reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2008 - On-Site Review by a URA

Current through Reg. 49, No. 28; July 12, 2024
(a) Identification
				  of URAs. If a URA's staff member is conducting an on-site or off-site review,
				  each staff member must provide his or her name, the name of his or her
				  organization, photo identification, and a URA identification card with the
				  certification or registration number assigned by TDI when requested by an
				  individual, including an injured employee or health care provider.
(b) On-site review. For on-site review
				  conducted at a health care facility, a URA:
(1) must ensure that on-site review staff:
(A) register with the appropriate contact
				  individual, if available, prior to requesting any clinical information or
				  assistance from health care facility staff; and
(B) wear appropriate health care facility
				  supplied identification tags while on the health care facility
				  premises;
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2009 - Notice of Determinations Made in Utilization Review

Current through Reg. 49, No. 28; July 12, 2024
(a) Notice requirements of favorable or
				  adverse determinations.
(1) A URA must send
				  written notification of a determination made in utilization review to the
				  individuals specified in and within the timeframes required for utilization
				  review.
(2) For prospective and
				  concurrent review, the timeframes are specified by:
(A) Section
				  134.600
				  of this title (relating to Preauthorization, Concurrent Review, and Voluntary
				  Certification of Health Care) for workers' compensation non-network coverage;
				  and
(B) Insurance Code §
												1305.353,
				  concerning Notice of Certain Utilization Review Determinations;
				  Preauthorization Requirements; and §
												10.102
				  of this title (relating to Notice of Certain Utilization Review Determinations;
				  Preauthorization and Retrospective Review Requirements) for workers'
				  compensation network coverage.
(3) For retrospective review, the timeframes
				  are specified by:
(A) Sections
				  133.240
				  and
				  133.250
				  of this title (relating to Medical Payment and Denials, and Reconsideration for
				  Payment of Medical Bills, respectively) for workers' compensation non-network
				  coverage;
(B) Sections
				  133.240,
				  133.250,
				  and
				  10.102
				  of this title, for workers' compensation network coverage.
(4) For workers' compensation non-network
				  coverage and network coverage, a URA must ensure that preauthorization numbers
				  assigned by the URA comply with the data and format requirements contained in
				  the standards adopted by the U.S. Department of Health and Human Services in 45
				  Code of Federal Regulations §162.1102 (relating to Standards for Health
				  Care Claims or Equivalent Encounter Information Transaction) based on the type
				  of service in the preauthorization request.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2010 - Requirements Prior to Issuing Adverse Determination

Current through Reg. 49, No. 28; July 12, 2024
In any instance in which a URA is questioning the medical
					 necessity or appropriateness of the health care services prior to issuance of
					 an adverse determination, the URA must afford the provider of record a
					 reasonable opportunity to discuss the plan of treatment for the injured
					 employee with a physician, dentist, or chiropractor. If the health care
					 services in question are dental services, then a dentist may conduct the
					 discussion if the services in question are within the scope of the dentist's
					 license to practice dentistry. If the health care services in question are
					 chiropractic services, then a chiropractor may conduct the discussion if the
					 services in question are within the scope of the chiropractor's license to
					 practice chiropractic. The discussion must include, at a minimum, the clinical
					 basis for the URA's decision and a description of documentation or evidence, if
					 any, that can be submitted by the provider of record that, on appeal, might
					 lead to a different utilization review decision.
(1) The URA must provide the URA's telephone
				  number so the provider of record may contact the URA to discuss the pending
				  adverse determination.
(2) The URA
				  must maintain, and submit to TDI or TDI-DWC on request, documentation that
				  details the discussion opportunity provided to the provider of record,
				  including the date and time the URA offered the opportunity to discuss the
				  adverse determination, the date and time that the discussion, if any, took
				  place, and the discussion outcome.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2012 - URA's Telephone Access and Procedures for Certain Drug Requests and Post-Stabilization Care

