reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.16 - Connection Between Two or More Companies Through Common Management

Current through Reg. 49, No. 28; July 12, 2024
There is no present rule on this subject. Licensees should
					 refer to statutory law.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.19 - Certain Prohibited Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  furnishing of free ambulance service, reduction of rates and understatement of
				  age are inducements to the policyholder which are discriminatory and are a
				  rebate of the premium to that extent; no insurer may engage in these
				  practices.
(b) No insurer may
				  misrepresent policy provisions and benefits or engage in misleading
				  advertising.
(c) The employment of
				  an agent by the association and the acting as an agent by the individual
				  without first obtaining a license from this department is a violation of the
				  Insurance Code, Article 12.07.
(d)
				  Unborn babies are not persons in being upon whom a life insurance policy may be
				  written and the insurer is wholly without the power to make such a contract.
				  The acceptance of risks which may be reasonably expected to die within a short
				  time after the policy is written is a fraud upon the association and the other
				  policyholders who are members of it. No insurer may insure the risks specified
				  in this subsection.
(e) The
				  alteration of policy forms and provisions without advance approval by the State
				  Board of Insurance is a violation of the Insurance Code, Article
				  14.18.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.20 - Availability of Company Records to the Membership

Current through Reg. 49, No. 28; July 12, 2024
There is no present section on this subject. Licensees
					 should refer to statutory law.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.21 - Liabilities

Current through Reg. 49, No. 28; July 12, 2024
(a) General. Every liability, contingent or
				  otherwise, shall be disclosed in accordance with sound accounting practice in
				  each financial statement of the condition of the company or
				  association.
(b) Contingent
				  liabilities. Whenever funds, as authorized by the board of directors, are
				  borrowed from any source for the purpose of association or company business, as
				  for example, to acquire new business by merger, and the repayment of such funds
				  is contingent upon the availability of funds in the expense fund over and above
				  all other obligations of the expense fund, the contingent obligation to repay
				  shall be considered as a nonstatement liability if the agreement for the
				  repayment of the obligation contains a clause substantially as follows: "The
				  obligation herein provided for shall be repayable, both as to principal and
				  interest, from the expense fund of __________ Company, only after ample
				  provision has been made for the payment of all other obligations of the expense
				  fund of __________ Company, and shall not under any circumstances be either due
				  or payable unless sufficient funds of the expense fund are available with which
				  to pay the sum free from any other expense fund obligation as provided by the
				  laws of the State of Texas and the rules and regulations of the State Board of
				  Insurance."
(c) Releases. Any
				  obligations of a company or association which might otherwise be considered as
				  a general liability may be treated as a nonstatement liability provided that
				  the holder of such obligation releases all right of repayment from the mortuary
				  fund and all rights of repayment from the expense fund except upon a contingent
				  basis and accepts in lieu of all other rights, contracted or otherwise, an
				  agreement for repayment containing a clause substantially similar to the clause
				  quoted in subsection (b) of this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.22 - Minutes of Directors and Membership Meetings

Current through Reg. 49, No. 28; July 12, 2024
(a) Minutes shall be kept and preserved of
				  all meetings of the membership, and of all meetings of the board of directors.
				  Whenever action is taken at any such meeting upon any matters hereinafter set
				  out, the complete minutes relating to such action, duly verified as required by
				  law shall be promptly filed, in duplicate, with the commissioner of insurance.
				  One authenticated copy of such minutes shall be returned to the company or
				  association and it shall be maintained in the permanent records thereof. Any
				  action pertaining to any of the following matters affecting the operation of a
				  company or association are subject to this section:
(1) election of officers or directors and the
				  designation of, or a change in the designation of, the officer or other person
				  or persons responsible for the handling of the funds of the company or
				  association;
(2) mergers;
(3) reinsurance agreements;
(4) amendments to the constitution and
				  bylaws;
(5) amendments to the
				  articles of association or articles of incorporation;
(6) any change or modification in the rates
				  to be charged on policies then in force;
(7) dissolution of the company or
				  association; and
(8) the execution,
				  transfer, assignment or change in any contract of management, employment, or
				  general agency.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.23 - Rate Increases

