reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle M - Federal Patient Protection and Affordable Care Act › Chapter 1696 - Coverage for Elective Abortion; Prohibitions and Requirements › Section 1696.001. Definitions

Sec. 1696.001.  DEFINITIONS.  In this chapter:
(1)  "Elective abortion" means an abortion, as defined by Section 245.002, Health and Safety Code, other than an abortion performed due to a medical emergency as defined by Section 171.002, Health and Safety Code.
(2)  "Health benefit exchange" means an American Health Benefit Exchange administered by the federal government or created under Section 1311(b) of the Patient Protection and Affordable Care Act (42 U.S.C. Section 18031(b)).
(3)  "Qualified health plan" has the meaning assigned by Section 1301(a) of the Patient Protection and Affordable Care Act (42 U.S.C. Section 18021(a)).
Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 1, eff. December 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle M - Federal Patient Protection and Affordable Care Act › Chapter 1696 - Coverage for Elective Abortion; Prohibitions and Requirements › Section 1696.002. Prohibited Coverage Through Health Benefit Exchange

Sec. 1696.002.  PROHIBITED COVERAGE THROUGH HEALTH BENEFIT EXCHANGE.  (a)  A qualified health plan offered through a health benefit exchange may not provide coverage for elective abortion.
(b)  This section does not prevent a person from purchasing optional or supplemental coverage for elective abortion under a health benefit plan other than a qualified health plan offered through a health benefit exchange.
Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 1, eff. December 1, 2017.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter A. General Provisions › Section 1698.001. Applicability of Chapter

Sec. 1698.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to rates for the following health benefit plans:
(1)  an individual major medical expense insurance policy to which Chapter 1201 applies;
(2)  individual health maintenance organization coverage; or
(3)  a small employer health benefit plan provided under Chapter 1501.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter A. General Provisions › Section 1698.002. Applicability of Other Laws Governing Rates

Sec. 1698.002.  APPLICABILITY OF OTHER LAWS GOVERNING RATES.  The requirements of this chapter are in addition to any other provision of this code governing health benefit plan rates.  Except as otherwise provided by this chapter, in the case of a conflict between this chapter and another provision of this code, this chapter controls.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter B. Review of Rates › Section 1698.051. Review of Premium Rates

Sec. 1698.051.  REVIEW OF PREMIUM RATES.  (a)  In this section:
(1)  "Individual health benefit plan" means:
(A)  an individual accident and health insurance policy to which Chapter 1201 applies; or
(B)  individual health maintenance organization coverage.
(2)  "Small employer health benefit plan" has the meaning assigned by Section 1501.002.
(b)  The commissioner by rule shall establish a process under which the commissioner reviews health benefit plan rates and rate changes for compliance with this chapter and other applicable state and federal law, including 42 U.S.C. Sections 300gg, 300gg-94, and 18032(c) and those sections' implementing regulations, including rules establishing geographic rating areas.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter B. Review of Rates › Section 1698.052. Additional Rules and Guidance Related to Individual Health Plan Rates

Sec. 1698.052.  ADDITIONAL RULES AND GUIDANCE RELATED TO INDIVIDUAL HEALTH PLAN RATES.  (a)  In this section, "qualified health plan" has the meaning assigned by Section 1301(a), Patient Protection and Affordable Care Act (42 U.S.C. Section 18021).
(b)  The commissioner shall adopt rules and provide guidance regarding additional requirements related to individual health benefit plans, including qualified health plans, to address the following factors:
(1)  whether the plan issuer has complied with all requirements for pooling risk and participating in risk adjustment programs in effect under state or federal law;
(2)  the covered benefits or health benefit plan design or, for a rate change, any changes to the benefits or design;
(3)  the allowable variations for case characteristics, risk classifications, and participation in programs promoting wellness; and
(4)  any other factor listed in 45 C.F.R. Section 154.301(a)(4) to the extent applicable.
(c)  In making a determination under this section regarding a proposed rate for a qualified health plan, the commissioner shall consider, in addition to the factors under Subsection (b), the following factors:
(1)  the purchasing power of consumers who are eligible for a premium subsidy under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148);
(2)  if the plan is in the silver level, as described by 42 U.S.C. Section 18022(d), whether the rate is appropriate for the plan in relation to the rates charged for qualified health plans offering different levels of coverage, taking into account any funding or lack of funding for cost-sharing reductions and the covered benefits for each level of coverage; and
(3)  whether the plan issuer utilized the induced demand factors developed by the Centers for Medicare and Medicaid Services for the risk adjustment program established under 42 U.S.C. Section 18063 for the level of coverage offered by the plan or any state-specific induced demand factors established by department regulations.
(d)  The commissioner may consider the following factors:
(1)  if the commissioner determines appropriate for comparison purposes, medical claims trends reported by plan issuers in this state or in a region of this country or the country as a whole; and
(2)  inflation indexes.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter B. Review of Rates › Section 1698.053. Plan Design Flexibility Within Rating Areas

