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Texas Insurance Code - INS § 562.105. Contract Requirements

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) A program operator shall contract, directly or indirectly, with a provider offering discounted health care services or products under the discount health care program.  The written contract must contain all of the following provisions:

(1) a description of the discounts to be provided to a member;

(2) a provision prohibiting the provider from charging a member more than the discounted rate agreed to in the written agreement with the provider;  and

(3) a provision requiring the provider to promptly notify the program operator if the provider no longer participates in the program or loses the authority to provide services or products.

(b) The program operator may not charge or receive from a provider any fee or other compensation for entering into the agreement.

(c) If the program operator contracts with a network of providers, the program operator shall obtain written assurance from the network that:

(1) the network has a written agreement with each network provider that includes a discounted rate that is applicable to a program operator's discount health care program and contains all of the terms described in Subsection (a);  and

(2) the network is authorized to obligate the network providers to provide services to members of the discount health care program.

(d) The program operator shall require the network to:

(1) maintain and provide the program operator on a monthly basis an up-to-date list of providers in the network;  and

(2) promptly remove a provider from its network if the provider no longer participates or loses the authority to provide services or products.

(e) The program operator shall maintain a copy of each written agreement the program operator has with a provider or a network for at least two years following termination of the agreement.

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 562.105. Contract Requirements - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-562-105/

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