Tenn. Code Ann. § 56-7-1006. Physician maintenance of licensure or certification; reimbursement or network participation: Health and Accident Insurance – Tennessee
Status: Enacted Year Enacted: 2018
A health insurance entity shall not deny reimbursement to or prevent a physician from participating in any of the insurance entity’s provider networks based solely on a physician’s decision not to participate in any form …
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Tex. Health & Safety Code § 12.012. Awarding Contracts or Grants and Selecting Service Providers: Powers and Duties of Department of State Health Services – Texas
Status: Enacted Year Enacted: 1989
In awarding contracts or grants for services, or in selecting service providers under any program administered by the department, the department shall give preference to providers who can deliver appropriate services of similar quality in …
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Tex. Ins. Code § 1301.052. Designation of Advanced Practice Nurse or Physician Assistant as Preferred Provider: Preferred Provider Benefit Plans – Texas
Status: Enacted Year Enacted: 2003
An insurer offering a preferred provider benefit plan may not refuse a request made by a physician participating as a preferred provider under the plan and an advanced practice nurse or physician assistant to have …
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Tex. Ins. Code § 1451.001. Definitions; Health Care Practitioners: Access to Certain Practitioners and Facilities – Texas
Status: Enacted Year Enacted: 2003
Definitions for the Chapter on access to physicians and facilities.
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Tex. Ins. Code § 1451.101. Definitions: Access to Certain Practitioners and Facilities – Texas
Status: Enacted Year Enacted: 2005
Definitions for the Statute governing an insurance company’s limited ability to influence an insured’s selection of a provider
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Tex. Ins. Code § 1451.207. Prohibited Conduct: Access to Certain Practitioners and Facilities – Texas
Status: Enacted Year Enacted: 2005
Outlines the ways in which an insurance company may not interfere with a insured’s selection of a dentist or the insured’s right to seek certain types of care.
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Tex. Ins. Code § 1451.255. Right of Female Enrollee to Select Obstetrician or Gynecologist: Access to Certain Practitioners and Facilities – Texas
Status: Enacted Year Enacted: 2003
A health plan shall permit a female enrollee to select her obstetrician and gynecologist. However, they may limit an enrollee’s self-referral to only one participating provider. This is a separate right from choosing a primary …
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Tex. Ins. Code § 843.304. Exclusion of Provider Based on Type of License Prohibited: Texas Health Maintenance Organization Act – Texas
Status: Enacted Year Enacted: 2003
A health maintenance organization may not exclude a licensed provider based solely on the type of license that provider holds.
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Utah Code § 31A-45-102. Definitions: Managed Care Organizations – Utah
Status: Enacted Year Enacted: 2017
Definitions relate to Managed Care Organizations
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Utah Code § 31A-45-501. Access to health care providers: Managed Care Organizations – Utah
Status: Enacted Year Enacted: 1997
A managed care organization must pay for covered healthcare services rendered to an enrollee by a healthcare provider so long as it meets the following conditions.
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Utah Code § 31A-8-408. Organizations offering point of service or point of sales products: Health Maintenance Organizations and Limited Health Plans – Utah
Status: Enacted Year Enacted: 1991
A health maintenance organization offering products that permit memebrs to obtain coverage from noncontracted providers such as point of services must comply with the following provisions.
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Va. Code Ann. §§ 38.2-3400 through 3407.19: Provisions Relating to Accident and Sickness Insurance – Virginia
Status: Enacted Year Enacted: 1950
Virginia’s provisions relating to accident and sickness insurance.
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Va. Code Ann. §§ 38.2-4200 through 4229.2: Health Services Plans — In General – Virginia
Status: Enacted Year Enacted: 1983
Describes preferred provider subscription contracts.
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Wis. Stat. § 146.905. Reduction in Fees Prohibited: Miscellaneous Health Provisions – Wisconsin
Status: Enacted Year Enacted: 1991
Except as provided in sub. (2), a health care provider, as defined in s. 146.81(1)(a) to (p), that provides a service or a product to an individual with coverage under a disability insurance policy, as …
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Wis. Stat. § 609.10. Standard Plan and Point-of-Service Option Plan Required: Defined Network Plans – Wisconsin
Status: Enacted Year Enacted: 1985
In this section, “point-of-service option plan“ means a health maintenance organization or preferred provider plan that permits an enrollee to obtain covered health care services from a provider that is not a participating provider of …
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Wis. Stat. § 609.35. Applicability of Requirements to Preferred Provider Plans: Defined Network Plans – Wisconsin
Status: Enacted Year Enacted: 2001
Notwithstanding ss. 609.22 (2), (3), (4), and (7), 609.32 (1), and 609.34 (1), a preferred provider plan that does not cover the same services when performed by a nonparticipating provider that it covers when those …
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