Question 13005 of 324 · Texas Life, Accident and Health Agent Exam
Texas rules require that an enrollee who needs emergency care
Exactly one answer is correct.
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Correct answer to question 13005
- B: is covered even when the hospital or physician is not in the HMO's network
Explanation
An HMO plan must cover emergency care, including screening and stabilization, regardless of whether the physician or provider has a contract with the HMO. The HMO pays a non-network provider at the usual and customary rate or an agreed rate.
More questions: Texas Law: Health Maintenance Organizations
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- 13010HMOs in Texas are described in Insurance Code Chapter 843 and in 28 TAC Chapter 11. Which agency is primarily responsible for enforcing these rules?
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