(a) A limited service HMO must develop and maintain an ongoing quality improvement structure and program that complies with Chapter 11, Subchapter T, of this title (relating to Quality of Care).
(b) Each limited service HMO must provide uniquely described services with any corresponding copayments for each covered service and benefit, and provide a limited health care service plan as defined in Insurance Code §843.002 (concerning Definitions). Each limited service HMO must comply with all requirements for a limited health care service plan specified in this subchapter.
(c) Each limited service HMO schedule of enrollee copayments must specify an appropriate description of covered services and benefits, as required by §11.506 of this title (relating to Mandatory Contractual Provisions: Group, Individual, and Conversion Agreement and Group Certificate), and may specify recognized procedure codes or other information used for maintaining a statistical reporting system.
(d) Each limited service HMO evidence of coverage must include a glossary of terms, including the terms used in the evidence of coverage required by §11.501 of this title (relating to Contents of the Evidence of Coverage). The glossary must be included in the information to prospective and current group contract holders and enrollees, as required by Insurance Code §843.201 (concerning Disclosure of Information about Health Care Plan Terms).

Source Note: The provisions of this §11.2402 adopted to be effective August 1, 2017, 42 TexReg 2169