Section 1501.061 - 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.Tex. Ins. Code § 1501.061
Amended By Acts 2005, 79th Leg., Ch. 728, Sec. 11.053(b), eff. 9/1/2005.Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. 4/1/2005.