Current through Reg. 49, No. 28; July 12, 2024
(a) With the
				  consent of the State Board of Insurance, a local mutual burial association may
				  change its rates by adopting and filing with the State Board of Insurance a new
				  rate schedule, but in each instance each rate must be within the minimum and
				  maximum as promulgated by the State Board of Insurance.
(b) Any changes in rates of local mutual aid
				  associations and statewide mutual assessment corporations shall be filed with
				  the commissioner of insurance along with the minutes pertaining thereto as
				  required under these sections.
(c)
				  Applications for approval of rate increases must be submitted on forms
				  furnished by the State Board of Insurance or forms acceptable to the State
				  Board of Insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.24 - Procedure for Amending Constitution and Bylaws

Current through Reg. 49, No. 28; July 12, 2024
(If articles of association are changed, the same procedure
					 should be followed as for amending constitution and bylaws.)
(1) The constitution and bylaws must be
				  amended in accordance with the Insurance Code, Article 14.05, which reads
				  substantially as follows: "Bylaws of any association may be amended by a
				  majority of the members of the association present when ratified by the board
				  of directors, but only at meetings called for that purpose, or at regular
				  meetings. Amendments to the bylaws shall not be effective until approved by the
				  commissioner of insurance. Notices of all meetings, whether regular or special,
				  at which amendments to bylaws will be considered, must be mailed to all
				  members. Such notices must contain full copies of the proposed changes in the
				  bylaws and a fair explanation of the intent and effect thereof."
(2) To avoid the necessity of declining to
				  approve the purported amendments because of deficiency in the notice, it is
				  suggested that such notices be submitted to the commissioner of insurance
				  before they are mailed to the members.
(3) After the meetings, the following must be
				  submitted to the commissioner of insurance:
(A) two copies of the printed notice to
				  members accompanied by an affidavit of the secretary that the notice was mailed
				  by first class mail to every member;
(B) two copies of the minutes of the
				  membership meeting reciting the action taken, duly signed by the appropriate
				  officers;
(C) two copies of the
				  minutes of the meeting of the board of directors ratifying the action taken by
				  the membership, duly signed by the appropriate officers; and
(D) two copies of the amendment as adopted,
				  duly certified by president and secretary.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.26 - Computation of Time

Current through Reg. 49, No. 28; July 12, 2024
In computing any period of time for the mailing of notices
					 of a meeting of the membership or board of directors of a mutual assessment
					 company or association, the day of mailing and the day of meeting shall not be
					 counted.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.27 - Reserve Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) General.
				  The life insurance reserves required to be maintained by all mutual assessment
				  associations shall be computed in accordance with recognized actuarial
				  principles based upon the liability of the association as set out in its
				  various life insurance contracts. In general, the following rules will apply.
(1) As required by the Insurance Code Article
				  14.15, §2, the reserve liabilities for all outstanding contracts of life
				  insurance shall be computed as soon as possible after the end of each calendar
				  year and a detailed copy of such valuation submitted to the State Board of
				  Insurance. One copy of the valuation must be retained in the home office of the
				  association and be available for the periodical examination of such
				  association. The valuation submitted to the State Board of Insurance must
				  include a recap and summary and be in such form as to enable the reserve
				  analysts to verify the accuracy of such valuation based on the outstanding
				  business as of date of valuation. Valuation forms will be supplied by the State
				  Board of Insurance for those associations which desire to compute their
				  reserves manually by group valuation methods. Machine valuations of reserves
				  must include data sufficient to verify the accuracy and completeness of the
				  valuation.
(2) If the association
				  has computed its reserve liability based on the 1956 Chamberlain Table which
				  provides for reserves calculated on a calendar year basis, the tabular reserve
				  must be increased by an unearned net premium for policies for which the mode of
				  premium payment is other than monthly. Such unearned net premium reserve will
				  be the aggregate of the net premiums applicable to full months of insurance
				  coverage subsequent to valuation date for which the contract premiums were paid
				  prior to the date of valuation. The State Board of Insurance will accept a
				  reasonable estimate of this unearned net premium in lieu of an amount
				  determined by actual computation.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.28 - Uncollected Premiums

