State RegulationsTX specific✓ Verified · outline & fact-checked · Sep 2026Difficulty 1/5
Before a Texas HMO issues or delivers an evidence of coverage to enrollees, what must it do?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under 28 TAC 11.501, the evidence of coverage is a filed document: the HMO must file it with the Texas Department of Insurance and obtain the commissioner's approval before it is issued or delivered to enrollees. Filing lets TDI confirm that the document describes the covered services, limitations, and complaint and appeal process and that no provision conflicts with Insurance Code Chapters 843 and 1271. Issuing an unapproved form is a violation and exposes the HMO to enforcement.
Why the other options are wrong
- A) The employer signs the group contract but does not approve the coverage document for TDI purposes.
- C) County recording is not part of the HMO filing process; coverage documents are approved by TDI.
- D) Notarization by the enrollee is not a condition of issuing an evidence of coverage.
Memory hook
File first, deliver second; an unapproved evidence of coverage may not be issued.