reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter C. Relations With Other States › Section 751.101. Commissioner Authority; Interactions With Other Insurance Commissioners of Other States

Sec. 751.101.  COMMISSIONER AUTHORITY; INTERACTIONS WITH OTHER INSURANCE COMMISSIONERS OF OTHER STATES.  (a)  The commissioner has responsibility for conducting market conduct examinations on domestic insurers.  The commissioner may delegate that responsibility to the insurance commissioner of another state, if that insurance commissioner agrees to accept the delegated responsibility.  If the commissioner elects to delegate responsibility for examining an insurer, the commissioner shall accept a report of the examination prepared by the insurance commissioner to whom the responsibility has been delegated.
(b)  If the insurer to be examined is part of an insurance holding company system, the commissioner may also seek to simultaneously examine any affiliate of the insurer that is authorized to write the same types of insurance in this state as the insurer if the insurance commissioner of the state in which the affiliate is organized consents and delegates responsibility for that examination.
(c)  In lieu of conducting a targeted examination of an insurer that holds a certificate of authority in this state but is not a domestic insurer, the commissioner shall accept a report of a market conduct examination regarding that insurer prepared by the insurance commissioner of the state in which the insurer is organized or by another state if:
(1)  the laws of the examining state that are applicable to the subject of the examination are substantially similar to those of this state; and
(2)  the examining state has a market conduct surveillance system that the commissioner deems comparable to the market conduct surveillance system required under this chapter.
(d)  The commissioner's determination under Subsection (c)(2) is discretionary with the commissioner and is not subject to appeal.
(e)  Subject to a determination under Subsection (c), if a market conduct examination conducted by another state results in a finding that an insurer should modify a specific practice or procedure, the commissioner shall accept documentation that the insurer has made a similar modification in this state in lieu of initiating a market conduct action or examination related to that practice or procedure.  The commissioner may require other or additional practice or procedure modifications.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter D. Market Analysis Procedures › Section 751.151. Collection of Information; Commissioner Analysis

Sec. 751.151.  COLLECTION OF INFORMATION; COMMISSIONER ANALYSIS.  (a)  Subject to Subsection (d), the commissioner shall gather insurance market information from:
(1)  data available to the department, including survey results and information required to be reported to the department;
(2)  information collected by the National Association of Insurance Commissioners and other public and private sources; and
(3)  information from within and outside the insurance industry.
(b)  The commissioner shall analyze the information compiled under Subsection (a) as necessary to:
(1)  develop a baseline understanding of the insurance marketplace; and
(2)  identify for further review insurers or insurance practices that deviate significantly from the norm or that pose a potential risk to the insurance consumer.
(c)  The commissioner shall use the market analysis handbook as a resource in performing the analysis required under this section.
(d)  Except as otherwise specifically provided, the department or the commissioner, as applicable, may not require an insurer to report information in a manner that is inconsistent with the records the insurer maintains in the ordinary course of business or can create at a reasonable expense or effort.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter D. Market Analysis Procedures › Section 751.152. Additional Analysis of Market Actions

Sec. 751.152.  ADDITIONAL ANALYSIS OF MARKET ACTIONS.  (a)  If, as a result of the market analysis, the commissioner determines that further inquiry into a particular insurer or insurance practice is needed, the commissioner shall consider taking one or more of the market conduct actions described by Subsection (b) before conducting a targeted examination.  If a market conduct action selected by the commissioner requires the participation of or a response by the affected insurer, the commissioner shall notify the insurer of the action selected in writing.
(b)  Market conduct actions described by Subsection (a) may include:
(1)  correspondence with the insurer;
(2)  insurer interviews;
(3)  information gathering;
(4)  policy and procedure reviews;
(5)  interrogatories; and
(6)  review of insurer self-evaluation and compliance programs, including insurer membership in a best-practice organization.
(c)  The commissioner shall select market conduct actions that are efficient and cost-effective for the department and the insurer while protecting the interests of the insurance consumer.
(d)  The commissioner shall take steps reasonably necessary to:
(1)  eliminate requests for information that duplicates or conflicts with information provided as part of an insurer's annual financial statement, the annual market conduct statement of the National Association of Insurance Commissioners, or other required schedules, surveys, or reports that are regularly submitted to the commissioner, or with data requests made by other states if that information is available to the commissioner, unless the information is state specific; and
(2)  coordinate the market conduct actions and findings of this state with those of other states.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.201. Examination

