reglab/housing_qa huggingface dataset:
TX Ins Code § 4007.002 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4007 - Notice to Department by Certain Property and Casualty Insurance Companies Regarding Agents|Section 4007.002. Notice to Department Required

Sec. 4007.002.  NOTICE TO DEPARTMENT REQUIRED.  (a)  On forms prescribed by the commissioner, an insurance company shall notify the department not later than the 30th day after the date on which:(1)  balances due from an insurance agent for more than 90 days exceed $1 million or 10 percent of the company's policyholder surplus computed on December 31 of the preceding year or the most recent quarter if a report is specifically required by the department;(2)  an agent's authority to settle claims for the company is withdrawn; or(3)  the contract with an agent is canceled or terminated.(b)  An insurance company may comply with the notification requirement of Subsection (a)(1) by submitting a single annual report if:(1)  the company routinely operates above the limit established by Subsection (a)(1); and(2)  the commissioner verifies that fact under a procedure adopted by the commissioner.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1I.001, eff. April 1, 2009.|
TX Ins Code § 4008.001 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.001. Purpose

Sec. 4008.001.  PURPOSE.  Certain insurance products are so complex that the general agent licensing and continuing education requirements are insufficient to ensure the level of agent expertise necessary to safeguard consumer interests.  Agents should be equipped with the necessary skills and knowledge to assist insureds appropriately in their purchases.  Requiring agent training or demonstration of knowledge before an agent may sell particularly complex products mitigates the negative impact caused by agents selling complex products without the training and knowledge necessary to sell those products in a manner that is fair and beneficial to insureds.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.002 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.002. Training and Examination Requirements Authorized

Sec. 4008.002.  TRAINING AND EXAMINATION REQUIREMENTS AUTHORIZED.  (a)  The commissioner may adopt rules requiring an agent who holds a license issued under this code to be certified, through specific education, training, examination, and experience requirements as provided by this chapter, before an agent may sell a product or product line designated by the commissioner.(b)  Education, training, examination, and experience requirements established by rule under this chapter may be used to satisfy any other agent education, training, examination, and experience requirements otherwise established under this code.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.003 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.003. Rules

Sec. 4008.003.  RULES.  (a)  In adopting rules under this chapter, the commissioner shall:(1)  designate the products or product lines that may not be sold without certification under this chapter; and(2)  specify the reasons why it is necessary that the sale of a designated product or product line requires education, experience, or examination.(b)  By rule, the commissioner may specify:(1)  any precertification education or experience that must be completed before a designated product or product line may be sold by an agent;(2)  whether an agent must complete a precertification examination concerning the designated product or product line the agent intends to sell;(3)  whether an agent certified under this chapter must complete specific continuing education to maintain the certificate; and(4)  whether, and if so, how frequently, an agent certified under this chapter must periodically retake the examination to maintain the certificate.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.004 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.004. Application of Certification Requirements to Certain Agents

Sec. 4008.004.  APPLICATION OF CERTIFICATION REQUIREMENTS TO CERTAIN AGENTS.  (a)  The commissioner by rule shall establish whether the certification requirements established under this chapter for sale by an agent of a designated product or product line apply:(1)  only to an agent who, as of the effective date of the certification requirement, does not hold the underlying agent license required to sell that product or product line; or(2)  to each licensed agent who engages in the sale of that product or product line.(b)  If the commissioner adopts rules requiring each agent described by Subsection (a)(2) to be certified under this chapter, the rules must specify the date by which the agent must comply with the certification requirements.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.005 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.005. Issuance of Certificate

Sec. 4008.005.  ISSUANCE OF CERTIFICATE.  The department shall issue a certificate under this chapter to an agent if the department determines that the agent:(1)  has submitted a properly completed certification application to the department in a form acceptable to the department;(2)  has completed, within the 12-month period preceding the date of the certification application, all requirements for the certification required by rules adopted under this chapter; and(3)  has not committed an act for which a license or certification may be denied under Subchapter C, Chapter 4005.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.006 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.006. Certificate Expiration

Sec. 4008.006.  CERTIFICATE EXPIRATION.  Unless the commissioner by rule specifies a different period, each certificate issued under this chapter expires on the expiration date of the agent's appropriate underlying license.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.007 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.007. Certificate Renewal

Sec. 4008.007.  CERTIFICATE RENEWAL.  (a)  An agent may renew an unexpired certificate before the expiration of the certificate by:(1)  completing all  renewal requirements established by rule under this chapter; and(2)  filing a properly completed renewal application with the department in a form acceptable to the department.(b)  A person may not renew a certificate that has been suspended or revoked.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4008.008 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle A - General Provisions|Chapter 4008 - Agent Certification and Education Programs for Complex Insurance Products|Section 4008.008. Administration by Testing Service Authorized