Sec. 1698.053.  PLAN DESIGN FLEXIBILITY WITHIN RATING AREAS.  Notwithstanding any other provision of this code, a health benefit plan issuer may:
(1)  offer different plan designs by rating area to individuals and small employers; and
(2)  provide network access beyond the geographic rating area.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter B. Review of Rates › Section 1698.054. Federal Actuarial Levels and Plan Cost-Sharing

Sec. 1698.054.  FEDERAL ACTUARIAL LEVELS AND PLAN COST-SHARING.  Notwithstanding any other provision of this code, a health benefit plan issuer may offer plan designs with deductibles, coinsurance, and other cost-sharing mechanisms necessary to comply with federal actuarial values in the individual and small group market in this state.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle N - Rates › Chapter 1698 - Rates for Certain Coverage › Subchapter B. Review of Rates › Section 1698.055. Federal Funding

Sec. 1698.055.  FEDERAL FUNDING.  The commissioner shall seek all available federal funding to cover the cost to the department of reviewing rates under this subchapter.
Added by Acts 2021, 87th Leg., R.S., Ch. 877 (S.B. 1296), Sec. 1, eff. September 1, 2021.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter A. General Provisions › Section 1701.001. Definition

Sec. 1701.001.  DEFINITION.  In this chapter, "use" includes issue and deliver.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter A. General Provisions › Section 1701.002. Applicability of Chapter to Forms of Certain Documents

Sec. 1701.002.  APPLICABILITY OF CHAPTER TO FORMS OF CERTAIN DOCUMENTS.  This chapter applies to the form of the following document:
(1)  a policy, contract, or certificate of:
(A)  accident or health insurance, including group accident or health insurance;
(B)  medical or surgical insurance, including group medical or surgical insurance;
(C)  life or term insurance, including group life or term insurance;
(D)  endowment insurance;
(E)  industrial life insurance;  or
(F)  fraternal benefit insurance;
(2)  an annuity or pure endowment contract, including a group annuity contract;
(3)  an application attached or required to be attached to the policy, contract, or certificate;  or
(4)  a rider or endorsement to be attached to, printed on, or used in connection with the policy, contract, or certificate.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter A. General Provisions › Section 1701.003. Applicability of Chapter to Certain Insurers

Sec. 1701.003.  APPLICABILITY OF CHAPTER TO CERTAIN INSURERS.  (a)  Except as provided by Subsection (b), this chapter applies to any insurer that uses a document described by Section 1701.002 in this state, including:
(1)  a life, accident, health, or casualty insurance company;
(2)  a mutual life insurance company;
(3)  a mutual insurance company other than a mutual life insurance company;
(4)  a mutual or natural premium life insurance company;
(5)  a general casualty company;
(6)  a Lloyd's plan;
(7)  a reciprocal or interinsurance exchange;
(8)  a fraternal benefit society;  and
(9)  a group hospital service corporation.
(b)  This chapter does not apply to a society, company, or other insurer whose activities are by statute exempt from department control and that is entitled by statute to a certificate from the department showing that exempt status.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter A. General Provisions › Section 1701.004. Construction of Chapter

Sec. 1701.004.  CONSTRUCTION OF CHAPTER.  This chapter may not be construed to enlarge the powers of an insurer subject to this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter A. General Provisions › Section 1701.005. Exemptions

