Section 26.411 - Service Areas for Health Carriers Offering Coverage Through a Health Group Cooperative(a) A health carrier may provide coverage to only one health group cooperative in any county, except that a health carrier may provide coverage to additional health group cooperatives if it is providing coverage in an expanded service area.(b) A health carrier may provide health group cooperative coverage to an expanded service area that includes the entire state on providing certification to TDI, signed by an officer of the health carrier, that the health carrier intends to provide health group cooperative coverage to an expanded service area that includes the entire state.(c) A health carrier may apply for an expanded service area that includes less than the entire state by submitting an application for approval to TDI. The health carrier may begin using the expanded service area on approval or 60 days after the day the application is received by TDI, unless the application is disapproved by TDI within that time. The application must include, in a nondiscriminatory manner and in compliance with Insurance Code Chapter 544 (concerning Prohibited Discrimination): (1) the geographic service areas, defined in terms of counties or ZIP codes, to the extent possible; and(2) if the service area cannot be defined by counties or ZIP codes, a map that clearly shows the geographic service areas.(d) A filing under this section does not affect any service areas that have been established in accordance with Insurance Code Chapter 843 (concerning Health Maintenance Organizations) or Chapter 1301 (concerning Preferred Provider Benefit Plans). A health carrier may not issue coverage to a health group cooperative in a service area that is not also contained entirely within the health carrier's service area established under Insurance Code Chapter 843 or 1301.28 Tex. Admin. Code § 26.411
The provisions of this §26.411 adopted to be effective August 31, 2004, 29 TexReg 8360; amended to be effective January 31, 2006, 31 TexReg 512; Amended by Texas Register, Volume 42, Number 19, May 12, 2017, TexReg 2560, eff. 5/17/2017