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(a) A program operator shall:
(1) provide a toll-free telephone number and Internet website for members to obtain information about the discount health care program and confirm or find providers currently participating in the program; and
(2) remove a provider from the discount health care program not later than the 30th day after the date the program operator learns that the provider is no longer participating in the program or has lost the authority to provide services or products.
(b) A program operator shall issue at least one membership card to serve as proof of membership in the discount health care program that must:
(1) contain a clear and conspicuous statement that the discount health care program is not insurance; and
(2) if the discount health care program includes discount prescription drug benefits, include:
(A) the name or logo of the entity administering the prescription drug benefits;
(B) the international identification number assigned by the American National Standards Institute for the entity administering the prescription drug benefits;
(C) the group number applicable to the member; and
(D) a telephone number to be used to contact an appropriate person to obtain information relating to the prescription drug benefits provided under the program.
(c) Not later than the 15th day after the date of enrollment, a program operator shall issue at least one set of disclosure materials describing the terms and conditions of the discount health care program to each household in which a person is a member, including a statement that:
(1) the discount health care program is not insurance, with the word “not” capitalized;
(2) the member is required to pay the entire amount of the discounted rate;
(3) the discount health care program does not guarantee the quality of the services or products offered by individual providers; and
(4) if the member remains dissatisfied after completing the discount health care program's complaint system, the member may contact the member's state insurance department.
(d) A program operator shall ensure that an application form or other membership agreement:
(1) clearly and conspicuously discloses the duration of membership and the amount of payments the member is obligated to make for the membership; and
(2) contains a clear and conspicuous statement that the discount health care program is not insurance.
(e) A program operator shall allow any member who cancels a membership in the discount health care program not later than the 30th day after the date the person becomes a member to receive a refund, not later than the 30th day after the date the program operator receives a valid cancellation notice and returned membership card, of all periodic membership charges paid by that member to the program operator and the amount of any one-time enrollment fee that exceeds $50.
(f) A program operator shall:
(1) maintain a surety bond, payable to the department for the use and benefit of members in a manner prescribed by the department, in the principal amount of $50,000, except that a program operator that is an insurer that holds a certificate of authority under Title 6 is not required to maintain the surety bond;
(2) maintain an agent for service of process in this state; and
(3) establish and operate a fair and efficient procedure for resolution of complaints regarding the availability of contracted discounts or services or other matters relating to the contractual obligations of the discount health care program to its members.
Cite this article: FindLaw.com - Texas Insurance Code - INS § 562.103. Program Operator Duties - last updated April 14, 2021 | https://codes.findlaw.com/tx/insurance-code/ins-sect-562-103.html
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