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TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 11 - HEALTH MAINTENANCE ORGANIZATIONS
SUBCHAPTER Y - LIMITED SERVICE HMOS
SECTION/RULE §11.2403 - Prohibited Practices
Chapter Review Date 05/05/2022

A limited service HMO may not:(1) exclude services required for preexisting conditions which would otherwise be covered under the plan;(2) establish waiting periods for coverage of preexisting conditions;(3) impose a lifetime coverage maximum for any covered service or benefit;(4) limit or otherwise interfere with an enrollee's right to terminate his or her membership in the plan before the end of the enrollment year;(5) limit coverage for emergency services under a limited health care service plan;(6) charge an emergency fee in addition to a copayment for emergency services; or(7) count medication-related services and services provided by telephone toward the annual outpatient visit total for either serious or nonserious mental illness.

Source Note: The provisions of this §11.2403 adopted to be effective August 1, 2017, 42 TexReg 2169.

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