™Your Policy Risk Impact Agent
45,791 sections across 577 Texas regulatory chapters.
R.21 28 TAC §21.3023 — NONFORMULARY PRESCRIPTION DRUGS; ADVERSE DETERMINATION
1.0K chars
If the issuer of a health benefit plan, its delegated entity, or their employees or agents refuses to provide coverage for a prescription drug that is not included in a drug formulary, and the enrollee's physician or other health care provider with prescriptive authority has dete…
R.21 28 TAC §21.3022 — CONTINUATION OF BENEFITS
2.0K chars
(a) An issuer of a health benefit plan that offers prescription drug benefits must make a prescription drug that was approved or covered for a medical condition or mental illness available to each enrollee at the contracted benefit level until the health benefit plan renewal date…
R.21 28 TAC §21.3020 — DEFINITIONS; PRESCRIPTION DRUG FORMULARY
4.8K chars
The following words and terms when used in this division have the following meanings, unless the context clearly indicates otherwise: (1) Adverse determination--As defined in Insurance Code § 4201.002 . (2) Allowed amount--The amount that the applicable health benefit plan issuer…