reglab/housing_qa huggingface dataset:
TX Ins Code § 4151.001 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.001. Definitions

Sec. 4151.001.  DEFINITIONS.  In this chapter:(1)  "Administrator" means a person who, in connection with annuities or life benefits, health benefits, accident benefits, pharmacy benefits, or workers' compensation benefits, collects premiums or contributions from or adjusts or settles claims for residents of this state.  The term includes a delegated entity under Chapter 1272 and a workers' compensation health care network authorized under Chapter 1305 that administers a workers' compensation claim for an insurer, including an insurer that establishes or contracts with the network to provide health care services.  The term does not include a person described by Section 4151.002.(2)  "Insurer" means a person who engages in the business of life, health, accident, or workers' compensation insurance under the law of this state.  For purposes of this chapter only, the term also includes an "insurance carrier," as defined by Section 401.011(27), Labor Code, other than a governmental entity or a workers' compensation self-insurance group subject to regulation under Chapter 407A, Labor Code.(3)  "Person" means an individual, partnership, corporation, organization, government or governmental subdivision or agency, business trust, estate trust, association, or any other legal entity.(4)  "Plan" means a plan, fund, or program established, adopted, or maintained by a plan sponsor or insurer to the extent that the plan, fund, or program is established, adopted, or maintained to provide indemnification or expense reimbursement for any type of life, health, or accident benefit.(5)  "Plan sponsor" means a person, other than an insurer, who establishes, adopts, or maintains a plan that covers residents of this state, including a plan established, adopted, or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, an association, a committee, a joint board of trustees, or any similar group of representatives who establish, adopt, or maintain a plan.(6)  "Workers' compensation benefits" means benefits provided under Title 5, Labor Code, or services provided through a certified workers' compensation health care network authorized under Chapter 1305.(7)  "Workers' compensation insurance coverage" means  coverage subject to Subtitle E, Title 10.  The term includes coverage described by Sections 401.011(44)(A) and (B), Labor Code.(8)  "Workers' compensation self-insurer" means a legal entity subject to regulation under Chapter 407, Labor Code.|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. 1.01, eff. September 1, 2007.|
TX Ins Code § 4151.0021 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.0021. Applicability to Certain Processing Agents

Sec. 4151.0021.  APPLICABILITY TO CERTAIN PROCESSING AGENTS.  (a)  In this section, "processing agent" means a person described by Section 413.0111, Labor Code.(b)  A processing agent is not an administrator for purposes of this chapter if the processing agent is acting as an assignee of a pharmacy and if:(1)  the assignee has a written contract with the pharmacy to:(A)  act as the provider of licensed pharmacy services in lieu of the pharmacy; and(B)  purchase the pharmacy's claims at face value, or at a value expressly stated in the contract; and(2)  the contract specifically prohibits the assignee from performing any function of an administrator, as that term is defined in this chapter, unless the assignee holds a certificate of authority under this chapter.|Added by Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.03, eff. September 1, 2007.|
TX Ins Code § 4151.0022 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.0022. Nonapplicability

Sec. 4151.0022.  NONAPPLICABILITY.  This chapter does not apply to a health care sharing ministry operated under Chapter 1681.|Added by Acts 2013, 83rd Leg., R.S., Ch. 455 (S.B. 874), Sec. 4, eff. June 14, 2013.|
TX Ins Code § 4151.003 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.003. Applicability of Other Provisions of Code

Sec. 4151.003.  APPLICABILITY OF OTHER PROVISIONS OF CODE.  An administrator is subject to Section 823.457, Subchapter H of Chapter 101, Chapter 541, Subchapter A of Chapter 542, and Chapter 804.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.0031 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.0031. Market Analysis

Sec. 4151.0031.  MARKET ANALYSIS.  The commissioner may conduct market analyses and examinations of an administrator under Chapter 751.|Added by Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.03, eff. September 1, 2007.|
TX Ins Code § 4151.004 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.004. Applicability to Certain Insurers and Health Maintenance Organizations