Current through Reg. 49, No. 28; July 12, 2024
The association may take an asset in the mortuary fund for
					 uncollected net premiums on policies for which the reserve has been included in
					 the reserve valuation. No credit will be allowed for deferred premiums if a
					 method adopted by the company or association for computing its reserve
					 liability on outstanding policies is based on the 1956 Chamberlain Reserve
					 Table. The State Board of Insurance will accept a reasonable estimate of the
					 amount of this asset in lieu of an amount determined by actual
					 computation.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter A - STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS › Section 13.29 - Establishment and Maintenance of Permissive Deficiency Reserves

Current through Reg. 49, No. 28; July 12, 2024
(a) At the time of determination (effective
				  December 31, 1965):
(1) determine on a
				  reasonable basis the amount of net assets of the mortuary fund of the mutual
				  assessment company attributable to the various blocks of life and health and
				  accident business. The various blocks of business to which proportionate parts
				  of the net assets are to be allocated includes those blocks for which a
				  separation of accounting for rating or other purposes has been required by the
				  board or by the commissioner of insurance under various reinsurance and/or
				  merger agreements or are otherwise required by law. In the absence of adequate
				  records for determining mortuary fund balances for the various blocks, such
				  allocations may be made on a reasonable basis taking into consideration past
				  and prospective claim experience of such blocks;
(2) determine and allocate the amount of
				  permissive deficiency reserve which will be applied against the reserves for
				  the various blocks of life and health and accident business.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter B - STIPULATED PREMIUM INSURANCE COMPANIES › Section 13.101 - Establishment and Maintenance of Permissive Deficiency Reserve

Current through Reg. 49, No. 28; July 12, 2024
(a) At the time of reinsurance of a Chapter
				  14 association or company:
(1) Determine on a
				  reasonable basis the amount of net assets of the mutual assessment company
				  attributable to the various blocks of life and health and accident business.
				  The various blocks of business to which proportionate parts of the net assets
				  are to be allocated includes those blocks for which a separation of accounting
				  for rating or other purposes has been required by the board or by the
				  commissioner of insurance under various reinsurance and/or merger agreements or
				  are otherwise required by law. In the absence of adequate records for
				  determining the net assets applicable to the various blocks, such allocations
				  may be made on a reasonable basis taking into consideration past and
				  prospective claim experience of such blocks.
(2) Allocate the amount of permissive
				  deficiency reserve in the stipulated premium company which will be applied
				  against the reserves for the various blocks of life and health and accident
				  business.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter B - STIPULATED PREMIUM INSURANCE COMPANIES › Section 13.102 - Life Policy Forms

Current through Reg. 49, No. 28; July 12, 2024
(a) The reserve
				  basis adopted by the company shall be shown on the rate schedule and may be
				  shown in the policy.
(b) Family
				  group policies, upon which the rate is calculated on an individual insured
				  basis, shall contain a provision with reference to a reduction of premium in
				  the event of the death of any insured by the amount of premium being paid on
				  behalf of the deceased insured.
(c)
				  Policies shall provide a grace period of at least 31 days for the payment of
				  every premium after the first, which may be subject to an interest charge,
				  during which month the insurance shall continue in force, which may stipulate
				  that if the insured shall die during the period of grace the overdue premium
				  will be deducted in any settlement under the policy.
(d) Policies shall provide that claims are to
				  be paid within 60 days after receipt of due proof of claim.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter C - LLOYD'S PLAN INSURERS › Section 13.201 - Approval of Attorney in Fact

Current through Reg. 49, No. 28; July 12, 2024
No original, additional, or substitute attorney in fact may
					 act for a Lloyd's plan company until he or she is appointed by the underwriters
					 of the Lloyd's plan company and is approved, after a hearing before the
					 commissioner, as an attorney in fact for the Lloyd's plan
					 company.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter C - LLOYD'S PLAN INSURERS › Section 13.202 - Distinction between Attorney in Fact and Deputy Attorney in Fact