Sec. 1701.005.  EXEMPTIONS.  (a)  This chapter does not apply to:
(1)  a rider or endorsement that is used at the request of the holder of a policy, contract, or certificate subject to this chapter and that  relates to:
(A)  the manner of distribution of benefits under the policy, contract, or certificate; or
(B)  the reservation of rights and benefits under the policy, contract, or certificate; or
(2)  the modification of a previously approved insurance policy form for the sole purpose of adding the statement required by Section 154.2021(a)(3), Finance Code.
(b)  The commissioner by written order may exempt a document from the requirements of this chapter for the period the commissioner considers proper if the commissioner determines that:
(1)  this chapter may not practically be applied to the document;
(2)  the document's preparation, use, and meaning have become routine or commonplace;  or
(3)  the filing and approval of the form of the document are not desirable, appropriate, required, or necessary for the protection of the public.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
Amended by:
Acts 2009, 81st Leg., R.S., Ch. 1190 (H.B. 3762), Sec. 34, eff. September 1, 2009.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter A. General Provisions › Section 1701.006. Exemption for Certain Group Annuity Transactions

Sec. 1701.006.  EXEMPTION FOR CERTAIN GROUP ANNUITY TRANSACTIONS.  (a)  The filing and approval requirements in this chapter do not apply to any group annuity policy, certificate, or contract written or issued by an insurer authorized to engage in the business of insurance in this state that involves use of a separate account if benefits would also have guarantees from an insurer's general account.
(b)  For purposes of this section, a group annuity policy, certificate, or contract includes a single premium group annuity policy, certificate, or contract that is negotiated between an insurer and an applicable group or plan sponsor.
Added by Acts 2023, 88th Leg., R.S., Ch. 412 (H.B. 1587), Sec. 3, eff. June 9, 2023.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.051. Filing Required

Sec. 1701.051.  FILING REQUIRED.  (a)  Except as provided by Section 1701.005, an insurer may not use a document described by Section 1701.002 in this state unless the form of the document is filed with the department in accordance with this chapter.
(b)  Except as provided by Section 1701.052, the insurer must file the form of the document not later than the 60th day before the date the document is used.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.052. File and Use

Sec. 1701.052.  FILE AND USE.  (a)  An insurer may use a document described by Section 1701.002 immediately after the form of the document is filed if the form, when filed, is accompanied by a certification that meets the requirements of Subsection (b).
(b)  The certification accompanying a form must:
(1)  be signed by:
(A)  an attorney licensed to practice law in this state;
(B)  an actuary familiar with the requirements of this code and applicable rules adopted under this code;
(C)  the chief executive officer of the insurer;  or
(D)  an individual designated by the chief executive officer of the insurer;  and
(2)  affirm that:
(A)  the certification is made on behalf of the insurer filing the form;
(B)  the insurer is bound by the certification;
(C)  the individual making the certification has reviewed the form;  and
(D)  to the best knowledge, information, and belief of the individual making the certification, the form complies with this code and rules applicable to the form.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.053. Filing Fee

Sec. 1701.053.  FILING FEE.  (a)  The department shall collect a fee in an amount determined by the commissioner for the filing of the form of a document under this chapter.
(b)  The fee may not exceed:
(1)  $100 for filing the form of a new or amended document that is not exempt from review under Section 1701.005(b);  and
(2)  $50 for filing the form of a new or amended document that is exempt from review under Section 1701.005(b).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.054. Approval of Form

Sec. 1701.054.  APPROVAL OF FORM.  (a)  A form filed under this chapter that is not affirmatively approved or disapproved in a written order of the commissioner on or before the 60th day after the date the form is filed is considered approved on the 61st day after the date of filing unless the approval period is extended under this section.
(b)  An insurer may request in writing that the approval period for a form be extended for an additional period not to exceed 45 days.
(c)  An extension requested under this section is considered granted on the date the department receives the request.
(d)  Only one extension may be granted under this section.
(e)  If an extension is granted under this section and the commissioner does not affirmatively approve or disapprove the form before the extended period expires, the form is considered approved on the day after the date the extended period expires.
(f)  If the commissioner approves a form that is filed without a certification meeting the requirements of Section 1701.052(b) before the expiration of the approval period, including any extension, the remaining portion of the period is waived.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.055. Disapproval of Form or Withdrawal of Approval or Exemption