Sec. 751.201.  EXAMINATION.  (a)  If the commissioner determines that a market conduct action described by Section 751.152(b) is not appropriate, the commissioner may conduct a targeted examination in accordance with the market conduct uniform examination procedures and the market conduct examiners handbook.
(b)  A targeted examination may be conducted through a desk examination or an on-site examination.  To the extent feasible, the department shall conduct a market conduct examination through desk examinations and data requests before conducting an on-site examination.
(c)  The department shall conduct an examination in accordance with the market conduct examiners handbook and the market conduct uniform examinations procedures.
(d)  The department shall use the standard data request or a successor product that is substantially similar to the standard data request as adopted by the commissioner by rule.
(e)  If the insurer to be examined is not a domestic insurer, the commissioner shall coordinate the examination with the insurance commissioner of the state in which the insurer is organized.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.202. Work Plan

Sec. 751.202.  WORK PLAN.  Before beginning an examination, market conduct surveillance personnel shall prepare a work plan that includes:
(1)  the name and address of the insurer to be examined;
(2)  the name and contact information of the examiner-in-charge;
(3)  a statement of the reasons for the examination;
(4)  a description of the scope of the examination;
(5)  the date the examination is scheduled to begin;
(6)  notice to any non-insurance department personnel who will assist in the examination;
(7)  a time estimate for the examination; and
(8)  if the cost of the examination is billed to the affected insurer:
(A)  a budget for the examination; and
(B)  an identification of factors that will be included in the billing.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.203. Notice of Examination

Sec. 751.203.  NOTICE OF EXAMINATION.  (a)  Unless the examination is conducted in response to extraordinary circumstances as described by Section 751.153(b), the department shall notify an affected insurer of an examination not later than the 60th day before the scheduled date of the beginning of the examination.  The notice must include the examination work plan and a request that the insurer name an examination coordinator for the insurer.
(b)  In addition to the notice required under Subsection (a), the commissioner shall post notice that a market conduct examination has been scheduled on the National Association of Insurance Commissioners examination tracking system.
(c)  If a targeted examination is expanded beyond the reasons provided to the insurer in the notice of the examination required under Subsection (a), the commissioner shall provide written notice to the insurer, explaining the extent of the expansion and the reasons for the expansion.  The department shall provide a revised work plan to the insurer before the beginning of any significantly expanded examination.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.204. Pre-Examination Conference

Sec. 751.204.  PRE-EXAMINATION CONFERENCE.  Not later than the 30th day before the scheduled date of the examination, the commissioner shall conduct a pre-examination conference with the insurer's examination coordinator and key personnel to clarify expectations.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.205. Exit Conference

Sec. 751.205.  EXIT CONFERENCE.  Before the conclusion of an examination, the member of the market conduct surveillance personnel who is designated as the examiner-in-charge shall schedule an exit conference with the insurer.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.206. Examination Report

Sec. 751.206.  EXAMINATION REPORT.  (a)  Unless the commissioner and the insurer agree to a different schedule, the commissioner shall follow the time line established under this section.
(b)  The commissioner shall deliver the draft examination report to the insurer not later than the 60th day after the date the examination is completed.  For purposes of this section, the date the examination is completed is the date on which the exit conference is conducted.
(c)  Not later than the 30th day after the date on which the insurer receives the draft examination report, the insurer shall provide any written comments regarding the report to the department.
(d)  The department shall make a good faith effort to resolve issues with the insurer informally and shall prepare a final examination report not later than the 30th day after the date of receipt of the insurer's written comments on the draft report unless a mutual agreement is reached to extend the deadline.
(e)  The department shall include the insurer's responses in the final examination report.  The responses may be included as an appendix or in the text of the examination report.  An insurer is not obligated to submit a response.  An individual involved in the examination may not be named in either the report or the insurer response except to acknowledge the individual's involvement.
(f)  The commissioner may make corrections and other changes to the final examination report as appropriate, and shall issue the report to the insurer.  Not later than the 30th day after receipt of the final examination report under this subsection, the insurer shall accept the report, accept the findings of the report, or request a hearing.  The commissioner and the insurer by mutual agreement may extend the period for an additional 30 days.  A request for a hearing must be made in writing and must follow the requirements of Chapter 2001, Government Code.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.207. Confidentiality of Examination Report Information

