reglab/housing_qa huggingface dataset:
TX Ins Code § 4151.1042 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.1042. Responsibilities of Insurer; Semiannual Audit

Sec. 4151.1042.  RESPONSIBILITIES OF INSURER; SEMIANNUAL AUDIT.  (a)  If an insurer uses the services of an administrator, the insurer is responsible for determining the benefits, premium rates, reimbursement procedures, and claims payment procedures applicable to the coverage and for securing reinsurance, if any.  The insurer shall provide a copy of the written requirements relating to those matters to the administrator.  The responsibilities of the administrator as to any of those matters must be set forth in the written agreement between the administrator and the insurer.(b)  An insurer shall ensure competent administration of its programs.(c)  If an administrator administers benefits for more than 100 certificate holders, injured employees, plan participants, or policyholders on behalf of an insurer, the insurer shall, at least semiannually, conduct a review of the operations of the administrator.  At least biennially, the insurer shall conduct an on-site audit of the operations of the administrator.|Added by Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.12, eff. September 1, 2007.|
TX Ins Code § 4151.105 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.105. Payments to Administrator

Sec. 4151.105.  PAYMENTS TO ADMINISTRATOR.  (a)  If an insurer, plan, or plan sponsor uses the services of an administrator:(1)  a payment of a premium or contribution to the administrator by or on behalf of an insured or plan participant is considered to have been received by the insurer, plan, or plan sponsor;  and(2)  a payment of a return premium, contribution, or claim to the administrator by the insurer, plan, or plan sponsor is not considered payment to the insured, plan participant, or claimant until the insured, plan participant, or claimant receives the payment.(b)  This section does not limit a right of an insurer, plan, or plan sponsor against the administrator resulting from the administrator's failure to make a payment to an insured, plan participant, or claimant.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.106 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.106. Certain Funds Collected or Received by Administrator

Sec. 4151.106.  CERTAIN FUNDS COLLECTED OR RECEIVED BY ADMINISTRATOR.  (a)  An administrator who collects funds must identify and state separately in writing the amount of any premium or contribution specified by the insurer, plan, or plan sponsor for the coverage and provide the information to any person who pays to the administrator a premium or contribution.(b)  An administrator holds in a fiduciary capacity:(1)  a premium or contribution the administrator collects on behalf of an insurer, plan, or plan sponsor;  and(2)  a return premium the administrator receives from an insurer, plan, or plan sponsor.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.107 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.107. Delivery or Deposit of Certain Funds Received by Administrator

Sec. 4151.107.  DELIVERY OR DEPOSIT OF CERTAIN FUNDS RECEIVED BY ADMINISTRATOR.  (a)  On receiving a premium, contribution, or return premium, an administrator shall:(1)  timely deliver the funds to the person entitled to the funds according to terms of the written agreement;  or(2)  promptly deposit the funds in a fiduciary bank account established and maintained by the administrator.(b)  If premiums or contributions deposited in a fiduciary bank account were collected on behalf of more than one insurer, plan, or plan sponsor, the administrator shall:(1)  maintain records that clearly record separately the deposits to and withdrawals from the account on behalf of each insurer, plan, or plan sponsor;  and(2)  on request of an insurer, plan, or plan sponsor, provide to the insurer, plan, or plan sponsor a copy of the records relating to deposits and withdrawals on behalf of that insurer or plan.(c)  The requirements of Subsection (b):(1)  are in addition to requirements of any other federal or state law;  and(2)  do not authorize the commingling of funds if otherwise prohibited by law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.108 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.108. Withdrawals From Fiduciary Account

Sec. 4151.108.  WITHDRAWALS FROM FIDUCIARY ACCOUNT.  A withdrawal from a fiduciary bank account established under Section 4151.107 may be made only as provided in the written agreement for any of the following purposes:(1)  delivery to an insurer, plan, or plan sponsor entitled to payment;(2)  deposit in an account controlled and maintained in the name of the insurer, plan, or plan sponsor;(3)  transfer to and deposit in a claims payment account for payment of a claim as provided by Section 4151.111;(4)  payment to a group policyholder for delivery to the insurer entitled to payment;(5)  payment to the administrator of the administrator's commission, fees, or charges;(6)  delivery of a return premium to any person entitled to payment;  or(7)  payment of a premium for stop-loss or excess loss insurance.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.109 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.109. Payment of Claims From Fiduciary Account Prohibited

Sec. 4151.109.  PAYMENT OF CLAIMS FROM FIDUCIARY ACCOUNT PROHIBITED.  An administrator may not pay a claim from a fiduciary bank account established under Section 4151.107.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.110 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.110. Underwriting Standards

Sec. 4151.110.  UNDERWRITING STANDARDS.  If an administrator has the authority to accept or reject a risk, the written agreement must address underwriting or other standards of the insurer or plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.111 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.111. Adjudication of Claims

