Network adequacy standards waivers

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Sign up for waiver news and hearing notices.

Watch a webinar about waiver hearing process. See presentation slides (PDF).

PPBP & EPBP insurer’s resources

House Bill 3359 adds new health plan network adequacy standards for preferred provider and exclusive provider benefit plans, also known as PPOs and EPOs. See TDI’s adopted rules (PDF).

Waiver hearings

TDI will hold virtual public hearings to consider insurers' requests to waive network adequacy standards. Health care providers and consumers can share information for TDI's consideration.

Find information about waiver requests on the Texas Open Data Portal (ODP) and the System for Electronic Rates & Forms Filing (SERFF).

Join upcoming hearings

Click on the date to get the Zoom link. All times are Central Time. Hearings will be recorded and archived. Attendees can speak or submit information. 

Get more details about these upcoming hearings:

July 9, 2024, 9 a.m.

• Moda Health Plan, Inc.
• Humana Insurance Company

July 11, 2024, 9 a.m.

• Ameritas Life Insurance Corp.
• Companion Life Insurance Company
• Equitable Financial Life Insurance Company
• Equitable Financial Life Insurance Company of America
• Kansas City Life Insurance Company
• Metropolitan Life Insurance Company
• Nationwide Life Insurance Company
• Principal Life Insurance Company
• Reliance Standard Life Insurance Company
• Renaissance Life & Health Insurance Company of America
• Standard Insurance Company
• Sun Life Assurance Company of Canada
• United Concordia Insurance Company
• Vision Service Plan Insurance Company

Speak at a hearing

Speakers must submit a Witness registration form. TDI asks that forms be submitted at least two business days before the hearing. If you do not wish to speak, there is no need to register.

The moderator will call your name when it’s your turn to speak.

If you need accommodations, email HumanResources@tdi.texas.gov or call 512-676-6112.

Note: Insurance Code Section 1301.00565 says certain out-of-network physicians and hospitals may decline to be identified by name at the hearing. TDI will make good faith efforts to not identify such speakers by name.

Submit written information

TDI will consider written information relating to a waiver request. The deadline to submit is one week after the hearing date. Send it to NetworkWaivers@tdi.texas.gov. Include the SERFF number of the waiver request in the subject line.

For all other communications, email MCQA@tdi.texas.gov.

Access recorded hearings

Archived recordings of past hearings are online.

Additional resources

See the FAQ and webinar for more information about waivers and the waiver hearing process. The webinar presentation slides (PDF) are online also.

Find information about waiver requests

You can find information on each waiver requested this year and the status of the request. See the Network adequacy waiver request filings webpage.

View data on all waiver requests

The ODP shows data for network filings and waiver requests submitted to TDI. Get information about waiver requests, including network adequacy standards, specialty types involved, and counties affected.

Learn how to use the ODP.

These datasets include information about waiver requests in the Major Medical Networks table:

• Network data for major medical health care providers
• Network data for facility-based providers

This dataset includes information about waiver requests in the Vision Networks table:

• Network data for vision providers

To see information about a particular waiver request, use the SERFF tracking number to search and filter within the datasets on the ODP.

View details of a single waiver request

SERFF shows details of a specific waiver request. Type the SERFF number in the “SERFF tracking number” field on SERFF Filing Access.

Learn how to search SERFF.

Waiver decisions

Waiver status can be found on the Network adequacy waiver request filings webpage.

See the decision letter in SERFF.

For waivers granted, the ODP includes:

• Name of the insurance company offering the plan/network.
• Name of the network.
• The network adequacy standards waived (maximum travel time and distance standards for the listed specialty type and county type).
• Counties affected.
• Effective period.
• Access plan.

More details about upcoming hearings

Get a list of past and upcoming hearings on Network adequacy waiver request filings.