Sec. 751.207.  CONFIDENTIALITY OF EXAMINATION REPORT INFORMATION.  (a)  A final or preliminary market conduct examination report, and any information obtained during the course of an examination, is confidential and is not subject to disclosure under Chapter 552, Government Code.  This section may not be construed to limit the commissioner's authority to use any final or preliminary market conduct examination report, any examiner or company work papers or other documents, or any other information discovered or developed during the course of an examination in the furtherance of any legal or regulatory action that the commissioner, in the commissioner's sole discretion, may deem appropriate.
(b)  This chapter does not prevent the commissioner from disclosing at any time the contents of a final market conduct examination report to the department, the insurance department of any other state, or an agency of the federal government, if the department or agency receiving the report agrees in writing to maintain the information as confidential and in a manner consistent with this chapter.
(c)  The commissioner shall provide to an insurer subject to a final market conduct examination a written agreement described by Subsection (b) not later than the fifth day after the date the final market conduct examination is released under Subsection (b).
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.208. Assessment of Costs of Examination

Sec. 751.208.  ASSESSMENT OF COSTS OF EXAMINATION.  (a)  Subject to Subsection (d), if the reasonable and necessary cost of a market conduct examination is to be assessed against the affected insurer, fees for that cost must be consistent with those otherwise authorized by law.  The fees must be itemized and bills for the fees must be provided to the insurer on a monthly basis for review prior to submission for payment.
(b)  The commissioner shall actively manage and oversee examination costs, including costs associated with the use of department examiners and with retaining qualified contract examiners necessary to perform an on-site examination.  To the extent the commissioner retains outside assistance, the commissioner shall adopt by rule written protocols that:
(1)  clearly identify the types of functions to be subject to outsourcing;
(2)  provide specific time lines for completion of the outsourced review;
(3)  require disclosure of recommendations made by contract examiners;
(4)  establish and use a dispute resolution or arbitration mechanism to resolve conflicts with insurers regarding examination fees; and
(5)  require disclosure of the terms of contracts entered into with outside consultants, and specifically terms regarding the fees or hourly rates that may be charged by those consultants.
(c)  The commissioner must review and affirmatively endorse detailed billings made by a qualified contract examiner before the detailed billings are sent to the insurer.
(d)  An insurer may not be required to provide reimbursement for examiner fees under Subsection (a), whether those fees are incurred by market conduct surveillance personnel or qualified contract examiners, to the extent that those fees exceed the fees prescribed in the market conduct examiners handbook and any successor documents to that handbook, unless the commissioner demonstrates that the fees prescribed in the handbook are inadequate under the circumstances of the examination.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter E. Examinations › Section 751.209. Limit on Certain Examinations

Sec. 751.209.  LIMIT ON CERTAIN EXAMINATIONS.  The commissioner may not conduct a market conduct examination more frequently than once every three years.  The commissioner may defer conducting a market conduct examination for longer than once every three years.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter F. Confidentiality Requirements › Section 751.251. No Waiver

Sec. 751.251.  NO WAIVER.  (a)  The disclosure to the commissioner under this subchapter of a document, material, or information does not constitute the waiver of any applicable privilege or claim of confidentiality regarding the document, material, or information.
(b)  Notwithstanding Subsection (a), an insurer may not be compelled to disclose a self-audit document or waive any statutory or common law privilege.  An insurer may, however, voluntarily disclose a document described by this subsection to the commissioner in response to any market conduct action or examination.
(c)  For the purposes of Subsection (b), "self-audit document" means a document that is prepared as a result of or in connection with an insurance compliance audit.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter F. Confidentiality Requirements › Section 751.252. Authority of Commissioner

Sec. 751.252.  AUTHORITY OF COMMISSIONER.  (a)  The commissioner may share documents, materials, or other information obtained by or disclosed to the commissioner under this chapter with other state, federal, and international regulatory agencies and law enforcement authorities if the recipient agrees to and has the legal authority to maintain the confidentiality and privileged status of the document, material, or other information.
(b)  The commissioner may receive documents, materials, or information, including otherwise confidential and privileged documents, materials, or information, from the National Association of Insurance Commissioners and that association's affiliates or subsidiaries, and from regulatory and law enforcement officials of other foreign or domestic jurisdictions.  The commissioner shall maintain as confidential or privileged any document, material, or information received with notice or the understanding that the document, material, or information is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information.
(c)  Consistent with this section, the commissioner may enter into agreements governing the sharing and use of information.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter G. Market Conduct Surveillance Personnel › Section 751.301. Personnel; Qualifications

