1. (a) If any portion of any evidence of coverage is disapproved, the commissioner will specify the reason for the disapproval. The commissioner 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 Act, these sections, or other applicable statutes and rules;
   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 Articles 21.21, 21.21A, 21.21-1, 21.21-2, 21.21-5, 21.21-6, or 21.55 in accordance with Article 20A.09(j) 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 a form is disapproved the HMO may file a written request for a hearing on the matter. A hearing will be scheduled within 30 days from the date the request is received.

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.