Sec. 4008.008.  ADMINISTRATION BY TESTING SERVICE AUTHORIZED.  The commissioner may accept an examination administered by a testing service, as provided under Subchapter B, Chapter 4002, to satisfy an examination requirement required by rule under this chapter.|Added by Acts 2009, 81st Leg., R.S., Ch. 451 (H.B. 2456), Sec. 5, eff. June 19, 2009.|
TX Ins Code § 4201.001 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter A. General Provisions|Section 4201.001. Purpose

Sec. 4201.001.  PURPOSE.  The purpose of this chapter is to:(1)  promote the delivery of quality health care in a cost-effective manner;(2)  ensure that a utilization review agent adheres to reasonable standards for conducting utilization review;(3)  foster greater coordination and cooperation between a health care provider and utilization review agent;(4)  improve communications and knowledge of benefits among all parties concerned before an expense is incurred; and(5)  ensure that a utilization review agent maintains the confidentiality of medical records in accordance with applicable law.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.003 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter A. General Provisions|Section 4201.003. Rules

Sec. 4201.003.  RULES.  (a)  The commissioner may adopt rules to implement this chapter.(b)  A rule adopted under this chapter relates only to a person or entity subject to this chapter.(c)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1147, Sec. 2.008(11), eff. September 1, 2011.(d)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1147, Sec. 2.008(11), eff. September 1, 2011.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.008(11), eff. September 1, 2011.|
TX Ins Code § 4201.004 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter A. General Provisions|Section 4201.004. Telephone Access

Sec. 4201.004.  TELEPHONE ACCESS.  (a)  A utilization review agent shall:(1)  have appropriate personnel reasonably available, by toll-free telephone at least 40 hours per week during normal business hours in this state, to discuss patients' care and allow response to telephone review requests;(2)  have a telephone system capable, during hours other than normal business hours, of accepting or recording incoming telephone calls or of providing instructions to a caller; and(3)  respond to a call made during hours other than normal business hours not later than the second working day after the later of:(A)  the date the call was received; or(B)  the date the details necessary to respond have been received from the caller.(b)  A utilization review agent must provide to the commissioner a written description of the procedures to be used when responding with respect to poststabilization care subsequent to emergency treatment as requested by a treating physician or other health care provider.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.051 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.051. Persons Providing Information About Scope of Coverage or Benefits

Sec. 4201.051.  PERSONS PROVIDING INFORMATION ABOUT SCOPE OF COVERAGE OR BENEFITS.  This chapter does not apply to a person who:(1)  provides information to an enrollee about scope of coverage or benefits provided under a health insurance policy or health benefit plan; and(2)  does not determine whether a particular health care service provided or to be provided to an enrollee is:(A)  medically necessary or appropriate; or(B)  experimental or investigational.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1330 (H.B. 4290), Sec. 8, eff. September 1, 2009.|
TX Ins Code § 4201.052 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.052. Certain Contracts With Federal Government

Sec. 4201.052.  CERTAIN CONTRACTS WITH FEDERAL GOVERNMENT.  This chapter does not apply to a contract with the federal government to provide utilization review with respect to a patient who is eligible for services under Title XVIII or XIX of the Social Security Act (42 U.S.C. Section 1395 et seq. or Section 1396 et seq.).|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.053 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.053. Medicaid and Other State Health or Mental Health Programs

Sec. 4201.053.  MEDICAID AND OTHER STATE HEALTH OR MENTAL HEALTH PROGRAMS. (a) Except as provided by Section 4201.057, this chapter does not apply to:(1)  the state Medicaid program;(2)  the services program for children with special health care needs under Chapter 35, Health and Safety Code;(3)  a program administered under Title 2, Human Resources Code;(4)  a program of the Department of State Health Services relating to mental health services;(5)  a program of the Department of Aging and Disability Services relating to intellectual disability services; or(6)  a program of the Texas Department of Criminal Justice.(b)  Sections 4201.303(c), 4201.304(b), 4201.357(a-1), and 4201.3601 do not apply to:(1)  the child health program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code;(2)  the Employees Retirement System of Texas or another entity issuing or administering a coverage plan under Chapter 1551;(3)  the Teacher Retirement System of Texas or another entity issuing or administering a plan under Chapter 1575 or 1579;(4)  The Texas A&M University System or The University of Texas System or another entity issuing or administering coverage under Chapter 1601; and(5)  a managed care organization providing a Medicaid managed care plan under Chapter 533, Government Code.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1037 (H.B. 1621), Sec. 1, eff. September 1, 2015.|
TX Ins Code § 4201.054 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.054. Workers' Compensation Benefits

