Hmos: Summary And Analysis

278 Words2 Pages
Chapter 1271 of the Texas Insurance Code governs HMOs. Section D of Chapter 1271 is titled “Certain Benefits Required,” and sets forth the basic benefits that a health care plan offered by an HMO must contain. Included under Section D is Section 1271.155, which is titled “Emergency Care” and sets forth the required coverage for emergency care. Section 1217.155(a) states that “[a] health maintenance organization shall pay for emergency care performed by non-network physicians or providers at the usual and customary rate or at an agreed rate.” Chapter 3 to Title 28 of the Texas Administrative Code governs PPOs. Section 3.3725 provides regulations for the payment of certain out-of-network claims. Section 3.3725(a) states that “[i]f an
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