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  URA must have appropriate personnel reasonably available by toll-free telephone
				  at least 40 hours per week during normal business hours in both Central Time
				  and Mountain Time, to discuss an injured employee's care and to respond to
				  telephone review requests.
(b) A
				  URA must have procedures that the URA will implement when responding to
				  requests for:
(1) drugs that require
				  preauthorization, in situations in which the injured employee has received or
				  is currently receiving the requested drugs and an adverse determination could
				  lead to a medical emergency; and
(2) post-stabilization care and pain
				  management medication immediately subsequent to surgery or emergency treatment,
				  as requested by the treating physician or provider of record.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2013 - Confidentiality

Current through Reg. 49, No. 28; July 12, 2024
(a) Confidentiality requirements. To ensure
				  confidentiality, a URA must, when contacting a physician's, doctor's, or other
				  health care provider's office, provide its certification number, name, and
				  professional qualifications.
(1) If requested
				  by the physician, doctor, or other health care provider, the URA must present
				  written documentation that it is acting as an agent of the insurance carrier
				  for the relevant injured employee.
(2) Medical records and injured employee
				  specific information must be maintained by a URA in a secure area with access
				  limited to essential personnel only.
(3) A URA must retain information generated
				  and obtained by the URA in the course of utilization review for at least four
				  years.
(4) A URA's charges for
				  providing a copy of recorded personal information to individuals may not exceed
				  10 cents per page and may not include any costs that are otherwise recouped as
				  part of the charge for utilization review.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2014 - Regulatory Requirements Subsequent to Certification or Registration

Current through Reg. 49, No. 28; July 12, 2024
(a) Complaints to TDI. Complaints received by
				  TDI against a URA must be processed under TDI's established procedures for
				  investigation and resolution of complaints.
(b) TDI inquiries. TDI may address inquiries
				  to a URA related to any matter connected with URA transactions TDI considers
				  necessary for the public good or for the proper discharge of TDI's duties.
				  Under Insurance Code §
										38.001, a URA that
				  receives an inquiry from TDI must respond to the inquiry in writing not later
				  than the 15th day after the date the inquiry is received.
(c) TDI-DWC inquiries. This section does not
				  limit the ability of the commissioner of workers' compensation or TDI-DWC to
				  make inquiries, conduct audits, or receive and investigate complaints against
				  URAs or personnel employed by or under contract with URAs to perform
				  utilization review to determine compliance with or violations of Labor Code
				  Title 5, the Insurance Code, or applicable TDI-DWC rules.
(d) On-site review by TDI. For scheduled and
				  unscheduled on-site reviews, TDI may make a complete on-site review of the
				  operations of each URA at the principal place of business for each agent as
				  often as is deemed necessary. An on-site review will only be conducted during
				  working days and normal business hours. A URA must make available all records
				  relating to its operation during any scheduled or unscheduled on-site reviews.
(1) Scheduled on-site reviews. A URA will be
				  notified of any scheduled on-site review by letter, which will specify, at a
				  minimum, the identity of TDI's designated representative and the expected
				  arrival date and time.
(2)
				  Unscheduled on-site reviews. At a minimum, notice of an on-site review of a URA
				  will be in writing and be presented by TDI's designated representative on
				  arrival.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2015 - Administrative Violations

Current through Reg. 49, No. 28; July 12, 2024
(a) A fraudulent or
				  deceptive act or omission in obtaining, attempting to obtain, or use of
				  certification or registration as a URA is a violation of Insurance Code Chapter
				  4201.
(b) The commissioner's
				  authority under this subchapter is in addition to any other authority to
				  enforce a sanction, penalty, fine, forfeiture, denial, suspension, or
				  revocation otherwise authorized by law, including remedies under Insurance Code
				  Chapter 4201, Subchapter M, concerning Enforcement.
(c) This section does not limit the ability
				  of the commissioner of workers' compensation or TDI-DWC to make inquiries,
				  conduct audits, or receive and investigate complaints against URAs or personnel
				  employed by or under contract with URAs to perform utilization review to
				  determine compliance with or violations of Labor Code Title 5 or TDI-DWC rules.
				  Nothing in this section prohibits joint enforcement actions by TDI and TDI-DWC
				  or delegations of authority between TDI and TDI-DWC to enforce relevant
				  statutes or rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2016 - Specialty URA