Sec. 1701.055.  DISAPPROVAL OF FORM OR WITHDRAWAL OF APPROVAL OR EXEMPTION.  (a)  Except as provided by Subsection (d), the commissioner may disapprove or, after notice and hearing, withdraw approval of a form if the form:
(1)  violates this code, a rule of the commissioner, or any other law;  or
(2)  contains a provision, title, or heading that is unjust, encourages misrepresentation, or is deceptive.
(b)  A form filed under this chapter that contains a coordination of benefits provision may not be approved for use in this state unless the form provides for the order of benefits determination for insured dependent children.  An order of benefits determination provision may not be approved if the provision:
(1)  violates this code, a rule of the commissioner, or any other law;  or
(2)  contains a provision, title, or heading that is unjust, encourages misrepresentation, or is deceptive.
(c)  If necessary to accomplish the purpose of Subsection (b), the commissioner may adopt a policy provision and order the inclusion of that provision in a document subject to that subsection.
(d)  If a form has been on file with the department for at least 180 days and has previously been affirmatively approved by the commissioner, been considered approved under this chapter, or been exempted from the approval requirements under this chapter, the commissioner may withdraw the approval or exemption only if:
(1)  the form violates this code or a rule adopted under this code;  or
(2)  the commissioner finds proof of gross misrepresentation or fraud to a policyholder.
(e)  An order of the commissioner disapproving or withdrawing approval for a form must state the grounds for the disapproval or withdrawal of approval and describe in adequate detail the changes that are necessary to obtain approval.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.056. Use of Disapproved Form Prohibited

Sec. 1701.056.  USE OF DISAPPROVED FORM PROHIBITED.  An insurer who receives written notice that a form filed by the insurer has been disapproved by the commissioner shall immediately stop using the form.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.057. Withdrawal of Individual Accident and Health Insurance Policy Form Approval

Sec. 1701.057.  WITHDRAWAL OF INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICY FORM APPROVAL.  (a)  Except as provided by Subsection (b), the commissioner may, after notice and hearing, withdraw approval of an individual accident and health insurance policy form if, after consideration of all relevant facts, the commissioner determines that:
(1)  the benefits provided under the form are unreasonable in relation to the premium charged;  or
(2)  the reserve required by Section 862.102 is not maintained by the insurer on the policies issued on the form.
(b)  If an individual accident and health insurance policy form has been on file with the department for at least 360 days and has been affirmatively approved by the commissioner, been considered approved under this chapter, or been exempted from the approval requirements of this chapter, the commissioner may withdraw the approval or exemption only if:
(1)  the form violates this code or a rule adopted under this code;  or
(2)  the commissioner finds proof of gross misrepresentation or fraud to a policyholder.
(c)  To enable the department to determine compliance with Subsection (b), the commissioner:
(1)  shall require an insurer to file the rates charged by that insurer for individual accident and health insurance policies;  and
(2)  may adopt and require an insurer to file in conjunction with the annual statement required under Section 841.255, 982.101, or 982.103 a form for reporting the insurer's experience on individual accident and health insurance policy forms issued by the insurer.
(d)  The commissioner shall, in accordance with Section 1201.007, adopt reasonable rules necessary to establish standards under which the approval of an individual accident and health insurance policy form may be withdrawn.
(e)  This section does not grant the commissioner the authority to determine, fix, prescribe, or promulgate rates to be charged for an individual accident and health insurance policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.058. Reconsideration of Form

Sec. 1701.058.  RECONSIDERATION OF FORM.  (a)  Not later than the 45th day after the date of an order of the commissioner disapproving or withdrawing approval of a form under Section 1701.055, an insurer may correct the deficiencies described by the order and file the corrected form with the department for reconsideration by the commissioner.
(b)  If the commissioner does not approve or disapprove a form filed for reconsideration under this section on or before the 45th day after the date the form is filed, the form is considered approved on the 46th day after the date the form is filed.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.059. Replacement or Amendment of Document