Sec. 4201.054.  WORKERS' COMPENSATION BENEFITS.  (a)  Except as provided by this section, this chapter applies to utilization review of a health care service provided to a person eligible for workers' compensation medical benefits under Title 5, Labor Code. The commissioner of workers' compensation shall regulate as provided by this chapter a person who performs utilization review of a medical benefit provided under Title 5, Labor Code.(b)  Sections 4201.303(c), 4201.304(b), 4201.357(a-1), and 4201.3601 do not apply to utilization review of a health care service provided to a person eligible for workers' compensation benefits under Title 5, Labor Code.(c)  Title 5, Labor Code, prevails in the event of a conflict between this chapter and Title 5, Labor Code.(d)  The commissioner of workers' compensation may adopt rules as necessary to implement this section.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.Amended by: Acts 2007, 80th Leg., R.S., Ch. 134 (H.B. 1006), Sec. 7(a), eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 134 (H.B. 1006), Sec. 7(b), eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.075(a), eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.075(b), eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.075(a), eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.075(b), eff. September 1, 2007.Acts 2015, 84th Leg., R.S., Ch. 1037 (H.B. 1621), Sec. 2, eff. September 1, 2015.|
TX Ins Code § 4201.055 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.055. Health Care Service Provided Under Automobile Insurance Policy

Sec. 4201.055.  HEALTH CARE SERVICE PROVIDED UNDER AUTOMOBILE INSURANCE POLICY.  This chapter does not apply to utilization review of a health care service provided under an automobile insurance policy or contract that is authorized under Chapter 2301 or Article 5.13-2 or that is issued under Chapter 981.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.056 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.056. Employee Welfare Benefit Plans

Sec. 4201.056.  EMPLOYEE WELFARE BENEFIT PLANS.  This chapter does not apply to the terms or benefits of an employee welfare benefit plan defined by Section 3(1) of the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002(1)).|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.057 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.057. Health Maintenance Organizations

Sec. 4201.057.  HEALTH MAINTENANCE ORGANIZATIONS.  (a)  In this section, "health maintenance organization" includes a health maintenance organization that contracts with the Health and Human Services Commission or with an agency operating part of the state Medicaid managed care program to provide health care services to recipients of medical assistance under Chapter 32, Human Resources Code.(b)  This chapter applies to a health maintenance organization except as expressly provided by this section.(c)  As a condition of holding a certificate of authority to engage in the business of a health maintenance organization, a health maintenance organization that performs utilization review must:(1)  comply with this chapter, except Subchapter C; and(2)  submit to assessment of a maintenance tax under Chapter 258 to cover the costs of administering compliance with this subsection.(d)  The commissioner shall adopt rules for appropriate verification and enforcement of compliance with Subsection (c).(e)  Notwithstanding Subsection (c)(1), a health maintenance organization that performs utilization review for a person or entity subject to this chapter, other than a person or entity for which the health maintenance organization is the payor, must obtain a certificate of registration under Subchapter C and shall comply with all of the provisions of this chapter.(f)  This chapter does not prohibit or limit the distribution of a portion of the savings from the reduction or elimination of unnecessary medical services, treatment, supplies, confinements, or days of confinement in a health care facility through profit sharing, bonus, or withholding arrangements to a participating physician or participating health care provider for providing health care services to an enrollee.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.058 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter B. Applicability of Chapter|Section 4201.058. Insurers

Sec. 4201.058.  INSURERS.  (a)  This chapter applies to an insurer subject to this code that delivers or issues for delivery a health insurance policy in this state except as expressly provided by this section.  As a condition of holding a certificate of authority to engage in the business of insurance, an insurer that performs utilization review shall comply with this chapter, except Subchapter C.  The insurer is subject to assessment of a maintenance tax under Chapter 257 to cover the costs of administering compliance with this subsection.(b)  The commissioner shall adopt rules for appropriate verification and enforcement of compliance with Subsection (a).(c)  Notwithstanding Subsection (a), an insurer subject to this code that performs utilization review for a person or entity subject to this chapter, other than a person or entity for which the insurer is the payor, must obtain a certificate of registration under Subchapter C and shall comply with all of the provisions of this chapter.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.101 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter C. Certification|Section 4201.101. Certificate of Registration Required

Sec. 4201.101.  CERTIFICATE OF REGISTRATION REQUIRED.  A utilization review agent may not conduct utilization review unless the commissioner issues a certificate of registration to the agent under this subchapter.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.102 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter C. Certification|Section 4201.102. Requirements for Certification

Sec. 4201.102.  REQUIREMENTS FOR CERTIFICATION.  (a)  The commissioner may issue a certificate of registration only to an applicant who has met all the requirements of this chapter and all applicable rules adopted by the commissioner.(b)  As a condition of holding a certificate of registration or renewal of a certificate, a utilization review agent must maintain compliance with Subchapters D, E, and F.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|
TX Ins Code § 4201.103 (2021)
2021 Texas Statutes|Insurance Code|Title 14 - Utilization Review and Independent Review|Chapter 4201 - Utilization Review Agents|Subchapter C. Certification|Section 4201.103. Certificate Renewal

Sec. 4201.103.  CERTIFICATE RENEWAL.  Certification may be renewed biennially by filing, not later than March 1, a renewal form with the commissioner accompanied by a fee in an amount set by the commissioner.|Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.|