Sec. 751.301.  PERSONNEL; QUALIFICATIONS.  (a)  To conduct market conduct surveillance under this chapter, the commissioner may designate department staff to perform duties under this chapter, and may supplement that staff with qualified outside professional assistance if the commissioner determines that that assistance is necessary.
(b)  Market conduct surveillance personnel must be qualified by education and experience and, if applicable, must hold appropriate professional designations.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter G. Market Conduct Surveillance Personnel › Section 751.302. Conflict of Interest

Sec. 751.302.  CONFLICT OF INTEREST.  (a)  An individual who is a member of the market conduct surveillance personnel has a conflict of interest, either directly or indirectly, if the individual is affiliated with the management of, has been employed by, or owns a pecuniary interest in an insurer subject to an examination conducted under this chapter.
(b)  This section may not be construed to automatically preclude the individual from being:
(1)  a policyholder or claimant under an insurance policy;
(2)  a grantee of a mortgage or similar instrument on the individual's residence from a regulated entity if done under customary terms and in the ordinary course of business;
(3)  an investment owner in shares of regulated diversified investment companies; or
(4)  a settlor or beneficiary of a blind trust into which any otherwise permissible holdings have been placed.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter G. Market Conduct Surveillance Personnel › Section 751.303. Access to Information

Sec. 751.303.  ACCESS TO INFORMATION.  (a)  Except as otherwise provided by law, market conduct surveillance personnel shall, as practicable, have free and full access to all books and records, and all employees, officers, and directors, of the insurer during regular business hours.
(b)  On the request of market conduct surveillance personnel, an insurer that uses a third-party model or product for any of the activities under examination shall make the details of those models or products available to that personnel.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter G. Market Conduct Surveillance Personnel › Section 751.304. Authority of Market Conduct Surveillance Personnel

Sec. 751.304.  AUTHORITY OF MARKET CONDUCT SURVEILLANCE PERSONNEL.  Market conduct surveillance personnel may examine insurance company personnel under oath if that action is ordered by the commissioner under Subchapter C, Chapter 36.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 751 - Market Conduct Surveillance › Subchapter H. Sanctions › Section 751.351. Sanctions

Sec. 751.351.  SANCTIONS.  (a)  The commissioner may impose sanctions under Chapter 82 against an insurer determined, as a result of a market conduct action or other action under this chapter, to have violated this code, a rule adopted under this code, or another insurance law of this state.
(b)  In determining an appropriate sanction under Subsection (a) the commissioner shall consider:
(1)  any actions taken by the insurer to maintain membership in, and comply with the standards of, best-practice organizations that promote high ethical standards of conduct in the insurance marketplace; and
(2)  the extent to which the insurer maintains regulatory compliance programs to self-assess, self-report, and remediate problems detected by the insurer.
Added by Acts 2005, 79th Leg., Ch. 291 (S.B. 14), Sec. 3, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 752 - Enforcement of Balance Billing Prohibitions › Section 752.0001. Definition

Sec. 752.0001.  DEFINITION.  In this chapter, "administrator" has the meaning assigned by Section 1467.001.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.01, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 752 - Enforcement of Balance Billing Prohibitions › Section 752.0002. Injunction for Balance Billing

Sec. 752.0002.  INJUNCTION FOR BALANCE BILLING.  (a)  If the attorney general receives a referral from the appropriate regulatory agency indicating that an individual or entity, including a health benefit plan issuer or administrator, has exhibited a pattern of intentionally violating a law that prohibits the individual or entity from billing an insured, participant, or enrollee in an amount greater than an applicable copayment, coinsurance, and deductible under the insured's, participant's, or enrollee's managed care plan or that imposes a requirement related to that prohibition, the attorney general may bring a civil action in the name of the state to enjoin the individual or entity from the violation.
(b)  If the attorney general prevails in an action brought under Subsection (a), the attorney general may recover reasonable attorney's fees, costs, and expenses, including court costs and witness fees, incurred in bringing the action.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.01, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 5 - Protection of Consumer Interests › Subtitle G - Regulation of Insurer Market Conduct › Chapter 752 - Enforcement of Balance Billing Prohibitions › Section 752.0003. Enforcement by Regulatory Agency