Current through Reg. 49, No. 28; July 12, 2024
(a) Application. To
				  be certified or registered as a specialty URA, an applicant must submit to TDI
				  the application, information, and fee required in §
										19.2004
				  of this title (Certification or Registration of URAs).
(b) Same specialty required. A specialty URA
				  must conduct utilization review under the direction of a health care provider
				  who is of the same specialty as the agent and who is licensed or otherwise
				  authorized to provide the specialty health care service by a state licensing
				  agency in the United States. To conduct utilization review, a specialty URA
				  must be of the same specialty as the health care provider who ordered the
				  service. For example, when conducting utilization review of prescription drugs
				  prescribed by a physician with a specialty in neurological surgery, the
				  specialty URA must be a physician with a specialty in neurological
				  surgery.
(c) Rule requirements. A
				  specialty URA is subject to the requirements of this subchapter, except for the
				  following provisions:
(1)
											§
											19.2005(a)
				  of this title (relating to General Standards of Utilization Review);
(2)
											§19.2006(a), (c), (d), and (e) of
				  this title (relating to Requirements and Prohibitions Relating to
				  Personnel);
(3)
											§
											19.2010
				  of this title (relating to Requirements Prior to Issuing Adverse
				  Determination); and
(4)
											§
											19.2011(a)(4)
				  and (5) of this title (relating to Written
				  Procedures for Appeal of Adverse Determination).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 19 - LICENSING AND REGULATION OF INSURANCE PROFESSIONALS › Subchapter U - UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE › Section 19.2017 - Independent Review of Adverse Determinations

Current through Reg. 49, No. 28; July 12, 2024
(a) Life-threatening conditions.
(1) Notification for life-threatening
				  conditions. For life-threatening conditions, notification of an adverse
				  determination by a URA must comply with:
(A)
				  Section
				  134.600
				  of this title (relating to Preauthorization, Concurrent Review, and Voluntary
				  Certification of Health Care) for workers' compensation non-network
				  coverage;
(B) Insurance Code §
												1305.353
				  and § 10.102 of this title (relating to Notice of Certain Utilization
				  Review Determinations; Preauthorization and Retrospective Review Requirements)
				  for workers' compensation network coverage; and
(C) Section
				  19.2009(a)(2)
				  of this title (relating to Notice of Determinations Made in Utilization
				  Review), including notice of the independent review process and the procedure
				  for obtaining a copy of the request for a review by an IRO form. The notice
				  must describe how to obtain independent review of the adverse determination and
				  how TDI assigns a request for independent review to an IRO.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter A - UNFAIR COMPETITION AND UNFAIR PRACTICES OF INSURERS, AND MISREPRESENTATION OF POLICIES › Section 21.1 - Deceptive Acts or Practices of Insurers, Agents, and Connected Persons

Current through Reg. 49, No. 28; July 12, 2024
Purpose of regulation. It is the purpose of these sections
					 to further define and state the standards that are necessary to prohibit
					 deceptive acts or deceptive practices by insurers and insurance agents and
					 other persons in their conduct of the business of insurance or in connection
					 therewith, whether done directly or indirectly, and irrespective of whether the
					 person is acting as insurer, principal, agent, employer, or employee, or in
					 other capacity or connection with such insurer.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter A - UNFAIR COMPETITION AND UNFAIR PRACTICES OF INSURERS, AND MISREPRESENTATION OF POLICIES › Section 21.2 - Interpretations

