- (a) Each single service HMO shall provide uniquely described services with any corresponding copayments for each covered service and benefit and shall provide a single health care service plan as defined under Insurance Code §843.002(26). Each single service HMO must comply with all requirements for a single health care service plan specified in this subchapter.
- (b) Each single service HMO schedule of enrollee copayments shall specify an appropriate description of covered services and benefits, as required under §11.506 of this title (relating to Mandatory Contractual Provisions: Group, Individual and Conversion Agreement and Group Certificate), and may specify recognized procedures or other information which is used for the purpose of maintaining a statistical reporting system.
- (c) Each single service HMO evidence of coverage shall include a glossary of terminology, including such terms used in the evidence of coverage required by §11.501 of this title (relating to Forms Which Must be Approved Prior to Use). Such glossary shall be included in the information to prospective and current group contract holders and enrollees, as required under Insurance Code §843.201.
- (d) In the event of a conflict between the provisions of this subchapter and other provisions of this chapter, this subchapter prevails with regard to single service HMOs. It is not considered a conflict if a topic that is not addressed in this subchapter appears elsewhere in this chapter.
Source Note:The provisions of this §11.2201 adopted 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.