Current through Reg. 49, No. 28; July 12, 2024
(a) Attorney in fact.
(1) Wherein the terms "attorney in fact" and
				  "actual attorney in fact" are used in the statutes or State Board of Insurance
				  rules, they are synonymous.
(2) An
				  attorney in fact has total authority to operate the Lloyd's plan company acting
				  pursuant to authorization from the underwriters of the Lloyd's plan company
				  under power of attorney.
(3) An
				  attorney in fact need not be licensed by the State Board of Insurance as an
				  agent pursuant to the Insurance Code, Article 21.14.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.301 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to regulate, to the
					 extent permitted by law and dictated by sound public policy, groups doing
					 business in Texas as risk retention groups or purchasing
					 groups.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.302 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, shall have the following meanings, unless the context clearly
					 indicates otherwise.
(1) Doing
				  business in Texas as a risk retention group or purchasing group--
(A) operating in, soliciting members in,
				  having members in, or having an office in, Texas; and
(B) claiming to be, representing itself to
				  be, or operating as, a risk retention group or purchasing group.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.303 - Scope

Current through Reg. 49, No. 28; July 12, 2024
The following two kinds of groups are subject to this
					 subchapter:
(1) a group doing business
				  in Texas as a risk retention group or purchasing group, which actually has the
				  status of a risk retention group or purchasing group; and
(2) a group doing business in Texas as a risk
				  retention group or purchasing group, but not actually having the status of a
				  risk retention group or purchasing group because the group has not completed
				  the registration process or does not conform to other statutory
				  criteria.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.304 - General Prohibition

Current through Reg. 49, No. 28; July 12, 2024
No organization or group may do business in Texas as a risk
					 retention group or purchasing group without having the status of a risk
					 retention group or purchasing group under the Insurance Code, Article
					 21.54.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.305 - Registration

Current through Reg. 49, No. 28; July 12, 2024
A group violating the requirements described in this
					 section shall not have the status of a purchasing group or risk retention group
					 under the Insurance Code, Article 21.54.
(1) A group doing business in Texas as a
				  purchasing group must first furnish notice to, and register with, the
				  commissioner of insurance, pursuant to the Insurance Code, Article 21.54,
				  §7.
(2) A group doing business
				  in Texas as a risk retention group must first complete the process of being
				  chartered or registered under the Insurance Code, Article 21.54, §3 or
				  §4.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.306 - Operation by Members Only

Current through Reg. 49, No. 28; July 12, 2024
(a) Every group
				  doing business in Texas as a risk retention group shall be operated only by its
				  members collectively.
(b) In this
				  section, a group is operated only by its members collectively if the members
				  collectively retain the power to direct the affairs of the group and to enter
				  at arm's length into transactions with suppliers of goods and
				  services.
(c) Any group or
				  organization that fails to conform to this section shall not have the status of
				  a risk retention group under the Insurance Code, Article 21.54.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.307 - Providing Other Than Liability Insurance

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  group doing business in Texas as a risk retention group shall not provide
				  physical damage coverage, property coverage, surety bonds, or any insurance
				  except:
(1) liability insurance; or
(2) reinsurance with respect to the liability
				  of any other risk retention group, or any members of such other group, which is
				  engaged in businesses or activities so that the group or member meets the
				  requirement of the Insurance Code, Article 21.54, §2(6), for membership in
				  the risk retention group which provides the reinsurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.308 - Requirement of Similar or Related Liability Exposure

Current through Reg. 49, No. 28; July 12, 2024
This section states rules for a group doing business in
					 Texas as a purchasing group or risk retention group, defining the requirement
					 of similar or related liability exposure, pursuant to the Insurance Code,
					 Article 21.54, §2(9) and (10). If a group violates any of the provisions
					 in this section, the group does not meet the requirement. Any group or
					 organization that fails to meet the requirement shall not have the status of a
					 risk retention group or a purchasing group under the Insurance Code, Article
					 21.54.
(1) A group's membership shall
				  not be based on various theories of potential legal liability. By way of
				  example only, a professional liability exposure is not similar or related to a
				  product liability exposure.
(2) A
				  group's members must reasonably be able to engage in a joint loss prevention
				  program.
(3) If a group's
				  membership consists of businesses, all those businesses must be tied to the
				  same kind of product or service. By way of example only, if a group's
				  membership includes manufacturers and repairers, they all must manufacture or
				  repair the same kind of product.
(4) If a group's membership consists of
				  professionals who provide a service, all the members must provide the same kind
				  of service.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.309 - Sanctions

