Health insurance information for consumers. Texas healthcare cost consumer information guide. Mediation for out-of-network hospital-based health care provider claims. Understanding health insurance networks. Mandated health benefits. Coverage for mental and substance use disorder services. Affordable Care Act.
Actived: 3 days ago
Get help with a health insurance complaint
(6 days ago) If your health plan is through your job with a large employer (more than 50 employees): Visit the U.S. Department of Labor’s website. If it’s a Marketplace plan, CHIP plan, stand-alone dental or vision plan, or a plan though your job with a small employer (fewer than 50 employees): Call 888-866-6205 or visit externalappeal.com .
Information on Implementation of HB 2090
(4 days ago) TDI requested input on the implementation of Insurance Code Chapter 1662, Subchapter C, as added by Section 3 of House Bill 2090, related to the requirement for certain health plans to publish machine-readable files containing information on payment rates for in-network and out-of-network services and prescription drugs. View the request for
Information on Implementation of HB 3459
(4 days ago) TDI requested input on the implementation of House Bill 3459, 87th Legislature, Regular Session (2021), related to preauthorization requirements for certain health care services and utilization review for certain health benefit plans. View the request for information and the comments received. For more information, contact: [email protected]tdi.texas.gov.
HMO Forms and HMO Form Filings
(6 days ago) Financial Analysis Health Maintenance Organizations Forms. If the form is a fillable PDF, learn how to enable all fillable form features. HMO Forms and HMO Form Filings - Life, Accident, and Health. TDI Form Number. Description. File Format. Language. HMO001. Consumer Choice Evidence of Coverage (EOC) Checklist - Individual Plans.
Life, Health, and HMO
(3 days ago) Life, Accident, and Health data calls. Utilization Review Agents (URAs) Committees, Stakeholder Groups, and Appointments. Mandated Health Benefits. Exhibit A - Exclusions, Reductions and Limitations for Individual Health Provisions (.pdf format) HIV Consent Form. Federal HIPAA Information.
Evidence of Coverage
(3 days ago) Basic Service (offering a basic health care services plan - 28 TAC §11.508(a)) Limited Service (offering a mental health/chemical dependency or a long term care plan) Single Service (offering, e.g., a dental-only plan or a vision-only plan) The HMO's EOC must be clear and complete and must include information about: Benefits & Limitations
Preferred provider benefit plan (PPBP) and exclusive
(7 days ago) Preferred provider benefit plan (PPBP) and exclusive provider benefit plan (EPBP) networks. A Texas life/health insurer may elect to offer a PPBP or EPBP network to provide covered benefits to their enrollees, in accordance with Texas Insurance Code Chapter 1301, and rules in 28 Texas Administrative Code (TAC) Chapter 3, Subchapter X.
Balance billing: state-regulated health plan resources
(8 days ago) Responsibilities of health plans regulated by TDI State law requires health plans to cover medical screenings necessary to rule out that an emergency condition exists. Claim denials based on a failure to meet the prudent layperson standard for emergency care must be based on a review of the patient’s presenting symptoms, not on the later
(9 days ago) Memorial Hermann Health Plan, Inc. and Memorial Hermann Health Insurance Company of Houston: 20206224: 2/10/2020: Dale, Katheryn Nycole of Denton: 20206281: 03/06/2020: Health Care Service Corporation, a Mutual Legal Reserve Company doing business as Blue Cross and Blue Shield of Texas, a division of Health Care Service Corporation of …
Health Insurance Glossary
(5 days ago) Health benefit plan – Refers to health insurance plan offered by a health insurance company that provides a set of covered services. Health care facility – An entity that delivers health services such as a hospital or ambulatory surgical center. Health care sharing ministries – Nonprofits that limit membership to people of a similar faith
Need health insurance
(3 days ago) What are my options for getting health insurance? You might have access to a group health plan at work or from a union, association, or church. You can also buy an individual health plan directly from an insurance company or licensed agent. You also might be able to get coverage from Medicare or Medicaid.
Request for information to use in implementation of
(6 days ago) health care when researching health care providers and prescription drug costs and when scheduling health care services. This information should empower patients and consumers to seek and receive care from health providers based on accurate, personally-relevant information about cost and quality.
Essential Health Benefits Summary of Benchmark Plan
(Just Now) (E) Mental health and substance use disorder services, including behavioral health treatment Note that the limits on coverage described below may violate parity requirements at 42 USC §300gg-26 and 45 CFR §146.136 Mental/behavioral health outpatient services √ 25 visits √ 25 visits Mental/behavioral health inpatient services √ 10 days
Life, Accident and Health data calls, surveys, and
(4 days ago) Health plan compare - Annual report covering plan cost information for comprehensive health coverage, as well as general information about health plan issuers. Long-term care reports – Long-term care policy data is collected via five reporting forms and is due by June 30 of each year.
TDI Health bulletins
(7 days ago) Life and Health. For more specific information on a particular bulletin, please refer to the contact person/division at the end of the bulletin. For copies of bulletins, please contact us at 512-676-6585 or via email at: [email protected]tdi.texas.gov.
Group and Individual Health Medicare Supplement and Select
(4 days ago) GROUP AND INDIVIDUAL HEALTH MEDICARE SUPPLEMENT AND SELECT CHECKLIST. Every effort has been made to ensure the accuracy of the information in this document. All parties should consult the Texas Insurance Code, the Texas Administrative Code, and other applicable laws. FILING REQUIREMENTS. General - 28 TAC §§3.1 - 3.8
Mental Health and Substance Use Disorder Parity Rules
(2 days ago) Rule. TDI rules related to mental health and substance use disorder parity are at 28 TAC Chapter 21, Subchapter P . TDI adopted the rule on August 18, with an effective date of September 7, 2021. The rule adoption is available on TDI’s rule page . Templates for completing the parity compliance analyses required by Division 3 of the rule are
Life Settlements Checklists
(3 days ago) Life Health Main Forms Page. See our Agents / Adjusters section to learn about applying for and managing a Life settlement broker or a Life settlement provider license. If the form is a fillable PDF, learn how to enable all fillable form features. Life Settlements Checklists - Life, Accident, and Health. TDI Form Number. Description. File Format.
