Under TIC 843.315, what information must a Texas HMO give an enrollee about a primary care physician or provider it has assigned to that enrollee?

Why D is correct

Under TIC 843.315, a health maintenance organization shall inform an enrollee of the name, address, and telephone number of the primary care physician or provider to whom the enrollee has been assigned, and of the enrollee's right to select a different primary care physician or provider. Both elements are mandatory, and neither is conditioned on a request from the enrollee. The practical point for a producer is that an assigned-physician notice that omits the enrollee's right to change physicians is a defective notice under the statute.

Why the other options are wrong

• A) An enrollee who fails to select a physician does not waive the disclosure; the duty is tied to the HMO's act of assigning.
• B) The rule requires the name, address, and telephone number of the assigned physician or provider plus notice of the right to choose a different one, not the name alone.
• C) Notice of the right to select a different physician or provider is mandatory and unconditional; it is not given only on the enrollee's written request.

Memory hook

Assigned means name, address, phone, plus your right to switch.