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Chapter 1271

Benefits Provided by Health Maintenance Organizations; Evidence of Coverage; Charges

Subchapter A. General Provisions

1271.001 Applicability of Definitions 1271.002 Right to Evidence of Coverage; Issuance 1271.003 Evidence of Coverage Not Health Insurance Policy 1271.004 Individual Health Care Plan 1271.005 Applicability of Other Law 1271.006 Benefits to Dependent Child and Grandchild 1271.007 Religious Convictions 1271.008 Balance Billing Prohibition Notice

Subchapter B. Contents of Evidence of Coverage

1271.051 Evidence of Coverage: Contract and Certificate Requirements 1271.052 Information About Benefits and Limitations 1271.053 Information About Obtaining Services 1271.054 Information About Complaints and Appeals 1271.055 Out-of-Network Services 1271.056 Unfair or Deceptive Provisions and Statements Prohibited 1271.057 Discretionary Clauses Prohibited

Subchapter C. Commissioner Approval

1271.101 Approval of Form of Evidence of Coverage or Group Contract 1271.102 Procedures for Approval of Form of Evidence of Coverage or Group Contract; Withdrawal of Approval 1271.103 Withdrawal of Approval of Form 1271.104 Information Required by Commissioner

Subchapter D. Certain Benefits Required

1271.151 Provision of Basic Health Care Services 1271.152 Standards for Basic Health Care Services 1271.153 Periodic Health Evaluations 1271.154 Well-Child Care from Birth 1271.155 Emergency Care 1271.156 Benefits for Rehabilitation Services and Therapies 1271.157 Non-Network Facility-Based Providers 1271.158 Non-Network Diagnostic Imaging Provider or Laboratory Service Provider 1271.159 Non-Network Emergency Medical Services Provider

Subchapter E. Choice of Primary Care Physician for Certain Enrollees

1271.201 Designation of Specialist as Primary Care Physician 1271.202 Appeal 1271.203 Effective Date of Designation

Subchapter F. Schedule of Charges

1271.251 Approval of Formula or Method for Computing Schedule of Charges 1271.252 Consideration of Individual Health Status Prohibited 1271.253 Information Required by Commissioner

Subchapter G. Continuation of Coverage, Conversion Contracts, and Renewal

1271.301 Entitlement to Continuation of Group Coverage 1271.302 Request for Continued Coverage; Deadline 1271.303 Payment for Continued Coverage 1271.304 Termination of Continued Coverage 1271.306 Conversion Contracts 1271.307 Renewability of Coverage: Individual Health Care Plans and Conversion Contracts