Sec. 4151.004.  APPLICABILITY TO CERTAIN INSURERS AND HEALTH MAINTENANCE ORGANIZATIONS.  An insurer or health maintenance organization that is not exempt under Section 4151.002(3) or (4) is subject to all provisions of this chapter other than Sections 4151.005, 4151.051-4151.054, 4151.056, and 4151.206(a)(1).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.005 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.005. Administrator Not Insurance Agent

Sec. 4151.005.  ADMINISTRATOR NOT INSURANCE AGENT.  (a)  An administrator licensed in any state who accepts an agent's commission for coverage for a risk located in this state and disburses that commission to an agent in this state is not considered an agent for purposes of this state's laws relating to the licensing of agents.(b)  The exemption provided by this section does not authorize an administrator to perform any other act for which a license as an agent is required by law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.0051 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.0051. Referral to Adjuster by Administrator

Sec. 4151.0051.  REFERRAL TO ADJUSTER BY ADMINISTRATOR.  (a)  An administrator may not knowingly refer a claim or loss for adjustment in this state to an individual purporting to be or acting as an adjuster unless the individual holds a license under Chapter 4101.(b)  Before first referring a claim or loss for adjustment, an administrator must ascertain from the commissioner whether the individual selected to perform the adjustment holds a license under Chapter 4101.  After receipt of information from the department that the individual does hold an adjuster license, the administrator may refer claims or losses to the individual for adjustment until the administrator has actual knowledge or receives information from the department that the individual no longer holds an adjuster license under Chapter 4101.  The department shall keep an updated list of individuals who hold adjuster licenses.|Added by Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.03, eff. September 1, 2007.|
TX Ins Code § 4151.006 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter A. General Provisions|Section 4151.006. Rules

Sec. 4151.006.  RULES.  The commissioner may adopt, in the manner prescribed by Subchapter A, Chapter 36, rules that are fair, reasonable, and appropriate to augment and implement this chapter, including rules establishing financial standards, reporting requirements, and required contract provisions.|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. 1.04, eff. September 1, 2007.|
TX Ins Code § 4151.051 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter B. Certificate of Authority|Section 4151.051. Certificate of Authority Required

Sec. 4151.051.  CERTIFICATE OF AUTHORITY REQUIRED.  (a)  An individual, corporation, organization, trust, partnership, or other legal entity may not act as or hold itself out as an administrator unless the entity is covered by and is engaging in business under a certificate of authority issued under this chapter.(b)  An administrator is required to hold only one certificate of authority issued under this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.052 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter B. Certificate of Authority|Section 4151.052. Application

Sec. 4151.052.  APPLICATION.  (a)  An application for a certificate of authority to engage in business as an administrator must be in a form prescribed by the commissioner and must include the following:(1)  a copy of each basic organizational document of the applicant, including the articles of incorporation, bylaws, articles of association, trade name certificate, and any other similar document and a copy of any amendment to any of those documents;(2)  a description of the applicant and the applicant's services, facilities, and personnel;(3)  if the applicant is not domiciled in this state, a power of attorney executed by the applicant appointing the commissioner, the commissioner's successors in office, or the commissioner's appointed designee as the applicant's attorney in this state on whom process may be served in any legal action or proceeding based on a cause of action arising in this state against the applicant;(4)  an audited financial statement of the applicant covering the preceding three calendar years or any lesser period that the applicant and any predecessors of the applicant have been in existence, or if an audited financial statement is not available, an unaudited financial statement as of a date not earlier than the 120th day before the date the application is filed, accompanied by an affidavit or certification of the applicant that:(A)  the unaudited financial statement is true and correct, as of its date; and(B)  a material change in financial condition has not occurred from the date of the financial statement to the execution date of the affidavit or certification; and(5)  any other information the commissioner reasonably requires.(b)  An applicant for a certificate of authority or a certificate holder under this chapter shall notify the department in the manner prescribed by commissioner rule of a change of control in the applicant's or certificate holder's ownership not later than the 30th day after the effective date of the change and shall notify the department of any other fact or circumstance affecting the applicant's or certificate holder's qualifications for a certificate of authority in this state as required 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. 1.05, eff. September 1, 2007.|
TX Ins Code § 4151.053 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter B. Certificate of Authority|Section 4151.053. Approval of Application