Sec. 1701.059.  REPLACEMENT OR AMENDMENT OF DOCUMENT.  The commissioner may order an insurer to replace a document described by Section 1701.002 with a corrected document or to amend and correct the document by endorsement or rider if:
(1)  the commissioner disapproves or withdraws approval of the form of the document under Section 1701.055(a);  or
(2)  the document is used before the form was approved under this chapter and corrections must be made to the document to bring the document into compliance with this code and rules of the commissioner before the commissioner will approve the form of the document.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.060. General Rulemaking Authority

Sec. 1701.060.  GENERAL RULEMAKING AUTHORITY.  (a)  The commissioner may adopt reasonable rules necessary to implement the purposes of this chapter, including, after notice and hearing, rules that establish procedures and criteria under which:
(1)  each type of form submitted to the department under this chapter will be reviewed and approved by the commissioner or exempted under Section 1701.005(b); and
(2)  particular types of forms designated by the commissioner may be given a summary review and approval if considered appropriate by the commissioner to expedite review and approval of those forms.
(b)  A rule adopted under this chapter may not be repealed or amended until after the first anniversary of the date the rule was adopted unless the commissioner determines that repeal or amendment is in the significant and material interests of the citizens of this state or is necessary as a result of legislative enactment.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.076(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.061. Noninsurance Benefits

Sec. 1701.061.  NONINSURANCE BENEFITS.  (a)  In this section, "noninsurance benefit" means a good or service provided or disclosed as part of a policy or certificate of insurance that is reasonably related to the type of policy or certificate being issued.  Examples of noninsurance benefits include:
(1)  discount cards for health care programs, vision care programs, dental care programs, prescriptions, physical fitness programs or facilities, or other similar programs;
(2)  financial planning, will preparation, or similar services; and
(3)  contributions for educational savings on behalf of a policyholder or certificate holder.
(b)  An insurer may include a noninsurance benefit that is reasonably related to a policy or certificate as part of the policy or certificate form to be issued to an insured or certificate holder.
(c)  A policy form filing that includes a noninsurance benefit shall include:
(1)  a description of the noninsurance benefit;
(2)  a notice that fully discloses the noninsurance benefit to the policyholder or certificate holder; and
(3)  an explanation of any condition on which termination of the noninsurance benefit will occur.
(d)  Section 541.061 applies to a noninsurance benefit provided as part of a policy or certificate.
(e)  Section 1102.002 does not apply to a noninsurance benefit provided as part of a policy or certificate.
(f)  The commissioner may adopt rules to implement this section, including rules to:
(1)  determine which noninsurance benefits are reasonably related to the types of insurance subject to this chapter;
(2)  ensure that noninsurance benefits included as part of a policy or certificate are not unfairly deceptive or do not otherwise constitute a prohibited inducement; and
(3)  address application of other chapters of this code to noninsurance benefits provided as part of a policy or certificate, including Chapters 82-84, 222, 257, 463, 541-544, 1501, and 1506.
Added by Acts 2007, 80th Leg., R.S., Ch. 695 (H.B. 1847), Sec. 1, eff. June 15, 2007.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter B. Filing Requirement › Section 1701.062. Discretionary Clauses Prohibited

Sec. 1701.062.  DISCRETIONARY CLAUSES PROHIBITED.  (a) An insurer may not use a document described by Section 1701.002 in this state if the document contains a discretionary clause.
(b)  A discretionary clause includes a provision that:
(1)  purports or acts to bind the claimant to, or grant deference in subsequent proceedings to, adverse eligibility or claim decisions or policy interpretations by the insurer; or
(2)  specifies:
(A)  that a policyholder or other claimant may not contest or appeal a denial of a claim;
(B)  that the insurer's interpretation of the terms of a document or decision to deny coverage or the amount of benefits is binding upon a policyholder or other claimant;
(C)  that in an appeal, the insurer's decision about or interpretation of the terms of a document or coverage is binding; or
(D)  a standard of review in any appeal process that gives deference to the original claim decision or provides standards of interpretation or review that are inconsistent with the laws of this state, including the common law.
Added by Acts 2011, 82nd Leg., R.S., Ch. 560 (H.B. 3017), Sec. 2, eff. June 17, 2011.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter C. Sanctions; Applicability of Other Laws › Section 1701.101. Restitution

