1. (a) If the department disapproves any portion of any evidence of coverage, the department will specify the reason for the disapproval. The department is authorized to disapprove any form or withdraw any previous approval for any of the following reasons:

   1. (1) it fails to meet the requirements of the Insurance Code Chapter 1271, these sections, or other applicable statutes and regulations;
   2. (2) it does not properly describe the services and benefits;
   3. (3) it contains any statements that are unclear, untrue, unjust, unfair, inequitable, misleading, or deceptive or that violate the Insurance Code Chapters 541, 542, 543, 544, and 547, in accordance with the Insurance Code §1271.005 or any regulations thereunder or any other applicable law;
   4. (4) it provides services or benefits that are too restrictive to achieve the purpose for which the form was designed;
   5. (5) it fails to attain a reasonable degree of readability, simplicity and conciseness;
   6. (6) it provides services or benefits or contains other provisions that would endanger the solvency of the issuing HMO; or
   7. (7) it is contrary to the law or policy of this state.
2. (b) If the department disapproves a form, the HMO may file a written request for a hearing on the matter. The department will schedule a hearing within 30 days from the date it receives the request.

Source Note:The provisions of this §11.504 adopted to be effective January 1, 1980, 4 TexReg 4622; amended to be effective December 6, 1984, 9 TexReg 6011; amended to be effective December 4, 1987, 12 TexReg 4363; amended to be effective August 17, 1992, 17 TexReg 5356; amended to be effective November 2, 1998, 23 TexReg 11347; amended to be effective February 24, 2005, 30 TexReg 854; amended to be effective November 15, 2006, 31 TexReg 9298.