Sec. 4151.053.  APPROVAL OF APPLICATION.  The commissioner shall approve an application for a certificate of authority to engage in business in this state as an administrator if the commissioner is satisfied that:(1)  granting the application would not violate a federal or state law;(2)  the financial condition of the applicant or of each person who would operate or control the applicant is such that granting a certificate of authority would not be adverse to the public interest;(3)  the applicant has not attempted to obtain the certificate of authority through fraud or bad faith;(4)  the applicant has complied with this chapter and rules adopted by the commissioner under this chapter;  and(5)  the name under which the applicant will engage in business in this state is not so similar to that of another administrator or insurer that it is likely to mislead the public.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.054 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter B. Certificate of Authority|Section 4151.054. Denial of Application

Sec. 4151.054.  DENIAL OF APPLICATION.  (a)  If the commissioner is unable to approve an application for a certificate of authority, the commissioner shall:(1)  provide the applicant with written notice specifying each deficiency in the application;  and(2)  offer the applicant the opportunity for a hearing to address each reason and circumstance for possible denial of the application.(b)  The commissioner must provide an opportunity for a hearing before the commissioner finally denies an application.(c)  At the hearing, the applicant has the burden to produce sufficient competent evidence on which the commissioner can make the determinations required by Section 4151.053.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.055 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter B. Certificate of Authority|Section 4151.055. Fidelity Bond Required

Sec. 4151.055.  FIDELITY BOND REQUIRED.  (a)  If the commissioner approves an application for a certificate of authority, before the commissioner issues the certificate of authority, the applicant must:(1)  obtain and maintain a fidelity bond that complies with this section;  and(2)  submit to the commissioner proof that the applicant has obtained the fidelity bond.(b)  The fidelity bond must protect against an act of fraud or dishonesty by the applicant in exercising the applicant's powers and duties as administrator.(c)  The fidelity bond may not be less than $10,000 and may not be more than the lesser of:(1)  10 percent of the amount of funds handled during the preceding year or, if no funds were handled during the preceding year, 10 percent of the amount of funds reasonably estimated to be handled by the administrator during the current calendar year;  or(2)  $500,000.(d)  On written request by an administrator for reduction of the amount of the fidelity bond for a particular year, the commissioner may authorize the reduction of the amount of the bond if the administrator presents evidence that the amount of funds to be handled during that year will be less than the amount handled during the preceding year.(e)  For purposes of this section, the amount of funds handled by a person in the person's capacity as administrator is either the total amount of premiums and contributions received by the administrator or the total amount of benefits paid by the administrator, whichever is greater, during the preceding calendar year in all jurisdictions in which the person acts as an administrator.(f)  Unless the administrator and the insurer or plan agree otherwise in writing, an administrator is required to obtain and maintain only one fidelity bond for all insurers and plans for which the administrator acts as administrator in this state.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.|
TX Ins Code § 4151.056 (2021)
2021 Texas Statutes|Insurance Code|Title 13 - Regulation of Professionals|Subtitle D - Other Professionals|Chapter 4151 - Third-Party Administrators|Subchapter B. Certificate of Authority|Section 4151.056. Duration of Certificate of Authority

Sec. 4151.056.  DURATION OF CERTIFICATE OF AUTHORITY.  A certificate of authority issued to an administrator under this chapter is effective until it is suspended, canceled, or revoked.  The issuance, denial, suspension, cancellation, or revocation of a certificate of authority to act as an administrator is subject to:(1)  Subchapters B and C, Chapter 4005;(2)  Chapter 82; and(3)  Subchapter G.|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. 1.06, eff. September 1, 2007.|
TX Ins Code § 4151.101 (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 4151.101. Written Agreement With Insurer or Plan Sponsor Required