Sec. 4151.111.  ADJUDICATION OF CLAIMS.  (a)  An administrator shall adjudicate a claim not later than the 60th day after the date on which the administrator receives valid proof of loss in connection with the claim.(b)  The administrator shall pay each claim on a draft authorized by the insurer, plan, or plan sponsor in the written agreement.(c)  In the event of a conflict between this section and a provision of the Labor Code relating to time periods for adjudication and payment of workers' compensation claims, the Labor Code provision prevails.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.13, eff. September 1, 2007.|
TX Ins Code § 4151.112 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.112. Maintenance of Books and Records

Sec. 4151.112.  MAINTENANCE OF BOOKS AND RECORDS.  (a)  An administrator shall maintain at the administrator's principal administrative office adequate books and records of each transaction in which the administrator engages with an insurer, plan, plan sponsor, insured, or plan participant.(b)  The administrator shall maintain the books and records:(1)  until the fifth anniversary of the end of the term of the written agreement to which the books and records relate;  and(2)  in accordance with prudent standards of insurance recordkeeping.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.113 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.113. Access to Books and Records

Sec. 4151.113.  ACCESS TO BOOKS AND RECORDS.  (a)  For the purpose of examination, audit, and inspection, the administrator shall provide to the commissioner and the commissioner's designee access to the books and records maintained as required by Section 4151.112.(b)  A trade secret, including the identity and address of a policyholder, certificate holder, or injured employee, is confidential, except the commissioner may use that information in a proceeding against the administrator.(c)  An insurer, plan, or plan sponsor is entitled to continuing access to the books and records sufficient to permit the insurer, plan, or plan sponsor to fulfill a contractual obligation to an insured or plan participant.  The right provided by this subsection is subject to any restriction included in the written agreement relating to the parties' proprietary rights to the books and records.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.14, eff. September 1, 2007.|
TX Ins Code § 4151.114 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.114. Disposition of Books and Records on Termination of Written Agreement

Sec. 4151.114.  DISPOSITION OF BOOKS AND RECORDS ON TERMINATION OF WRITTEN AGREEMENT.  On termination of the written agreement, an administrator may fulfill the requirements of Sections 4151.112 and 4151.113 by:(1)  delivering the books and records:(A)  to a successor administrator;  or(B)  if there is not a successor administrator, to the insurer, plan, or plan sponsor;  and(2)  giving written notice to the commissioner of the location of the books and records.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.115 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.115. Confidentiality of Personal Information

Sec. 4151.115.  CONFIDENTIALITY OF PERSONAL INFORMATION.  (a)  Information that identifies an individual covered by a plan is confidential.(b)  During the time information described by Subsection (a) is in an administrator's custody or control, the administrator shall take all reasonable precautions to prevent disclosure or use of the information for a purpose unrelated to administration of the plan.(c)  The administrator shall disclose information described by Subsection (a) only:(1)  in response to a court order;(2)  for an examination conducted by the commissioner under this chapter;(3)  for an audit or investigation conducted under the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 et seq.);(4)  to or at the request of the insurer or plan sponsor;  or(5)  with the written consent of the identified individual or the individual's legal representative.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.116 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.116. Advertising

Sec. 4151.116.  ADVERTISING.  Before an administrator uses advertising relating to business underwritten by an insurer, plan, or plan sponsor, the insurer, plan, or plan sponsor must approve use of the advertising.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.117 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter C. Powers and Duties of Administrators and Insurers|Section 4151.117. Compensation of Administrator

Sec. 4151.117.  COMPENSATION OF ADMINISTRATOR.  (a)  An administrator's compensation may be determined:(1)  as a percentage of the premiums or charges the administrator collects or the amount of claims the administrator pays or processes; or(2)  except as provided by Subsection (b), on another basis as specified in the written agreement.(b)  An insurer or plan sponsor may not permit or provide compensation or another thing of value to an administrator that is based on the savings accruing to the insurer or plan sponsor because of adverse determinations regarding claims for benefits, reductions of or limitations on benefits, or other analogous actions inconsistent with this chapter, that are made or taken by the administrator.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.15, eff. September 1, 2007.|
TX Ins Code § 4151.151 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter D. Pharmacy Benefit Plans|Section 4151.151. Definition

Sec. 4151.151.  DEFINITION.  In this subchapter, "pharmacy benefit manager" means a person, other than a pharmacy or pharmacist, who acts as an administrator in connection with pharmacy benefits.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.152 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter D. Pharmacy Benefit Plans|Section 4151.152. Identification Cards

Sec. 4151.152.  IDENTIFICATION CARDS.  (a)  Except as provided by rules adopted by the commissioner, an administrator for a plan that provides pharmacy benefits shall issue an identification card to each individual covered by the plan.  The administrator shall issue the identification card not later than the 30th day after the date the administrator receives notice that the individual is eligible for the benefits.(b)  The commissioner by rule shall adopt standard information to be included on the identification card.  The standard form identification card must include:(1)  the name or logo of the entity administering the pharmacy benefits;(2)  the international identification number assigned by the American National Standards Institute for the entity administering the pharmacy benefits;(3)  the group number applicable to the covered individual;(4)  the effective date of the coverage evidenced by the card;(5)  a telephone number to be used to contact an appropriate person to obtain information relating to the pharmacy benefits provided under the coverage;  and(6)  copayment information for generic and brand-name prescription drugs.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.153 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter D. Pharmacy Benefit Plans|Section 4151.153. Disclosure of Certain Patient Information Prohibited

