An HMO may provide to its enrollees health services that §11.508 of this title (relating to Mandatory Benefit Standards: Group, Individual and Conversion Agreements) does not include as basic health care services. An HMO may limit these optional health services as to time and cost. Group, individual and conversion certificates may contain optional benefits, including:

1. (1) corrective appliances and artificial aids;
2. (2) cosmetic surgery;
3. (3) ambulance services;
4. (4) care for military service connected disabilities for which the enrollee is legally entitled for services and for which facilities are reasonably available to such enrollee;
5. (5) care for conditions that state or local law requires be treated in a public facility;
6. (6) dental services, except for services required for conditions affecting the temporomandibular joint and inability to undergo dental treatment as set forth in §11.509(6) and (7) of this title (relating to Additional Mandatory Benefit Standards: Group Agreement Only);
7. (7) vision care;
8. (8) custodial or domiciliary care;
9. (9) experimental medical, surgical, or other experimental health care procedures, unless approved as a basic health care service by the policymaking body of the HMO;
10. (10) personal or comfort items and private rooms, unless medically necessary during inpatient hospitalization;
11. (11) whole blood and blood plasma;
12. (12) durable medical equipment for home use (such as wheel chairs, surgical beds, respirators, dialysis machines);
13. (13) infertility medical services, including gamete intrafallopian transfer (GIFT), zygote intrafallopian transfer (ZIFT), and outpatient infertility drugs;
14. (14) reversal of voluntary sterilization; and
15. (15) prescribed drugs and medicines incident to outpatient care.

Source Note:The provisions of this §11.512 adopted to be effective November 2, 1998, 23 TexReg 11347; amended to be effective February 24, 2005, 30 TexReg 854.