Prompt payment of health care claims emergency rules summary
(4 days ago) Billed charges are defined as the charges for medical care or health care services included on a claim submitted by a physician or provider. Billed charges must comply with all other applicable requirements of law, including Texas Health and Safety Code §311.0025, Texas Occupations Code §105.002, and Texas Insurance Code Art. 21.79F.
Certified Workers’ Compensation Health Care Networks
(8 days ago) Health care practitioners and medical office staff will learn how to identify a network claim through the patient intake and registration process. The responsibility for verifying network contracts and obtaining approval for out-of-network health care is also discussed.
Health price transparency
(Just Now) Consumers' rights to health care price estimates. Senate Bill 1731, enacted by the 80th Texas Legislature, created new rights for Texas health plan consumers to help them avoid unexpected health care bills.Consumers can request a cost estimate from a health care facility provider 1, physician 2, or from their health insurance company or HMO 3 before receiving care.
TDI sergeant recognized for helping with $120 million
(8 days ago) The National Health Care Anti-Fraud Association chose the case of United States vs. Trivikram Reddy for its Special Investigation Resource and Intelligence System Investigation of the Year Award. Torres was on the multi-agency …
Health care provider training and resources
(1 days ago) A health care provider is a health care facility or a health care practitioner. A health care facility is a hospital, emergency clinic, outpatient clinic, or other facility, that is appropriately licensed to provide inpatient and outpatient medical services to patients experiencing acute illness or trauma.
Health care claims data required from health plans
(4 days ago) Full schedule of official CPT, HCPCS, and ANE procedure codes. Other data elements as needed to validate the accuracy of the data. Data contributors can get more information about all the required data elements by contacting FAIR Health’s Director of Data Management Eric Okurowski at 212-257-2385 or [email protected]
Not sure who to call with your question or complaint
(1 days ago) Hospitals and nursing homes: Texas Health and Human Services 512-424-6500 File a complaint . Medicaid and CHIP: Texas Health and Human Services Medicaid: 800-252-8263 CHIP: 877-543-7669 File a complaint . Medicare (doctors, hospitals, plans, quality of care, medical equipment): Medicare.gov 800-633-4227 File a complaint
FAIR Health data submissions
(5 days ago) FAIR Health data submissions. The Texas Department of Insurance (TDI) has determined that data submissions by health plans to the Senate Bill 1264 benchmarking database are not necessary at this time. TDI rules state that health plan data submissions are to be “determined by the benchmarking database organization.”. FAIR Health, the
Lists of Texas insurance agents, adjusters, and agencies
(3 days ago) Temporary General Lines Life Accident and Health Agent (TGLLAH) Active Temporary General Lines Life Accident and Health Agents agttgllah.csv: Temporary Life Agent (TLAGT) Active Temporary Life Agents agttlagt.csv: Temporary Life Insurance Not to Exceed $25,000 Agent (TLI) Active Temporary Life Insurance Not to Exceed $25,000 Agents agttli.csv
FAQ: Mediation and arbitration requirements and processes
(1 days ago) The health plan must: 1. Log into the IDR portal. 2. Open the request. 3. Open the “Informal teleconference information” panel. 4. Enter the required information. After those steps are taken, each party will get an email confirming that the request was settled. Only the health plan can enter the informal teleconference information into the
AH015 1121 Individual Health Checklist
(4 days ago) Individual Health Checklist . Use this checklist: • When reviewing individual health insurance products or policies. • To ensure the product or policy meets requirements as listed in the Texas Insurance Code (TIC), the Texas Administrative Code …
GENEX Workers' Compensation Health Care Network (WCHCN)
(4 days ago) GENEX Workers' Compensation Health Care Network (WCHCN) Certificate Number 13515563. This information is the latest that the network has filed with TDI. Check with your worker’s compensation provider directly to verify the service area. Certification Date - June 30, 2011 Address
Health Maintenance Organization (HMO) FAQ
(9 days ago) Health Plan Management. Texas Health and Human Services Commission. Managed Care Operations-Mail Code H-320. PO Box 85200. Austin, TX 78708. Phone: 877-787-8999 (Toll-Free) TDD: 888-425-6889 (Toll-Free) For the deaf or hearing impaired. Medicare complaints are handled by the Centers for Medicaid and Medicare Services.
Your health plan can help you quit smoking or lose weight
(4 days ago) Some health plans charge you less after you quit. Join a gym. Check to see if your health plan offers discounts on gym memberships or fitness equipment. Most do. Be more active. Most health plans have free apps that help track your workouts, count your steps, or manage eating habits. If you track a habit, you’re a lot more likely to change it.
Health Maintenance Organization (HMO) FAQ
(6 days ago) All covered health care services that are offered by the HMO shall be sufficient in number and location to be readily available and accessible within the geographical service area to all enrollees. The HMO must have a sufficient number of primary care physicians and specialists with hospital admitting privileges at participating facilities who
SUBCHAPTER F. RATE REVIEW FOR HEALTH BENEFIT PLANS …
(8 days ago) Chapter 3. Life, Accident, and Health Insurance and Annuities (5) Index rate--A rate based on the total combined claims costs for providing essential health benefits within the single risk pool of the applicable market. (6) Plan--As defined in 45 CFR §144.103. (7) Product- …