Sec. 752.0003.  ENFORCEMENT BY REGULATORY AGENCY.  (a)  An appropriate regulatory agency that licenses, certifies, or otherwise authorizes a physician, health care practitioner, health care facility, or other health care provider to practice or operate in this state may take disciplinary action against the physician, practitioner, facility, or provider if the physician, practitioner, facility, or provider violates a law that prohibits the physician, practitioner, facility, or provider from billing an insured, participant, or enrollee in an amount greater than an applicable copayment, coinsurance, and deductible under the insured's, participant's, or enrollee's managed care plan or that imposes a requirement related to that prohibition.
(b)  The department may take disciplinary action against a health benefit plan issuer or administrator if the issuer or administrator violates a law requiring the issuer or administrator to provide notice of a balance billing prohibition or make a related disclosure.
(c)  A regulatory agency described by Subsection (a) or the commissioner may adopt rules as necessary to implement this section.  Section 2001.0045, Government Code, does not apply to rules adopted under this subsection.
Added by Acts 2019, 86th Leg., R.S., Ch. 1342 (S.B. 1264), Sec. 1.01, eff. September 1, 2019.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter A. General Provisions › Section 801.001. Definitions

Sec. 801.001.  DEFINITIONS.  In this chapter:
(1)  "Control" has the meaning described by Section 823. 005.
(2)  "Insurer" means the issuer of an insurance policy that is issued to another in consideration of a premium and that insures against a loss that may be insured against under the law.  The term includes a:
(A)  fraternal benefit society;
(B)  Lloyd's plan;
(C)  mutual company of any kind, including a:
(i)  statewide mutual assessment association;
(ii)  local mutual aid association or burial association; and
(iii)  county or farm mutual insurance company;
(D)  reciprocal or interinsurance exchange;
(E)  group hospital service corporation;
(F)  health maintenance organization;
(G)  nonprofit legal services corporation; and
(H)  stock company.
(3)  "Person" has the meaning assigned by Section 823.002.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1022 (H.B. 4291), Sec. 1, eff. June 19, 2009.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter A. General Provisions › Section 801.002. Exemption for Certain Fraternal Benefit Societies

Sec. 801.002.  EXEMPTION FOR CERTAIN FRATERNAL BENEFIT SOCIETIES.  This chapter does not apply to a fraternal benefit society that:
(1)  sells insurance policies only as an incidental benefit to its members;  and
(2)  on September 6, 1955, was:
(A)  organized and licensed by the department as a fraternal benefit society;  or
(B)  exempt under former Article 10.12 or 10.38, revised as Section 885.004.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.051. Approval, Denial, or Disapproval of Application for Certificate; Eligibility; Hearing

Sec. 801.051.  APPROVAL, DENIAL, OR DISAPPROVAL OF APPLICATION FOR CERTIFICATE; ELIGIBILITY; HEARING.  (a)  The department shall approve, deny, or disapprove an application for a certificate of authority to act as an insurer.
(b)  If the department determines that the applicant has complied with the law, the department shall approve the application and issue under the department's seal a certificate of authority to act as an insurer.
(c)  On the applicant's request, the commissioner shall hold a hearing on a denial.  Not later than the 30th day after the date of the applicant's request for a hearing, the commissioner shall request a hearing date.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1022 (H.B. 4291), Sec. 2, eff. June 19, 2009.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.052. Effect and Contents of Certificate

Sec. 801.052.  EFFECT AND CONTENTS OF CERTIFICATE.  A certificate of authority issued to an insurer under this chapter authorizes the insurer to engage in the business of insurance.  The certificate of authority must state the specific kinds of insurance authorized under the certificate.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.053. Duration of Certificate

Sec. 801.053.  DURATION OF CERTIFICATE.  A certificate of authority issued to an insurer under this chapter is effective until it is suspended or revoked.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.054. Preference for Domestic Company

Sec. 801.054.  PREFERENCE FOR DOMESTIC COMPANY.  In issuing a certificate of authority to an applicant under this chapter, the department shall give preference to an application submitted by a domestic company.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.055. Deposit of Fees

Sec. 801.055.  DEPOSIT OF FEES.  A fee collected by the department under this chapter for a certificate of authority shall be deposited to the credit of the Texas Department of Insurance operating account.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.056. Failure to Provide Complete Set of Fingerprints: Ground for Denial of Application

