Texas § IN.1501.061 - REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY

§ IN.1501.061. REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY

REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY CONTRACT. A cooperative may contract only with a small or large employer health benefit plan issuer that demonstrates that the issuer: (1) is in good standing with the department; (2) has the capacity to administer health benefit plans; (3) is able to monitor and evaluate the quality and cost-effectiveness of care and applicable procedures; (4) is able to conduct utilization management and establish applicable procedures and policies; (5) is able to ensure that enrollees have adequate access to health care providers, including adequate numbers and types of providers; (6) has a satisfactory grievance procedure and is able to respond to enrollees' calls, questions, and complaints; and (7) has financial capacity, either through satisfying financial solvency standards, as applied by the commissioner, or through appropriate reinsurance or other risk-sharing mechanisms. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018 ), Sec. 11.053(b), eff. September 1, 2005.