Sec. 1701.101.  RESTITUTION.  (a)  The commissioner may order an insurer to make complete restitution to each insured of this state who is financially damaged by the insurer's use of a form filed and used but not approved under this chapter if, after notice and opportunity for hearing, the commissioner determines:
(1)  the form does not comply with this code and the rules of the commissioner;
(2)  use of the form resulted in financial damage to an insured of this state;  and
(3)  the insurer intentionally used the form with the knowledge that it did not comply with this code and the rules of the commissioner.
(b)  The commissioner may determine the form and amount of restitution ordered under this section and the period in which the restitution must be made.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter C. Sanctions; Applicability of Other Laws › Section 1701.102. Limit on Sanctions

Sec. 1701.102.  LIMIT ON SANCTIONS.  Except as provided by Section 1701.101, the commissioner may not impose penalties or other sanctions on an insurer for the issuance of a document the form of which is filed under Section 1701.052.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter C. Sanctions; Applicability of Other Laws › Section 1701.103. Applicability of Other Laws

Sec. 1701.103.  APPLICABILITY OF OTHER LAWS.  Except as provided by Section 1701.102, this chapter may not be construed to limit the applicability of any other statute.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 9 - Provisions Applicable to Life and Health Coverages › Chapter 1701 - Policy Forms › Subchapter D. Certain Policy Application Forms › Section 1701.151. Policy Application Form for Individual Accident and Health Policy

Sec. 1701.151.  POLICY APPLICATION FORM FOR INDIVIDUAL ACCIDENT AND HEALTH POLICY.  A policy application form that is required to be or that is attached to an individual accident and health policy shall comply with the rules of the commissioner adopted under Chapter 1201.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1802 - Property and Casualty Insurance Initiatives Task Force › Section 1802.001. Property and Casualty Insurance Initiatives Task Force

Sec. 1802.001.  PROPERTY AND CASUALTY INSURANCE INITIATIVES TASK FORCE.  (a)  The commissioner may establish a task force to study the utility and feasibility of instituting various property and casualty insurance initiatives in this state.
(b)  The initiatives studied may include:
(1)  possible coordination with:
(A)  the Texas Economic Development Bank to make certain property and casualty insurance an enterprise zone program under Chapter 2303, Government Code; and
(B)  Neighborhood Housing Service (NHS) programs to establish voluntary NHS-Insurance Industry Partnerships;
(2)  possible insurance agent programs to increase minority agency access to standard insurance companies, including minority intern programs with insurance companies;
(3)  possible tax incentives for insurance written in underserved areas; and
(4)  a consumer education program designed to increase the ability of consumers to differentiate among different products and providers in the property and casualty insurance market.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1803 - Reports of Insurance Coverage for State Agencies › Section 1803.001. Definitions

Sec. 1803.001.  DEFINITIONS.  In this chapter:
(1)  "Insurer" means an insurance company or other entity that is authorized by the department to engage in the business of insurance in this state, including:
(A)  a reciprocal or interinsurance exchange;
(B)  a mutual insurance company;
(C)  a county mutual insurance company; and
(D)  a Lloyd's plan.
(2)  "State agency" has the meaning assigned by Section 412.001, Labor Code.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1803 - Reports of Insurance Coverage for State Agencies › Section 1803.002. Reporting Requirements

Sec. 1803.002.  REPORTING REQUIREMENTS.  (a)  Each insurer that enters into an insurance policy or other contract or agreement with a state agency for the purchase by the state agency of property, casualty, or liability insurance coverage, including a policy, contract, or agreement subject to competitive bidding requirements, shall report to the State Office of Risk Management the intended sale of the insurance coverage.
(b)  The insurer shall report the intended sale of the insurance coverage not later than the 30th day before the date the sale is scheduled to occur in the manner prescribed by the State Office of Risk Management.
(c)  The State Office of Risk Management may require an insurer to submit copies of insurance forms, policies, and other relevant information.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1803 - Reports of Insurance Coverage for State Agencies › Section 1803.003. Failure to Report

