Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 11 - HEALTH MAINTENANCE ORGANIZATIONS
Subchapter Y - LIMITED SERVICE HMOS
Section 11.2403 - Prohibited Practices

Universal Citation: 28 TX Admin Code § 11.2403

Current through Reg. 50, No. 13; March 28, 2025

A limited service HMO may not:

(1) exclude services required for preexisting conditions which would otherwise be covered under the plan;

(2) establish waiting periods for coverage of preexisting conditions;

(3) impose a lifetime coverage maximum for any covered service or benefit;

(4) limit or otherwise interfere with an enrollee's right to terminate his or her membership in the plan before the end of the enrollment year;

(5) limit coverage for emergency services under a limited health care service plan;

(6) charge an emergency fee in addition to a copayment for emergency services; or

(7) count medication-related services and services provided by telephone toward the annual outpatient visit total for either serious or nonserious mental illness.

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