Current through Reg. 49, No. 28; July 12, 2024
The meanings given to the provisions, terms, and words of
					 this regulation are not to be limited to the common law meaning, which may have
					 been given thereto, but are to be interpreted to accomplish the purpose of
					 these sections in accordance with the provisions of Insurance Code Chapter 541
					 and Insurance Code §
										543.001.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter A - UNFAIR COMPETITION AND UNFAIR PRACTICES OF INSURERS, AND MISREPRESENTATION OF POLICIES › Section 21.3 - Unfair Trade Practices Prohibited

Current through Reg. 49, No. 28; July 12, 2024
(a) Misrepresentation of insurance policies,
				  unfair competition, and unfair practices by insurers, agents, and other
				  connected persons are prohibited by Insurance Code Chapter 541 and Insurance
				  Code §
										543.001
				  or by other provisions of the Insurance Code and this chapter. No person may
				  engage in this state in any trade practice that is a misrepresentation of an
				  insurance policy, that is an unfair method of competition, or that is an unfair
				  or deceptive act or practice as defined by the provisions of the Insurance Code
				  or as defined by these sections and other rules and regulations authorized by
				  the Insurance Code.
(b)
				  Irrespective of the fact that the improper trade practice is not defined in any
				  other section of these rules and regulations, no person may engage in this
				  state in any trade practice which is determined pursuant by law to be an unfair
				  method of competition or an unfair or deceptive act or practice in the business
				  of insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter A - UNFAIR COMPETITION AND UNFAIR PRACTICES OF INSURERS, AND MISREPRESENTATION OF POLICIES › Section 21.4 - Misrepresentation Defined; Standards for Determining Misrepresentation

Current through Reg. 49, No. 28; July 12, 2024
The term misrepresentation, or the prohibited conduct, act,
					 or practice that constitutes misrepresentation by a person subject to the
					 provisions of these sections, is defined as any one of the following acts or
					 omissions:
(1) any untrue statement of
				  a material fact;
(2) any omission
				  to state a material fact necessary to make the statements made (considered in
				  the light of the circumstances under which they are made) not
				  misleading;
(3) the making of any
				  statement in such manner or order as to mislead a reasonably prudent person to
				  a false conclusion of a material fact;
(4) any material misstatement of law;
				  or
(5) any failure to disclose any
				  matter required by law to be disclosed, including failure to make disclosures
				  in accordance with the provisions of these sections and other applicable
				  rules.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter A - UNFAIR COMPETITION AND UNFAIR PRACTICES OF INSURERS, AND MISREPRESENTATION OF POLICIES › Section 21.5 - Enforcement

Current through Reg. 49, No. 28; July 12, 2024
The commissioner shall cause to be brought such legal
					 action as is authorized by the Code in the enforcement of these sections and
					 cause to be enjoined misrepresentation and other unfair trade
					 practices.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter A - UNFAIR COMPETITION AND UNFAIR PRACTICES OF INSURERS, AND MISREPRESENTATION OF POLICIES › Section 21.6 - Prohibition against the Use of Guaranty Fund Protection in the Sale of Insurance

Current through Reg. 49, No. 28; July 12, 2024
The use in any manner of the protection afforded by the
					 Life and Health Insurance Guaranty Association Act (the Act) by any person in
					 the sale of any product included within the scope of the Act (Insurance Code
					 Chapter 463) will constitute unfair competition and unfair practices under
					 Insurance Code Chapter 541 and will be subject to the provisions
					 thereof.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.101 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
This division defines and states standards that assure
						truthful and adequate disclosure of the information considered material and
						relevant to insurance advertisements and solicitations or to advertisements
						that lead to solicitations. This division prohibits in such matters the
						omission of any material fact, and thus further prevents misrepresentation,
						deceptive acts, and deceptive methods in the advertising and solicitation of
						insurance. This division is intended to be supplementary to and cumulative of
						the standards in other rules and statutes, including those ordered under the
						authority of Chapter 21 and other chapters of the Insurance
						Code.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.102 - Scope

