Texas Attorney General Opinion: JM-1167 Page: 1 of 5
This text is part of the collection entitled: Texas Attorney General Opinions and was provided to The Portal to Texas History by the UNT Libraries Government Documents Department.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
TUIE ATTORNEY GENERAL
OF TEXAS
JxiM MATTOX April 25, 1990
ATTORNEY GENERAL
Mr. A. W. Pogue Opinion No. JM-1167
Commissioner
State Board of Insurance Re: Status of insurance prog-
1110 San Jacinto rams in which applicants are
Austin, Texas 78701-1998 referred, for a fee, to a
single health care provider
(RQ-1867)
Dear Commissioner Pogue:
You ask "whether referral programs that 'arrange for'
services of health care providers to enrollees at a discount
in return for a referral fee are subject to regulation as a
health maintenance organization."
Insurance Code article 20A.03 provides in part that "no
person shall establish or operate a health maintenance orga-
nization in this state . . . without obtaining a certificate
of authority under this Act," and that "any person may apply
to the commissioner [of insurance] for and obtain a certifi-
cate of authority to establish and operate a health main-
tenance organization in compliance with this Act." (The
"Act" referred to in the quoted portions of article 20A.03
is the Health Maintenance Organization Act, codified as
chapter 20A of the Insurance Code. See Ins. Code art.
20A.01. )
You say that the referral programs about which you are
concerned
have 'arrangements' with single service
health care providers such as dentists,
optometrists, and chiropractors either
verbally or in writing which provide that
each participating provider will offer
discounted services to enrollees of the
programs. Thereafter, the referral programs
target and market prospective enrollees
through agents and literature.
The plans offered to prospective enrollees
are such that a referral fee is charged,p. 6161
Upcoming Pages
Here’s what’s next.
Search Inside
This text can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Text.
Texas. Attorney-General's Office. Texas Attorney General Opinion: JM-1167, text, April 25, 1990; (https://texashistory.unt.edu/ark:/67531/metapth273605/m1/1/: accessed April 25, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.