State RegulationsTX specificDifficulty 1/5
For purposes of Texas HMO law, who is an "enrollee"?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under TIC 843.002, an enrollee is a person entitled to receive health care services under an evidence of coverage issued by the HMO. The term is not limited to the employee who signs up; covered dependents who are entitled to services are enrollees as well. This matters because the HMO's delivery, notice and complaint-handling obligations run to each enrollee, not merely to the group contract holder.
Why the other options are wrong
- B) A contracted physician is a provider under Chapter 843, not an enrollee.
- C) A TDI examiner is a regulator and has no entitlement to receive services under the evidence of coverage.
- D) The employer purchasing the coverage is the group contract holder, not the enrollee.
Memory hook
Enrollee = the one entitled to be treated, not the one doing the treating or paying for it.