Current through Reg. 49, No. 28; July 12, 2024
For the purpose of this division:
(1) "Advertisement" includes, but is not
					 limited to:
(A) printed and published
					 material, audio visual material and electronic media, descriptive literature of
					 an insurer or agent used in direct mail, newspapers, magazines, radio,
					 telephone and television scripts, billboards, and similar displays;
(B) descriptive literature and sales aids of
					 all kinds issued by an insurer or agent for presentation to members of the
					 public, including circulars, leaflets, booklets, depictions, illustrations, and
					 form letters;
(C) prepared sales
					 talks, presentations and materials for use by agents, and those representations
					 recurringly made by agents to members of the public;
(D) material used to:
(i) solicit additional coverage or policies
					 from existing insureds; or
(ii)
					 modify existing coverage or policies;
(E) material included with a policy when the
					 policy is delivered and materials used in the solicitation of renewals and
					 reinstatements, except those reinstatements provided for in the
					 policy;
(F) lead solicitations
					 which are defined as communications distributed to the public which, regardless
					 of form, content, or stated purpose, are intended to result in the compilation
					 or qualification of a list containing names or other personal information
					 regarding persons who have expressed a specific interest in a product or
					 coverage and which are intended to be used to solicit residents of this state
					 for the purchase of a policy, as defined in paragraph (3) of this section;
					 and
(G) any other communication
					 directly or indirectly related to a policy, as defined in paragraph (3) of this
					 section, and intended to result in the eventual sale or solicitation of a
					 policy.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.103 - Required Form and Content of Advertisements

Current through Reg. 49, No. 28; July 12, 2024
(a) It is required that advertisements be
					 truthful and not misleading either in fact or in implication.
(b) The format and content of an
					 advertisement of a policy must be sufficiently complete and clear to avoid
					 deception or the capacity or tendency to mislead or deceive. Whether an
					 advertisement has a capacity or tendency to mislead or deceive is determined by
					 the department of insurance, or the Commissioner of Insurance on appeal, from
					 the overall impression that the advertisement may be reasonably expected to
					 create upon a person of average education or intelligence within the segment of
					 the public to which it is directed.
(c) All information required to be disclosed
					 by this division will be set out conspicuously and in close conjunction with
					 the statements to which the information relates or with appropriate captions of
					 such prominence that required information is not minimized, rendered obscure,
					 or presented in an ambiguous fashion, or intermingled with the context of the
					 advertisement so as to be confusing or misleading. Regarding Internet
					 advertising, the disclosures required by the sections referenced in paragraphs
					 (1) - (5) of this subsection may be provided through a conspicuous and clearly
					 labeled link, provided that the link must be placed near the relevant
					 information to which it relates, and must connect directly to the information
					 necessary to comply with the applicable requirements:
(1) with respect to "invitation to inquire"
					 advertisements, §21.104(a) of this division (relating to Requirement of
					 Identification of Policy or Insurer);
(2)
												§21.104(i) of this division if
					 linked to same page satisfying §21.104(a) of this division, as permitted
					 in paragraph (1) of this subsection;
(3)
												§21.108(c) of this division
					 (relating to Use of Statistics and Citations);
(4)
												§21.113(b)(2) - (4), (c)(1), (d)(1)
					 and (f) of this division (relating to Rules Pertaining Specifically to Accident
					 and Health Insurance Advertising and Health Maintenance Organization
					 Advertising); and
(5)
												§21.114(1)(A) of this division (relating to Rules Pertaining Specifically
					 to Life Insurance and Annuity Advertising).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.104 - Requirement of Identification of Policy or Insurer