Sec. 801.056.  FAILURE TO PROVIDE COMPLETE SET OF FINGERPRINTS:  GROUND FOR DENIAL OF APPLICATION.  (a)  In this section, "authorization" means any authorization issued by the department to engage in an activity regulated under this code, including:
(1)  a certificate of authority;
(2)  a certificate of registration;
(3)  a license;  and
(4)  a permit.
(b)  The department may deny an application for an authorization if the applicant or a corporate officer of the applicant fails to provide a complete set of fingerprints on request by the department.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter B. Certificate of Authority › Section 801.057. Failure to File Annual Statement: Ground for Revocation or Suspension

Sec. 801.057.  FAILURE TO FILE ANNUAL STATEMENT:  GROUND FOR REVOCATION OR SUSPENSION.  A certificate of authority of an insurer that fails to file an annual statement required by law is subject to being suspended or revoked by the department.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter C. Competence, Fitness, or Reputation › Section 801.101. Department Inquiry

Sec. 801.101.  DEPARTMENT INQUIRY.  The department may inquire into the competence, fitness, or reputation of:
(1)  an officer or director of an insurer;  or
(2)  a person having control of an insurer.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter C. Competence, Fitness, or Reputation › Section 801.102. Denial of Application or Revocation of Certificate

Sec. 801.102.  DENIAL OF APPLICATION OR REVOCATION OF CERTIFICATE.  (a)  If after conducting an inquiry under Section 801.101 the department determines that the person who is the subject of the inquiry is not worthy of the public confidence, the department shall:
(1)  deny the application for a certificate of authority; or
(2)  revoke the insurer's certificate of authority.
(b)  On the applicant's request, the commissioner shall hold a hearing on a denial or revocation.  Not later than the 30th day after the date of the applicant's request for a hearing, the commissioner shall request a hearing date.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1022 (H.B. 4291), Sec. 3, eff. June 19, 2009.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter D. Felony Conviction › Section 801.151. Issuance of Certificate Prohibited

Sec. 801.151.  ISSUANCE OF CERTIFICATE PROHIBITED.  Except as provided by Sections 801.153 and 801.154, the department may not issue a certificate of authority to an applicant if a corporate officer or member of the board of directors of the applicant has been convicted of a felony involving:
(1)  moral turpitude;  or
(2)  breach of a fiduciary duty.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter D. Felony Conviction › Section 801.152. Revocation of Certificate

Sec. 801.152.  REVOCATION OF CERTIFICATE.  After notice and hearing, the department may revoke the certificate of authority of an insurer if a corporate officer or member of the board of directors of the insurer is convicted of a felony involving:
(1)  moral turpitude;  or
(2)  breach of a fiduciary duty.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter D. Felony Conviction › Section 801.153. Petition for Issuance or Reinstatement of Certificate

Sec. 801.153.  PETITION FOR ISSUANCE OR REINSTATEMENT OF CERTIFICATE.  A company may petition the commissioner for issuance or reinstatement of a certificate of authority of the company that is denied or revoked under this subchapter:
(1)  not earlier than the later of:
(A)  the fifth anniversary of the date of the final conviction;  or
(B)  if the officer or director is sentenced to confinement or imprisonment or placed on community supervision, the fifth anniversary of the date the officer or director completes the sentence or period of community supervision;  or
(2)  after the officer or director ceases to be an officer or director of the insurer.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter D. Felony Conviction › Section 801.154. Grant of Petition

Sec. 801.154.  GRANT OF PETITION.  The commissioner shall grant a petition for issuance or reinstatement of a certificate of authority under this subchapter if the petitioner demonstrates that granting the petition would be in the public interest and that justice would best be served by granting the petition.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 801 - Certificate of Authority › Subchapter D. Felony Conviction › Section 801.155. Rules Relating to Contents of Petition

Sec. 801.155.  RULES RELATING TO CONTENTS OF PETITION.  The department may adopt rules under this subchapter prescribing the contents of a petition for issuance or reinstatement of a certificate of authority.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter A. Annual Statement of Insurance Companies › Section 802.001. Form of Annual Statement

Sec. 802.001.  FORM OF ANNUAL STATEMENT.  (a)  The commissioner, as necessary to obtain an accurate indication of the company's condition and method of transacting business, may change the form of any annual statement required to be filed by any kind of insurance company.
(b)  The form may require only information that relates to the business of the insurance company.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter A. Annual Statement of Insurance Companies › Section 802.002. Actuarial Opinion Required

