A Texas HMO enrollee was assigned a primary care physician at enrollment and now wants a different one. Under TIC 843.315, what is the enrollee's right?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under TIC 843.315, at any time an enrollee is entitled to reject the primary care physician or provider assigned by the HMO and select another physician or provider from the list of primary care physicians and providers for the HMO delivery network, and a rejection of an assigned physician or provider is not a change in provider for purposes of the limitation on selecting a primary care physician. The right is unconditional as to timing, and it is cost-free in the sense that it does not consume the enrollee's allotted provider changes. A producer should never tell an unhappy enrollee that the enrollee is locked in to an assigned physician for the year.
Why the other options are wrong
- B) A rejection of an assigned physician or provider is expressly not counted as a change in provider for purposes of that limitation.
- C) The right to reject an assigned primary care physician exists at any time; it is not confined to an annual enrollment window.
- D) The assignment is a default, not a lock-in; the enrollee may reject it and select another network physician or provider.
Memory hook
Rejecting an assigned doctor is always free and never counts as a switch.