{"data":{"id":"us-tx/tex.-insurance-code-1501.061","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1501.061","heading":"REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY CONTRACT.","body":"A cooperative may contract only with a small or large employer health benefit plan issuer that demonstrates that the issuer:\n(1) is in good standing with the department;\n(2) has the capacity to administer health benefit plans;\n(3) is able to monitor and evaluate the quality and cost-effectiveness of care and applicable procedures;\n(4) is able to conduct utilization management and establish applicable procedures and policies;\n(5) is able to ensure that enrollees have adequate access to health care providers, including adequate numbers and types of providers;\n(6) has a satisfactory grievance procedure and is able to respond to enrollees' calls, questions, and complaints; and\n(7) has financial capacity, either through satisfying financial solvency standards, as applied by the commissioner, or through appropriate reinsurance or other risk-sharing mechanisms.\nAdded by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.\nAmended by:\nActs 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.053(b), eff. September 1, 2005.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE G. HEALTH COVERAGE AVAILABILITY","CHAPTER 1501. HEALTH INSURANCE PORTABILITY AND AVAILABILITY ACT","SUBCHAPTER B. COALITIONS AND COOPERATIVES"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1501.htm#1501.061","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"e96ff81a557d7ecde21d4262465b054c134b7a8b07f13023abcb17aa53987ec9","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1501.060","next":"us-tx/tex.-insurance-code-1501.062"},"notice":"GroundRules: Original legal text. Not legal advice."}