Sec. 4151.101.  WRITTEN AGREEMENT WITH INSURER OR PLAN SPONSOR REQUIRED.  (a)  An administrator may provide services only under a written agreement with an insurer or plan sponsor.(b)  The commissioner by rule may prescribe provisions that must be included in the written agreement.|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. 1.08, eff. September 1, 2007.|
TX Ins Code § 4151.102 (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 4151.102. Contents of Written Agreement

Sec. 4151.102.  CONTENTS OF WRITTEN AGREEMENT.  (a)  The written agreement must include each requirement prescribed by this subchapter except for a requirement that does not apply to any function the administrator performs.(a-1)  The written agreement must include a statement of the duties that the administrator is expected to perform on behalf of the insurer, and the lines, classes, or types of insurance that the administrator is authorized to administer.  The agreement must include, as applicable, provisions regarding claims handling and other standards relating to the business underwritten by the insurer.(b)  If a policy or plan document is issued to a trustee, a copy of the trust agreement and any amendment to that trust agreement becomes part of the written agreement.(c)  The written agreement may not contain a provision that unreasonably restricts the availability to a plan participant of an individual life, health, or accident policy or annuity through an agent selected by the plan participant.|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. 1.09, eff. September 1, 2007.|
TX Ins Code § 4151.103 (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 4151.103. Retention of Written Agreement; Inspection by Commissioner

Sec. 4151.103.  RETENTION OF WRITTEN AGREEMENT;  INSPECTION BY COMMISSIONER.  (a)  The administrator and the insurer, plan, or plan sponsor shall retain a copy of the written agreement as part of their official records:(1)  during the term of the agreement; and(2)  until the fifth anniversary of the date on which the agreement expires.(b)  On written request by the commissioner, the administrator shall make the written agreement available for inspection by the commissioner or the commissioner's designee.(c)  Information the commissioner or the commissioner's designee obtains from the written agreement is confidential and may not be made available to the public.  An employee of the department may examine the information in exercising powers and performing duties under this chapter.(d)  The commissioner shall adopt rules to address the transfer of records from one administrator to another.|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. 1.10, eff. September 1, 2007.|
TX Ins Code § 4151.104 (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 4151.104. Notice of Use of Administrator's Services

Sec. 4151.104.  NOTICE OF USE OF ADMINISTRATOR'S SERVICES.  (a)  If an insurer, plan, or plan sponsor uses the services of an administrator, the administrator shall give written notice to each insured and injured employee of the administrator's identity and the relationship among the administrator and the insurer, plan, or plan sponsor and the insured and injured employee.  The insurer, plan, or plan sponsor must approve the notice before the notice is distributed.(b)  An administrator administering workers' compensation claims may satisfy the requirements of Subsection (a) by including the notice as part of, or in conjunction with, the notice required under Section 406.005(c), Labor Code.(c)  An administrator who fails to provide notice as required by Subsection (a) is subject to an administrative penalty in the manner provided by Chapter 84.|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. 1.11, eff. September 1, 2007.|
TX Ins Code § 4151.1041 (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 4151.1041. Referral by Insurer

Sec. 4151.1041.  REFERRAL BY INSURER.  (a)  An insurer may not knowingly refer a claim or loss for administration in this state to a person purporting to be or acting as an administrator unless the person holds a certificate of authority under this chapter.(b)  Before first referring a claim or loss for administration, an insurer must ascertain from the commissioner whether the person performing the administration holds a certificate of authority under this chapter.  Once the insurer has ascertained that the person holds a certificate of authority, the insurer may refer a claim to the person for administration and may continue to refer claims to the person until the insurer has knowledge or receives information from the commissioner that the person no longer holds a certificate of authority.|Added by Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.12, eff. September 1, 2007.|