This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:49 GMT

TITLE 28 - INSURANCE
PART 1 - TEXAS DEPARTMENT OF INSURANCE
CHAPTER 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES
SUBCHAPTER E - HEALTH CARE COLLABORATIVES
SECTION/RULE §13.491 - Complaint Systems
Chapter Review Date 06/08/2021

(a) Each HCC must implement and maintain a complaint system that complies with Insurance Code §848.107 and this division that provides reasonable procedures for resolving an oral or written complaint initiated by a complainant concerning the HCC or health care services arranged by, or offered through, the HCC.(b) For purposes of this subchapter, a complaint is any oral or written expression of dissatisfaction by a complainant to an HCC regarding any aspect of the HCC's operation.(c) The HCC's complaint system must address a complaint initiated:(1) by or on behalf of a patient who sought or received health care services by a participant; or(2) by a participant.(d) The complaint system for complaints initiated by or on behalf of patients must include a process for the notice and appeal of a complaint.(e) The commissioner has discretion to examine a complaint system for compliance with Insurance Code §848.107 and this subchapter and will require the HCC to make corrections that the commissioner considers necessary.

Source Note: The provisions of this §13.491 adopted to be effective March 31, 2013, 38 TexReg 2100.

View Official Rule