Sec. 4151.153.  DISCLOSURE OF CERTAIN PATIENT INFORMATION PROHIBITED.  (a)  A pharmacy benefit manager may not sell a list of patients that contains information through which the identity of an individual patient is disclosed. (b)  A pharmacy benefit manager shall maintain all data that identifies a patient in a confidential manner that prevents disclosure to a third party unless the disclosure is otherwise authorized by law or by the patient.(c)  This section does not prohibit:(1)  general advertising about a specific pharmaceutical product or service;  or(2)  the request and receipt by a person of information regarding:(A)  a specific pharmaceutical product or service;(B)  the person's own records or claims;  or(C)  the person's dependent's records or claims.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.154 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter D. Pharmacy Benefit Plans|Section 4151.154. Discount Health Care Programs

Sec. 4151.154.  DISCOUNT HEALTH CARE PROGRAMS.  A pharmacy benefit manager may not require a pharmacist or pharmacy to:(1)  accept or process a claim for prescription drugs under a discount health care program as defined by Section 7001.001 unless the pharmacist or pharmacy agrees in writing to accept or process the claim;(2)  participate in a specified provider network as a condition of processing a claim for prescription drugs under a discount health care program; or(3)  participate in, or process claims under, a discount health care program as a condition of participation in a provider network.|Added by Acts 2015, 84th Leg., R.S., Ch. 573 (H.B. 3028), Sec. 2, eff. September 1, 2015.|
TX Ins Code § 4151.201 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter E. Department Regulation of Administrators|Section 4151.201. Examination of Administrator

Sec. 4151.201.  EXAMINATION OF ADMINISTRATOR.  (a)  The commissioner may examine an administrator with regard to its business in this state.(b)  The commissioner may designate one or more employees to perform an examination.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.202 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter E. Department Regulation of Administrators|Section 4151.202. Contents of Examination; On-Site Evaluation

Sec. 4151.202.  CONTENTS OF EXAMINATION;  ON-SITE EVALUATION.  (a)  An examination under Section 4151.201 must include a review of:(1)  each existing written agreement between the administrator and an insurer or plan sponsor;  and(2)  the administrator's financial statements.(b)  The commissioner also may have examiners conduct an on-site evaluation of the administrator's personnel and facilities and any books and records of the administrator relating to the transaction of business by and the financial condition of the administrator.(c)  Before an examiner enters an administrator's property, the commissioner shall give notice to the administrator of the examiner's intent to conduct an on-site evaluation.  The notice must:(1)  be in the form required by rule adopted by the commissioner;  and(2)  include the date and estimated time that the examiner will enter the administrator's property.(d)  An examiner shall comply with operational rules of an administrator while on the administrator's property.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.203 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter E. Department Regulation of Administrators|Section 4151.203. Cost of Examination

Sec. 4151.203.  COST OF EXAMINATION.  The cost of an examination under Section 4151.201 shall be paid from the fee collected under Section 4151.206(a)(2) and with revenue from the maintenance tax levied under Chapter 259.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.204 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter E. Department Regulation of Administrators|Section 4151.204. Examination Under Oath

Sec. 4151.204.  EXAMINATION UNDER OATH.  If necessary to make a complete evaluation of the activities and operations of an administrator, the commissioner may summon and examine under oath the administrator and the administrator's personnel.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.205 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter E. Department Regulation of Administrators|Section 4151.205. Annual Report

Sec. 4151.205.  ANNUAL REPORT.  (a)  An administrator shall annually, not later than June 30, file with the commissioner a report on a form prescribed by the commissioner.  The report must contain any information  required by the commissioner and must be verified by at least two officers of the administrator.(b)  The annual report must cover the preceding calendar year.(c)  Except as provided by Subsection (f), the annual report must include an audited financial statement performed by an independent certified public accountant.  An audited financial statement prepared on a consolidated basis must include a columnar consolidating or combining worksheet that shall be filed with the annual report and must comply with the following:(1)  amounts shown on the consolidated audited financial report must be shown on the worksheet;(2)  amounts for each entity must be stated separately; and(3)  explanations of consolidating and eliminating entries must be included.(d)  The annual report must include notes to the financial statement or attachments that reflect the complete name and address of each insurer in this state with which the administrator had an agreement during the preceding fiscal year.(e)  Information derived from an audited financial statement contained in an annual report under this section is confidential and is not subject to disclosure under Chapter 552, Government Code.(f)  An administrator who receives less than $10 million annually as compensation for performing administrative services and operates under written agreements subject to this chapter with insurers or plan sponsors in this state is not required to file an audited financial statement under Subsection (c), but must file a financial statement certified in the manner prescribed by commissioner rule.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.17, eff. September 1, 2007.|