Texas Insurance Code Title 8, Chapter 1273 - Point-of-service Plans

SUBCHAPTER A BLENDED CONTRACTS

• Texas Section 1273.001 - Definitions
  In this subchapter: (1) "Blended contract" means a single document, including a single contract policy, certificate, or evidence of coverage, that provides a combination of...
• Texas Section 1273.002 - Point-of-service Plan
  An insurer may contract with a health maintenance organization to provide benefits under a point-of-service plan, including optional coverage for out-of-area services or out-of-network care....
• Texas Section 1273.003 - Blended Contract
  (a) A health maintenance organization and an insurer may offer a blended contract. The use of a blended contract is limited to point-of-service arrangements between...
• Texas Section 1273.004 - Limited Benefits And Services; Cost-sharing Provisions
  Indemnity benefits and services provided under a point-of-service plan may be limited to those services described by the blended contract and may be subject to...

SUBCHAPTER B AVAILABILITY OF HEALTH BENEFIT COVERAGE OPTIONS

• Texas Section 1273.005 - Rules
  The commissioner may adopt rules to implement this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
• Texas Section 1273.051 - Definitions
  In this subchapter: (1) "Employee" means an individual employed by an employer. (2) "Health benefit plan" has the meaning assigned by Section 1501.002. (3) "Non-network...
• Texas Section 1273.052 - Offer Of Coverage Through Non-network Plan Required
  (a) Except as provided by Subsection (b), if the only health benefit coverage offered under an employer's health benefit plan is a network-based delivery system...
• Texas Section 1273.053 - Coverage Options
  The coverage required to be offered under this subchapter may be provided through: (1) a point-of-service plan; (2) a preferred provider benefit plan; or (3)...
• Texas Section 1273.054 - Premium For Coverage Options
  The premium for coverage required to be offered under this subchapter must be based on the actuarial value of that coverage and may be different...
• Texas Section 1273.055 - Cost-sharing Provisions
  (a) Different cost-sharing provisions may be imposed for a point-of-service plan offered under this subchapter, and those provisions may be higher than the cost-sharing provisions...
• Texas Section 1273.056 - Exceptions
  This subchapter does not apply to: (1) a small employer health benefit plan; or (2) a group model health maintenance organization that is a nonprofit,...
• Texas Section 1273.057 - Rules
  The commissioner shall adopt rules necessary to administer this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Last modified: September 28, 2016