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
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.