Current through Reg. 49, No. 28; July 12, 2024
(a) If an entity holding a certificate of
				  authority in Texas is doing business in Texas as a risk retention group, but
				  violates any one of §§
										13.305,
				  13.306,
				  13.307,
				  or
				  13.308
				  of this title (relating to Registration, Operation by Members Only, Providing
				  Other Than Liability Insurance; or Requirement of Similar or Related Liability
				  Exposure), the State Board of Insurance may revoke the certificate of authority
				  or impose other sanctions under the Insurance Code, Article 1.10,
				  §7.
(b) If a group, other than
				  a group described in subsection (a) of this section, is doing business in Texas
				  as a purchasing group or risk retention group, without the status of a
				  purchasing group or risk retention group, the group is subject to the same
				  actions that the State Board of Insurance may take against an unauthorized
				  insurer, in addition to any other actions.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.310 - Cease and Desist Orders

Current through Reg. 49, No. 28; July 12, 2024
The following may be authorized persons or unauthorized
					 persons, subject to emergency cease and desist orders under the Insurance Code,
					 Article 1.10A and Article 21.21:
(1) a
				  group doing business in Texas as a purchasing group or a risk retention group;
				  or
(2) an individual acting for any
				  such group.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.311 - Deceptive Acts or Practices

Current through Reg. 49, No. 28; July 12, 2024
The following are deceptive acts or practices under the
					 Insurance Code, Article 21.21:
(1)
				  representing a group to be a purchasing group located in another state, when
				  the group is actually located in Texas, according to the Insurance Code,
				  Article 21.54, §2(14);
(2)
				  soliciting members in Texas for a purchasing group, or for a group representing
				  itself to be a purchasing group, when:
(A)
				  the group's insurer is insolvent;
(B) the group's insurer is prohibited from
				  engaging in the business of insurance by a court order or administrative order
				  issued in any state; or
(C) the
				  group is prohibited from operating by a court order or administrative order
				  issued in the state in which the group is domiciled;
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.312 - Regulatory Fees

Current through Reg. 49, No. 28; July 12, 2024
The regulated entities subject to the fees imposed by this
					 section shall include all risk retention groups and purchasing groups defined
					 in the Insurance Code, Article 21.54, §2(9) and (10), and doing business
					 in this state. For filings and other actions on and after May 19, 1987, the
					 State Board of Insurance shall charge these entities fees in accordance with
					 the provisions of this section.
(1)
				  Initial filing fee for risk retention groups chartered and licensed pursuant to
				  the Insurance Code, Chapters 2, 8, 15, or 19. As provided in the Insurance
				  Code, Article 21.54, §3(f), risk retention groups shall be required to pay
				  a filing fee of $500.
(2) Initial
				  filing fee for risk retention groups not chartered in this state. As provided
				  in the Insurance Code, Article 21.54, §4(c), a filing fee of $250 shall be
				  paid for the filing of an identifying statement pursuant to the Insurance Code,
				  Article 21.54, §4(b)(1). This filing fee shall also include the cost of
				  filing a plan of operation if required by the provisions of the Insurance Code,
				  Article 21.54, §4(b)(2).
(3)
				  Annual filing fee for risk retention groups not chartered in this state. As
				  provided in the Insurance Code, Article 21.54, §4(e), risk retention
				  groups shall pay a filing fee of $250 for the filing of the financial statement
				  under the Insurance Code, Article 21.54, §4(d)(1).
(4) Initial filing fee for purchasing groups.
				  As provided in the Insurance Code, Article 21.54, §7(a), purchasing groups
				  who file with the commissioner of insurance the requisite notice that they
				  intend to do business in this state shall pay a filing fee of $50 upon the
				  submission of the notice.
(5)
				  Filing fee for document served on commissioner as agent. As provided in the
				  Insurance Code, Article 1.36 and Article 21.54, §§3(b), 4(b)(3), and
				  7(b)(4), a filing fee of $25 shall be paid for each document served on the
				  commissioner of insurance of this state as agent for service of process under
				  the Insurance Code, Article 21.54.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter D - RISK RETENTION GROUPS AND PURCHASING GROUPS › Section 13.313 - Forms Required for Risk Retention Groups and Purchasing Groups

