTER AA. LIMITED EXEMPTION FOR INSURANCE COVERAGE FROM THE REQUIREMENTS OF THE INSURANCE CODE, ARTICLE 3.42 |
| § 3.4101. Purpose |
| § 3.4102. Coverage Which May Be Exempted |
| § 3.4103. Obtaining Exemptions |
| § 3.4104. Duration of Exemptions |
| § 3.4105. Disciplinary Measures |
| SUBCHAPTER BB. PHARMACEUTICAL SERVICES |
| § 3.4201. Scope |
| § 3.4202. Definitions |
| § 3.4203. Notification and Information to Pharmacies and Pharmacists |
| § 3.4204. Pharmacy Application and Recertification |
| § 3.4205. Contracts for Pharmaceutical Services |
| SUBCHAPTER FF. CREDIT LIFE AND CREDIT ACCIDENT AND HEALTH INSURANCE |
| DIVISION 1. GENERAL PROVISIONS |
| § 3.5001. Authority and Scope |
| § 3.5002. Definitions |
| DIVISION 2. APPLICATIONS AND POLICIES |
| § 3.5101. Debtor's Choice of Insurer |
| § 3.5102. Delivery to Debtor |
| § 3.5103. Policy Provisions |
| § 3.5104. Benefits and Refunds |
| § 3.5105. Application Provisions |
| § 3.5106. Prohibited Provisions and Practices |
| § 3.5108. Termination of Coverage |
| § 3.5109. Interest on Premiums |
| § 3.5111. Open-End Transaction Forms |
| DIVISION 3. FILING AND APPROVAL OF FORMS AND RATES |
| § 3.5201. Submission of Form and Rate Filings |
| § 3.5202. Reasonable Relation of Benefits to Premiums for Approved Deviations |
| § 3.5203. Earned Premiums |
| § 3.5204. Claims Incurred |
| § 3.5205. Policies and Applications |
| § 3.5206. Presumptive Premium Rates |
| DIVISION 4. PRESUMPTIVELY ACCEPTABLE RELATION OF CREDIT LIFE INSURANCE BENEFITS TO PREMIUMS |
| § 3.5302. Joint Credit Life Insurance |
| § 3.5304. Premiums for Obligations Paid in Other Than Equal Monthly Installments |
| § 3.5305. Conditions of Life Insurance Benefits |
| § 3.5306. Premiums Based on Age |
| § 3.5307. Standard for Additional Benefits |
| DIVISION 5. STANDARDS OF BENEFITS FOR CREDIT ACCIDENT AND HEALTH INSURANCE |
| § 3.5501. Standards and Principles for the Application of the Rates |
| § 3.5502. Joint Credit Accident and Health Insurance |
| DIVISION 6. DEVIATION PROCEDURES |
| § 3.5601. Deviation by Case Allowed |
| § 3.5602. Request for an Approved Deviated Premium Rate |
| § 3.5603. Credibility Table |
| § 3.5604. Minimum Change |
| § 3.5605. Effective Date of Deviated Rate |
| § 3.5606. Effective Period of Downward Deviated Case Rate |
| § 3.5607. Termination of Upward Deviated Case Rate |
| § 3.5608. Annual Review of Approved Deviated Rates |
| § 3.5609. Notice of Change of Insurer on Deviated Rates Required |
| § 3.5610. Determination of Approved Deviated Case Rates |
| DIVISION 7. EXPERIENCE CALL |
| § 3.5701. Statistical Data |
| DIVISION 8. ADDITIONAL COVERAGES |
| § 3.5801. Proposal for Other Types of Coverage |
| DIVISION 9. PREMIUM REFUNDS |
| § 3.5901. Refund of Unearned Premiums |
| § 3.5902. Procedures for Payment of Refunds |
| § 3.5903. Responsibility for Refunds |
| § 3.5904. Refund Formula in Policy |
| § 3.5905. Refunds |
| § 3.5906. Treatment of Partial Months |
| DIVISION 10. RESPONSIBILITIES AND OBLIGATIONS OF INSURANCE COMPANIES AND THEIR AGENTS AND REPRESENTATIVES |
| § 3.6001. Responsibilities of Insurers |
| § 3.6002. Delegation by Insurer of Responsibilities of Policy Issuance and Premium Collection |
| § 3.6003. Restrictions on Interest of Creditors under Group and Individual Policies |
| § 3.6004. Delegation by Insurer of Certain Functions |
| § 3.6005. Claim Files Maintained by Insurer |
| § 3.6006. Proofs of Loss |
| § 3.6007. Method of Claims Payment |
| § 3.6008. Additional Restrictions on Settlement and Adjustment of Claims |
| § 3.6009. Insurer's Annual Audit of Credit Insurance Operations |
| § 3.6010. Availability of Source Documents |
| § 3.6011. Responsibility and Obligation of Insurers to Provide Copies of Consumer Bill of Rights for Credit Life, Credit Disability, and Credit Involuntary Unemployment Insurance to Each Insured |
| DIVISION 11. POLICY AND CLAIMS RESERVES |
| § 3.6101. Policy Reserves |
| § 3.6102. Claims Reserves |
| DIVISION 12. PROHIBITED TRANSACTIONS |
| § 3.6201. Unfair Methods of Competition |
| DIVISION 13. COMPENSATIONS AND ADJUSTMENT IN RATES |
| § 3.6301. Experience Refunds |
| DIVISION 14. EFFECTIVE DATE, SAVINGS CLAUSE, AND SEVERABILITY CLAUSE |
| § 3.6401. Effective Date |
| § 3.6402. Savings Clause |
| § 3.6403. Severability |