Sec. 802.002.  ACTUARIAL OPINION REQUIRED.  (a)  In this section, "qualified actuary" means:
(1)  a member in good standing of the American Academy of Actuaries;  or
(2)  a person who has otherwise demonstrated actuarial competence to the satisfaction of the commissioner or an insurance regulatory official of another state in which the insurance company is domiciled.
(b)  An insurance company's annual statement must include a statement of a qualified actuary entitled "Statement of Actuarial Opinion" that:
(1)  is located on or is attached to the first page of the annual statement;  and
(2)  provides the opinion of the actuary relating to policy reserves and other actuarial items for life insurance, accident and health insurance, and annuities, or loss and loss adjustment expense reserves for property and casualty risks, as described in the annual statement instructions of the National Association of Insurance Commissioners as appropriate for the type of risks insured.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter A. Annual Statement of Insurance Companies › Section 802.003. Filing Date of Annual Statement Delivered by Postal Service

Sec. 802.003.  FILING DATE OF ANNUAL STATEMENT DELIVERED BY POSTAL SERVICE.  Except as otherwise specifically provided, for an annual statement that is required to be filed in the offices of the commissioner and that is delivered by the United States Postal Service to the offices of the commissioner after the date on which the annual statement is required to be filed, the date of filing is the date of:
(1)  the postal service postmark stamped on the cover in which the document is mailed;  or
(2)  any other evidence of mailing authorized by the postal service reflected on the cover in which the document is mailed.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.201, eff. Sept. 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter B. Filing With National Association of Insurance Commissioners › Section 802.051. Applicability of Subchapter

Sec. 802.051.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to each company regulated by the commissioner, including:
(1)  a stock life, health, or accident insurance company;
(2)  a mutual life, health, or accident insurance company;
(3)  a stock fire or casualty insurance company;
(4)  a mutual fire or casualty insurance company;
(5)  a Mexican casualty company;
(6)  a Lloyd's plan;
(7)  a reciprocal or interinsurance exchange;
(8)  a fraternal benefit society;
(9)  a title insurance company;
(10)  a stipulated premium insurance company;
(11)  a nonprofit legal service corporation;
(12)  a health maintenance organization;
(13)  a statewide mutual assessment company;
(14)  a local mutual aid association;
(15)  a local mutual burial association;
(16)  an association exempt under Section 887.102;
(17)  a nonprofit hospital, medical, or dental service corporation, including a company subject to Chapter 842;
(18)  a county mutual insurance company; and
(19)  a farm mutual insurance company.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2017, 85th Leg., R.S., Ch. 967 (S.B. 2065), Sec. 5.006, eff. September 1, 2017.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter B. Filing With National Association of Insurance Commissioners › Section 802.052. Concurrent Filing With National Association of Insurance Commissioners

Sec. 802.052.  CONCURRENT FILING WITH NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS.  (a)  Each domestic, foreign, or alien insurance company authorized to engage in the business of insurance in this state shall file a copy of the company's annual statement with the National Association of Insurance Commissioners at the time the company files the statement with the commissioner.
(b)  The statement required by Subsection (a) must:
(1)  meet requirements adopted by the commissioner, including:
(A)  a change in substance or form;
(B)  an additional filing;  and
(C)  any requirement that the statement be in a computer compatible format;  and
(2)  include the signed jurat page and the actuarial opinion, as required by the jurisdiction in which the insurance company is domiciled.
(c)  The insurance company shall also file with the National Association of Insurance Commissioners a copy of any amendment or addition to the annual statement that is subsequently filed with the commissioner.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter B. Filing With National Association of Insurance Commissioners › Section 802.053. Exemption Authority

Sec. 802.053.  EXEMPTION AUTHORITY.  The commissioner may exempt any class of insurance companies from the requirements of this subchapter if the commissioner believes the information required under this subchapter will not be useful for regulatory purposes.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
2023 Texas Statutes › Insurance Code › Title 6 - Organization of Insurers and Related Entities › Subtitle A - General Provisions Applicable to Insurers and Related Entities › Chapter 802 - Annual Statement › Subchapter B. Filing With National Association of Insurance Commissioners › Section 802.054. Compliance

Sec. 802.054.  COMPLIANCE.  The commissioner may consider a foreign insurance company to be in compliance with the requirements of Section 802.052 if the company is domiciled in a state with a law substantially similar to that section.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.