Current through Reg. 49, No. 28; July 12, 2024
(a) Requirement for use of specific forms.
				  Risk retention group or purchasing group filings and registrations under the
				  Insurance Code, Chapter 2201, must be effected by using forms promulgated by
				  the commissioner of insurance.
(b)
				  Adoption by reference of forms. The commissioner of insurance adopts by
				  reference standard forms as specified in paragraphs (1) - (6) of this
				  subsection and subsection (c) of this section for use by risk retention groups
				  and purchasing groups which are subject to the provisions of this subchapter
				  and the Insurance Code, Chapter 2201. The forms are published by the Texas
				  Department of Insurance, and copies of the forms are available from the Company
				  Licensing and Registration Division, Texas Department of Insurance, Mail Code
				  305-2C, P.O. Box 149104, Austin, Texas 78714-9104. The following forms must be
				  utilized, as applicable, under the provisions of this subchapter and the
				  Insurance Code, Chapter 2201.
(1) Risk
				  retention groups seeking to be chartered in this state pursuant to the
				  Insurance Code Chapters 822, 861, and 883, must utilize Form
				  RRG-A-120.
(2) Risk retention
				  groups seeking to be chartered in this state pursuant to the Insurance Code,
				  Chapter 942 must utilize Form RRG-A-121.
(3) Foreign or alien risk retention groups
				  seeking to do business as a risk retention group in this state must utilize
				  Form RRG-A-122.
(4) All risk
				  retention groups and purchasing groups seeking to do business in this state
				  must utilize Form RRG/PG PC1, for appointing the commissioner as agent for
				  service of process.
(5) Purchasing
				  groups filing a notice of intent and registering to do business in this state
				  under the Insurance Code, §§
											2201.255
				  and
				  2201.256,
				  must utilize Form PG1.
(6) Agents
				  filing annual reports as required by the Insurance Code, §
											2201.007
				  must use Form PG3.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 1 - GENERAL PROVISIONS › Section 13.401 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
This subchapter implements Insurance Code Chapter 848 and
						other insurance laws of this state that apply to health care collaboratives to
						provide the framework to support the use of innovative health care
						collaborative payment and delivery systems in this state.
(1) Severability. If a court of competent
					 jurisdiction holds that any provision of this subchapter or its application to
					 any person or circumstance is invalid for any reason, the invalidity does not
					 affect other provisions or applications of this subchapter that can be given
					 effect without the invalid provision or application, and to this end the
					 provisions of this subchapter are severable.
(2) Effect of rules. The sections in this
					 subchapter govern the performance of appropriate statutory and regulatory
					 functions and do not limit the exercise of statutory authority by the
					 commissioner of insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 1 - GENERAL PROVISIONS › Section 13.402 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
						subchapter, have the following meanings unless the context clearly indicates
						otherwise.
(1) Affiliate--As defined
					 in Insurance Code §
											848.001(1).
(2) Clinical director--Health professional
					 who is:
(A) appropriately licensed in good
					 standing in Texas;
(B) an employee
					 of, or party to a contract with, an HCC; and
(C) responsible for clinical oversight of the
					 utilization review program, the credentialing of professional staff, and
					 quality improvement functions.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 1 - GENERAL PROVISIONS › Section 13.403 - Filing and Required Forms; How to Obtain Forms

