Network Adequacy Waiver Request - Facility-based Physicians & Providers

This dataset includes information related to network adequacy waiver requests filed by major medical health benefit plans. It includes data on facility-based physicians and providers. Related datasets are available for major medical (non-facility-based providers) and vision plans:

• <strong>Major medical:</strong> <a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Major-Medical/yfeb-xw4b/about_data" target="_blank"><u>Network Adequacy Waiver Request - Major Medical</u></a>. This dataset relates to waiver requests for networks used for major medical PPO and EPO plans and includes data on physicians, providers, and facilities, other than facility-based physicians and providers.

• <strong>Vision: </strong><a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Vision/2zru-e4u3/about_data" target="_blank"><u>Network Adequacy Waiver Request - Vision</u></a>. This dataset relates to waiver requests for networks used for vision PPO and EPO plans.

Insurers offering health benefits through a preferred or exclusive provider benefit plan (also called PPO and EPO plans) are required to demonstrate that the health insurance network meets Texas network adequacy standards. When a network does not meet these requirements and has a deficiency in a county for a specific physician or provider specialty type, an insurer may apply for a waiver to continue operating within its service area. The commissioner of the Texas Department of Insurance (TDI) may grant the waiver following a public hearing and consideration of relevant testimony and information.

Anyone may attend the public hearing and offer testimony. Learn more about how to submit information related to a waiver request or participate in a hearing here: <a href="https://www.tdi.texas.gov/hmo/mcqa/network-adequacy-standards-waivers.html" target="_blank"><u>Network Adequacy Standards Waivers</u></a>.

本数据集囊括了由主要医疗健康福利计划提交的网络充足度豁免申请的相关信息。该数据集涵盖了基于设施的医疗医师和提供者的数据。此外，针对主要医疗（非基于设施提供者）和视力计划，亦提供了相关数据集：

• <strong>主要医疗：</strong> <a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Major-Medical/yfeb-xw4b/about_data" target="_blank"><u>网络充足度豁免申请 - 主要医疗</u></a>。此数据集关联至用于主要医疗 PPO 和 EPO 计划的网络豁免申请，并包含医师、提供者和设施的数据，但非基于设施的医师和提供者的数据除外。

• <strong>视力：</strong><a href="https://data.texas.gov/dataset/Network-Adequacy-Waiver-Request-Vision/2zru-e4u3/about_data" target="_blank"><u>网络充足度豁免申请 - 视力</u></a>。此数据集关联至用于视力 PPO 和 EPO 计划的网络豁免申请。

提供通过首选或独家提供者福利计划（亦称为 PPO 和 EPO 计划）的健康福利的保险公司，需证明其健康保险网络符合德克萨斯州的网络充足度标准。当网络未满足这些要求，并在特定医师或提供者专业类型上存在县级行政区划内的不足时，保险公司可申请豁免以继续在其服务区域内运营。德克萨斯州保险部（TDI）专员在经过公开听证和考虑相关证词及信息后，可批准豁免。

任何人均可出席公开听证会并提交证词。有关提交与豁免申请相关的信息或参与听证会的更多信息，请参阅以下链接： <a href="https://www.tdi.texas.gov/hmo/mcqa/network-adequacy-standards-waivers.html" target="_blank"><u>网络充足度标准豁免</u></a>。