Sec. 1803.003.  FAILURE TO REPORT.  An insurer that fails to comply with the reporting requirements of this chapter is subject to sanctions under Chapter 82.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1803 - Reports of Insurance Coverage for State Agencies › Section 1803.004. Rules

Sec. 1803.004.  RULES.  The State Office of Risk Management shall adopt rules as necessary to implement this chapter.  The office shall consult with the commissioner in adopting rules.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1804 - Rates and Forms for National Defense Projects › Section 1804.001. Applicability of Chapter

Sec. 1804.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to insurance in relation to a national defense project in this state.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1804 - Rates and Forms for National Defense Projects › Section 1804.002. Special Rates and Rating Plans for Casualty Insurance

Sec. 1804.002.  SPECIAL RATES AND RATING PLANS FOR CASUALTY INSURANCE.  (a)  The commissioner may promulgate special rates and special rating plans for workers' compensation insurance, automobile insurance, and other lines of casualty insurance, to apply only to the construction or operation of a national defense project.
(b)  The commissioner may promulgate the special rates and special rating plans separately for each class of insurance or in combination for all classes of insurance.
(c)  The commissioner may adopt rules as may be necessary, proper, or advisable to place in effect special rates and special rating plans promulgated under this section.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1804 - Rates and Forms for National Defense Projects › Section 1804.003. Special Rates and Forms for Material Damage Insurance

Sec. 1804.003.  SPECIAL RATES AND FORMS FOR MATERIAL DAMAGE INSURANCE.  (a)  The commissioner may promulgate special rates and forms for fire insurance, windstorm insurance, and other kinds of material damage insurance required or used on a national defense project.
(b)  The commissioner may adopt rules incidental to the business described by Subsection (a) and necessary to place in effect special rates and forms promulgated under this section.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter A. General Provisions › Section 1805.001. Applicability of Chapter

Sec. 1805.001.  APPLICABILITY OF CHAPTER.  This chapter applies to the kinds of insurance and insurers subject to:
(1)  Section 403.002;
(2)  Section 941.003 with respect to the application of a law described by Section 941.003(b)(1) or (c);
(3)  Section 942.003 with respect to the application of a law described by Section 942.003(b)(1) or (c);
(4)  Subchapter A, B, or C, Chapter 5;
(5)  Subchapter H, Chapter 544;
(6)  Subchapter A, Chapter 2301;
(7)  Chapter 252, 253, 254, 255, 426, 1806, 1807, 2001, 2002, 2003, 2004, 2005, 2006, 2008, 2051, 2052, 2053, 2055, 2171, 2251, or 2252;
(8)  Subtitle B or C, Title 10; or
(9)   Chapter 2154, Occupations Code.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2H.001, eff. April 1, 2009.
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.0591(e), eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.051. License Application

Sec. 1805.051.  LICENSE APPLICATION.  (a)  A corporation, unincorporated association, partnership, or individual may file with the commissioner an application for an advisory organization license for the kinds of insurance specified in the application.
(b)  The applicant must:
(1)  file with the commissioner:
(A)  a copy of the applicant's:
(i)  constitution and bylaws;
(ii)  article of agreement or association or certificate of incorporation; and
(iii)  rules governing the applicant's activities as an advisory organization; and
(B)  a statement of qualifications to act as an advisory organization; and
(2)  pay a $100 license fee.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.052. Issuance of License; Term

Sec. 1805.052.  ISSUANCE OF LICENSE; TERM.  (a)  The commissioner shall issue a license to an applicant the commissioner determines is qualified, without regard to:
(1)  the state of domicile or residence of the applicant; or
(2)  the location of the applicant's place of business.
(b)  The commissioner shall grant or deny a license to an applicant not later than the 60th day after the date the commissioner receives the application.
(c)  A license issued under this subchapter remains in effect until the commissioner suspends or revokes the license.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.053. Information Reported by Advisory Organization

