Tex. Ins. Code § 1271.055 · Subchapter B. CONTENTS OF EVIDENCE OF COVERAGE
OUT-OF-NETWORK SERVICES.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) An evidence of coverage must contain a provision regarding non-network physicians and providers in accordance with the requirements of this section.
(b) If medically necessary covered services are not available through network physicians or providers, the health maintenance organization, on the request of a network physician or provider and within a reasonable period, shall:
(1) allow referral to a non-network physician or provider; and
(2) fully reimburse the non-network physician or provider at the usual and customary rate or at an agreed rate.
(c) Before denying a request for a referral to a non-network physician or provider, a health maintenance organization must provide for a review conducted by a specialist of the same or similar type of specialty as the physician or provider to whom the referral is requested.
Notes and commentary — not statutory text
History
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1271.htm
- Text hash
- sha256 9bad11a80c5c55859149895eea1e30119b751ab8355fa787b6a286264b8fffa9
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
Cited by 1 provision
Provisions in this library whose text cites Tex. Ins. Code § 1271.055. Each shows the citation as that text prints it.
Procedural information only. Not legal advice and not a substitute for the advice of an attorney. Confirm the current text with the official publisher before relying on it.