Current through Reg. 49, No. 28; July 12, 2024
(a) All HCC filings for original or renewal
					 application as required by this subchapter must be made to Company Licensing
					 & Registration, Mail Code 305-2C, Texas Department of Insurance, P.O. Box
					 149104, Austin, Texas 78714-9104, and copies of all HCC forms are available
					 through that address. All forms also are available on the department website at
					 www.tdi.texas.gov.
(b) All HCC
					 forms for an original or renewal application filing may be submitted
					 electronically in a format permitted by the department.
(c) Paragraphs (1) - (7) of this subsection
					 identify the forms specified for use with the rules adopted under this
					 subchapter. Forms identified in paragraphs (1) and (4) - (7) have a June 2012
					 revision date. Forms identified in paragraphs (2) and (3) have a March 2013
					 revision date. Each HCC or other individual or entity must use the form(s) as
					 required by this title in accord with the form's instructions and content
					 requirements and as appropriate to particular activities. The commissioner
					 adopts by reference the following forms:
(1)
					 Original/Renewal Application for Certificate of Authority to do the Business of
					 a Health Care Collaborative (HCC) in the State of Texas;
(2) Health Care Collaborative Officers and
					 Directors Page;
(3) Biographical
					 Affidavit;
(4) Request to Convert
					 to Renewal of Certificate of Authority to do the Business of a Health Care
					 Collaborative (HCC) in the State of Texas;
(5) Financial Authorization and Release
					 Form;
(6) Health Care Collaborative
					 Payor Information Form; and
(7)
					 Health Care Collaborative (HCC) Acquisition Form.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 1 - GENERAL PROVISIONS › Section 13.404 - Use of the Term "HCC;" Service Mark; Trademarks; d/b/a

Current through Reg. 49, No. 28; July 12, 2024
(a) While planning or developing an HCC, an
					 organization may use the terms "health care collaborative" or "HCC" as a part
					 of the proposed HCC's name provided the developmental status of the proposed
					 HCC is clearly communicated in all dealings with employers, individuals,
					 prospective contract holders, news media, and other individuals or
					 entities.
(b) After the certificate
					 of authority is issued, the HCC must include the name as it appears on the
					 certificate of authority on all advertising and forms distributed to the
					 public.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 2 - APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 13.411 - Filing Fee; Annual Assessments; Open Records

Current through Reg. 49, No. 28; July 12, 2024
(a) The application filing fee required by
					 Insurance Code §
											848.152 must
					 accompany the application required to be filed by Insurance Code §
											848.056
					 or §
											848.060.
(b) The fee for filing the original
					 application for certificate of authority is $10,000 and is
					 nonrefundable.
(c) The fee for
					 filing the annual renewal application for certificate of authority is $5,000
					 and is nonrefundable.
(d) In
					 addition to the filing fee addressed in this section, each HCC must pay to the
					 department annually an assessment as set forth in §13.421(c)(1) - (6) of
					 this title (relating to Examination; Fee for Expenses).
(e) Except as provided by Insurance Code
					 §
											848.005(b),
					 the application is public information subject to disclosure under the
					 Government Code Chapter 552.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 2 - APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 13.412 - Revisions During Review Process

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Revisions during the review of the application must be addressed to: Company
					 Licensing & Registration, Mail Code 305-2C, Texas Department of Insurance,
					 P.O. Box 149104, Austin, Texas 78714-9104.
(b) Each revision to the basic organizational
					 document, bylaws, or officers' and employees' bond must be accompanied by a
					 certification of the corporate secretary or corporate president of the
					 applicant that the revision submitted is true, accurate, and
					 complete.
(c) The department will
					 conduct examinations in connection with each application and notify the
					 applicant of the need for revisions necessary to meet the requirements of
					 Insurance Code Chapter 848, this subchapter, and applicable insurance laws and
					 regulations of this state. If the applicant does not make the necessary
					 revisions, the department may withdraw the application on behalf of the
					 applicant. If the time required for the revisions will exceed the time limit
					 provided in Insurance Code §
											848.056(c),
					 the applicant must request additional time within which to make the revisions.
					 The applicant must specifically state the length of time requested, which may
					 not exceed 90 days. The request for any extension must describe the need for
					 the additional time in writing in sufficient detail for the commissioner to
					 determine if good cause for the extension exists. The applicant may request
					 additional extensions. The commissioner has discretion to grant or deny the
					 request for an extension of time under Insurance Code §
											848.056.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 2 - APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 13.414 - Limited Exemption from Certain Information Filing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) This section specifies circumstances
					 under which an applicant is not required to provide the information specified
					 in §
											13.413(i)
					 of this title (relating to Contents of the Application) in filing an original
					 or renewal application for certificate of authority.
(b) An applicant is not required to provide
					 the information specified in §
											13.413(i)
					 of this title if:
(1) for each PSA in which
					 two or more individual or group participants provide common services, the
					 applicant's market share is 35 percent or less; and
(2) no contract between the HCC and any
					 participating hospital restricts the HCC or hospital from contracting with
					 other HCCs, networks, hospitals, physicians, physician groups, health care
					 providers, or private payors.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 2 - APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 13.416 - Review of Original or Renewal Application; Commissioner Discretion