Sec. 1805.053.  INFORMATION REPORTED BY ADVISORY ORGANIZATION.  (a)  An advisory organization may file with the commissioner prospective loss costs, supplementary rating information, and policy forms.  A filing made by an advisory organization under this section is subject to the provisions of this code or other insurance laws of this state governing rate filings.
(b)  An advisory organization at least quarterly shall file with the commissioner a list of:
(1)  each subscriber company engaging in business in this state; and
(2)  the products or information the subscriber company purchases.
(c)  On request by the commissioner, an advisory organization shall provide to the department a summary of the actuarial assumptions, trend factors, economic factors, and other criteria used in trending data for companies engaging in business in this state.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.054. Insurer's Authority to Subscribe to Advisory Organization

Sec. 1805.054.  INSURER'S AUTHORITY TO SUBSCRIBE TO ADVISORY ORGANIZATION.  An insurer engaging in business in this state may subscribe to an advisory organization.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.055. Submission, Receipt, and Use of Information by Insurer

Sec. 1805.055.  SUBMISSION, RECEIPT, AND USE OF INFORMATION BY INSURER.  (a)  Except as provided by Subsection (b), an insurer may submit to or receive from an advisory organization the following only if the advisory organization holds a license issued under this subchapter:
(1)  statistical plans;
(2)  historical data;
(3)  prospective loss costs;
(4)  supplementary rating information;
(5)  policy forms and endorsements;
(6)  research;
(7)  rates of individual insurers that are effective at the time the information is submitted or received or that were previously in effect; and
(8)  performance of inspections.
(b)  An insurer may not:
(1)  accept from an advisory organization recommendations for rates; or
(2)  submit to or receive from an advisory organization recommendations for profit or expenses other than loss adjustment expenses.
(c)  An insurer that subscribes to an advisory organization may use prospective loss costs, supplementary rating information, and policy forms filed by the advisory organization under Section 1805.053(a) and may incorporate the information into the insurer's filings.
(d)  Notwithstanding any other law, an insurer that reports data under this subchapter is not relieved of the responsibility of reporting that data directly to the department at the department's request.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.056. Audit

Sec. 1805.056.  AUDIT.  (a)  The department shall require an annual audit of an advisory organization that provides statistics or other information to the department in a proceeding to set rates.
(b)  The audit must:
(1)  be conducted at the expense of the advisory organization under rules adopted by the commissioner; and
(2)  examine the advisory organization's method of collecting, analyzing, and reporting data to ensure the accuracy of data.
(c)  The audit may examine source documents within individual companies.
(d)  Except for individual company information, an audit is public information.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.057. Rate Filing Review

Sec. 1805.057.  RATE FILING REVIEW.  The commissioner may:
(1)  review the rate filing of an insurer that relies on the prospective loss costs provided by an advisory organization; and
(2)  require the insurer to provide the insurer's actual data and loss experience in addition to the information provided by the advisory organization.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.058. Prohibited Acts

Sec. 1805.058.  PROHIBITED ACTS.  (a)  An advisory organization may not compile or distribute recommendations for:
(1)  rates; or
(2)  profit or expenses other than loss adjustment expenses.
(b)  An insurer or advisory organization may not:
(1)  attempt to monopolize, combine, or conspire with another person to monopolize an insurance market;
(2)  engage in a boycott, on a concerted basis, of an insurance market; or
(3)  make an agreement with another insurer, advisory organization, or person if the agreement has the purpose or effect of restraining trade unreasonably or substantially lessening competition in the business of insurance.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.
2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle A - General Provisions › Chapter 1805 - Joint Underwriting and Advisory Organizations › Subchapter B. Advisory Organizations › Section 1805.059. Disciplinary Action

Sec. 1805.059.  DISCIPLINARY ACTION.  (a)  If, after a hearing, the commissioner determines that the furnishing of specified services by an advisory organization involves an act or practice that is unfair, unreasonable, or otherwise inconsistent with this chapter or other applicable laws of this state, the commissioner may issue a written order:
(1)  specifying the manner in which the act or practice is unfair, unreasonable, or inconsistent with the applicable law; and
(2)  requiring the advisory organization to discontinue the act or practice.
(b)  In addition to any other remedies available at law, the commissioner may impose a sanction authorized under Chapter 82.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 2, eff. April 1, 2007.