| SUBCHAPTER GG. MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE |
| § 3.7001. Introduction |
| § 3.7002. Claim Reserves |
| § 3.7003. Premium Reserves |
| § 3.7004. Contract Reserves |
| § 3.7005. Reinsurance |
| § 3.7006. Specific Standards for Morbidity, Interest, and Mortality |
| § 3.7007. Glossary of Technical Terms Used |
| § 3.7008. Reserves for Waiver of Premium |
| § 3.7009. Purchase or Assumption of Existing Business |
| § 3.7010. Severability |
| SUBCHAPTER HH. STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS |
| § 3.8001. Definitions |
| § 3.8002. Purpose and General Provisions |
| § 3.8003. Criteria |
| § 3.8004. Admission and Monitoring |
| § 3.8005. Utilization Review |
| § 3.8007. Admission Criteria for Inpatient (Hospital or 24-hour Residential) Detoxification Services |
| § 3.8008. Continued Stay Criteria for Inpatient (Hospital or 24-hour Residential) Detoxification Services |
| § 3.8009. Discharge Criteria for Inpatient (Hospital or 24-hour Residential) Detoxification Services |
| § 3.8010. Recommended Length of Stay for Inpatient (Hospital or 24-hour Residential) Detoxification Services |
| § 3.8011. Admission Criteria for Inpatient Rehabilitation/Treatment (Hospital or 24-hour Residential) Services |
| § 3.8012. Continued Stay Criteria for Inpatient Rehabilitation/Treatment (Hospital or 24-hour Residential) Services |
| § 3.8013. Discharge Criteria for Inpatient Rehabilitation/Treatment (Hospital or 24-hour Residential) Services |
| § 3.8014. Recommended Length of Stay for Inpatient Rehabilitation/Treatment (Hospital or 24-hour Residential) Services |
| § 3.8015. Admission Criteria for Partial Hospitalization Services |
| § 3.8016. Continued Stay Criteria for Partial Hospitalization Services |
| § 3.8017. Discharge Criteria for Partial Hospitalization Services |
| § 3.8018. Recommended Length of Stay for Partial Hospitalization Services |
| § 3.8019. Admission Criteria for Intensive Outpatient Rehabilitation/Treatment Service |
| § 3.8020. Continued Stay Criteria for Intensive Outpatient Rehabilitation/Treatment Service |
| § 3.8021. Discharge Criteria for Intensive Outpatient Rehabilitation/Treatment Service |
| § 3.8022. Recommended Length of Stay for Intensive Outpatient Rehabilitation Treatment Service |
| § 3.8023. Admission Criteria for Outpatient Treatment Service |
| § 3.8024. Continued Stay Criteria for Outpatient Treatment Services |
| § 3.8025. Discharge Criteria for Outpatient Treatment Service |
| § 3.8026. Recommended Length of Stay for Outpatient Treatment Service |
| § 3.8027. Admission Criteria for Outpatient Detoxification Treatment Service |
| § 3.8028. Continued Stay Criteria for Outpatient Detoxification Treatment Services |
| § 3.8029. Discharge Criteria for Outpatient Treatment Service |
| § 3.8030. Recommended Length of Stay for Outpatient Detoxification Treatment Service |
| SUBCHAPTER KK. EXCLUSIVE PROVIDER BENEFIT PLAN |
| § 3.9201. Application |
| § 3.9202. Definitions |
| § 3.9203. Policy and Premium Rates |
| § 3.9204. Contracting with Health Care Providers |
| § 3.9205. Compliance of Limited Provider Network |
| § 3.9206. Quality Improvement and Utilization Management |
| § 3.9207. Credentialing Requirements for Health Care Providers |
| § 3.9208. Provider Network: Accessibility and Availability |
| § 3.9209. Mandatory Disclosure Requirements |
| § 3.9210. Complaints System |
| § 3.9211. Filing of Complaints |
| § 3.9212. Appeal of Non-Medicaid Adverse Determinations |
| SUBCHAPTER LL. HEALTH COVERAGE AWARENESS AND EDUCATION PROGRAM |
| § 3.9301. Purpose |
| § 3.9302. Definitions |
| § 3.9303. Acceptance of Donations |
| § 3.9304. Limitations on Offerees and Donors |
| § 3.9305. Limitations on Entities Subject to Department Regulation |
| § 3.9306. Procedures for Acceptance of Donations |
| SUBCHAPTER QQ. PROVIDER NETWORK CONTRACT REGISTRATION |
| § 3.9801. Definitions and General Provisions |
| § 3.9802. Provider Network Contracting Entity Registration Form Required |
| § 3.9803. Provider Network Contracting Entity Exemption of Affiliates Form Required |
| § 3.9804. Required Fees |
| § 3.9805. Express Authority |
| SUBCHAPTER RR. VALUATION MANUAL |
| § 3.9901. Valuation Manual |
| § 3.9902. Single State Company Exemptions |