Current through Reg. 49, No. 28; July 12, 2024
(a) An original application or renewal
					 application will be processed pursuant to Insurance Code §§
											848.056
					 -
					 848.060
					 and §
											848.153.
(b) The department will conduct an
					 examination as specified in §
											13.421(a)
					 of this title (relating to Examination; Fee for Expenses) in conjunction with
					 each application. If a hearing is held in connection with an application, then
					 the examination(s) will occur prior to the date of the hearing.
(c) Application review will include a
					 determination of compliance with Insurance Code §
											848.057.
					 The review of pro-competitive benefits of the proposed or existing HCC in
					 relation to anticompetitive effects of market power increase will be in accord
					 with established antitrust principles of market power analysis.
(d) The commissioner has sole discretion to
					 impose restrictions on an HCC applicant's certificate of authority that are
					 deemed necessary to preserve competition. Examples of these restrictions
					 include the following:
(1) prohibiting the HCC
					 applicant from including "anti-steering," "guaranteed inclusion," "product
					 participation," "price parity," or similar contractual clauses or provisions in
					 its contracts with a private payor;
(2) prohibiting the HCC applicant from tying
					 sales, explicitly or implicitly through pricing policies, of the HCC's services
					 to a private payor's purchase of other services from physicians or health care
					 providers outside of the HCC (and vice versa), including providers affiliated
					 with HCC participants;
(3)
					 prohibiting contracting with HCC participants on a basis that prevents or
					 discourages them from contracting outside the HCC, either individually or
					 through other HCCs or provider networks;
(4) prohibiting restrictions on a private
					 payor's ability to provide its health plan enrollees with cost, quality,
					 efficiency, and performance information used by the HCC to aid enrollees in
					 evaluating and selecting physicians and health care providers in the health
					 plan;
(5) prohibiting sharing with
					 or among the HCC's participants any competitively sensitive pricing or other
					 data that could be used to set prices or other terms for services that the
					 participants provide outside the HCC; and
(6) restricting the HCC's certificate of
					 authority to certain geographic areas or health care services.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 2 - APPLICATION FOR CERTIFICATE OF AUTHORITY › Section 13.417 - Withdrawal of an Application

Current through Reg. 49, No. 28; July 12, 2024
(a) On written
					 notice to the department, an applicant may request withdrawal of an application
					 from consideration by the department.
(b) The department may in its discretion
					 withdraw an application on behalf of the applicant if the department determines
					 that the applicant has failed to respond in a timely manner to requests made by
					 the department for additional information or if the application is
					 incomplete.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter E - HEALTH CARE COLLABORATIVES › Division 3 - EXAMINATIONS; REGULATORY REQUIREMENTS FOR AN HCC AFTER ISSUANCE OF CERTIFICATE OF AUTHORITY; AND ADVERTISING AND SALES MATERIAL › Section 13.421 - Examination; Fee for Expenses

Current through Reg. 49, No. 28; July 12, 2024
(a) The
					 department has authority to conduct examinations of HCCs under Insurance Code
					 §
											848.153. The
					 department will conduct examinations in conjunction with an application and as
					 needed to oversee the HCC's activity. The scope of the examination may vary
					 based on the scope of an applicant's or HCC's activities and may include desk
					 review. Any examination may include the review of one or more of the following
					 components:
(1) financial
					 condition;
(2) quality of health
					 care services;
(3) compliance with
					 laws affecting the conduct of business; or
(4) effect on market competition.