Current through Reg. 49, No. 28; July 12, 2024
(a) An advertisement must identify the person
					 or entity responsible for the advertisement.
(1) The full licensed name of the insurer is
					 required to be stated in each of its invitation to inquire and invitation to
					 contract advertisements, including the portion of the advertisement to be
					 returned to the insurer or agent, unless the portion to be returned is
					 delivered as a form detachable from another form containing the insurer's full
					 licensed name. The full licensed name must appear at or before the first
					 appearance of any shortened or substitute name in the body of the text, which
					 shortened or substitute name may be indicated as representing the insurer
					 thereafter in the advertisement.
(2) It is sufficient to state the full
					 licensed name, assumed name registered with the department pursuant to §
												19.902 of
					 this title (relating to One Agent, One License) or Texas agent's license number
					 of the agent when advertisements address coverages in general and do not
					 describe a specific policy or coverages of a particular insurer.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.105 - Description of Benefits, Coverage, and Policy Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a) An advertisement may not imply coverage
					 beyond the terms of the policy or policies advertised, either by use of
					 synonymous words or otherwise so as to imply broader coverage than
					 exists.
(b) An advertisement may
					 not represent, directly or indirectly, that a policy provides for the payment
					 of certain benefits in addition to other benefits when such is not the
					 fact.
(c) No advertisement may omit
					 information or use words, phrases, statements, references, or illustrations if
					 the omission of such information or use of such words, phrases, statements,
					 references, or illustrations has the capacity, tendency, or effect of
					 misleading or deceiving purchasers or prospective purchasers as to the nature
					 or extent of any loss covered, premium payable, or policy benefit
					 payable.
(d) An advertisement may
					 not contain untrue statements with respect to the time within which claims will
					 be paid or represent or imply that claim settlements will be liberal or
					 generous beyond the terms of a policy or that special treatment not provided
					 for in the policy will be provided or extended. An unusual amount paid for a
					 unique claim for the policy advertised is misleading and may not be used,
					 unless it is disclosed that such payment is unusual or unique.
(e) An advertisement may not falsely
					 represent directly or indirectly, that a policy may be sold only to certain
					 persons because of their occupation, association, age, sex, or other
					 condition.
(f) Benefits provided by
					 a rider to a policy, and/or benefits that are in addition to the primary policy
					 benefits, shall not be advertised in a manner that has the effect of misleading
					 or deceiving, or the potential to mislead or deceive, prospective purchasers as
					 to the existence or nature of the primary policy benefits.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.106 - Premiums

Current through Reg. 49, No. 28; July 12, 2024
(a) No advertisement may state a premium for
					 a policy that does not apply to the exact coverage advertised.
(b) If a premium is quoted in an
					 advertisement that does not apply to all classes of risk solicited, the class
					 or classes to which it applies must be identified.
(c) Advertisements referencing optional
					 endorsements, riders or other benefits available at an additional cost, shall
					 disclose the fact of additional cost.
(d) Invitation to contract advertisements
					 which provide specific premiums and advertise an endorsement, rider or other
					 optional benefit which may be added to the policy advertised at an additional
					 cost must separately disclose the additional premium required for each such
					 endorsement, rider or other optional benefit.
(e) Advertisements dealing with the
					 availability of credit card billing of premiums must disclose that such method
					 of billing is clearly optional to the purchaser.
(f) If an invitation to contract
					 advertisement contains the specific or estimated cost of the coverage and the
					 rate charged may be changed by the insurer prior to the renewal of the policy,
					 the advertisement must disclose that fact.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.107 - Testimonials, Appraisals, or Analyses

Current through Reg. 49, No. 28; July 12, 2024
(a) A
					 person or entity making a testimonial, recommendation or endorsement shall be
					 deemed a "spokesperson" for an insurer or agent if the person or entity:
(1) has a proprietary or other financial
					 interest in the insurer or agent or a related entity as a stockholder,
					 director, officer, employee or otherwise;
(2) has been formed by the insurer or agent,
					 or is owned or controlled by the insurer or agent, its employees, or the person
					 or persons who own or control the insurer or agent;
(3) has any person in a policy-making
					 position who is affiliated with the insurer or agent in any of the capacities
					 described in paragraphs (1) and (2) of this subsection; or
(4) is in any way directly or indirectly
					 compensated for making a testimonial, recommendation or endorsement.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.108 - Use of Statistics and Citations

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 An advertisement in respect of the time within which claims are paid, the
					 dollar amounts of claims paid, the number of claims paid, the number of persons
					 insured under a particular policy or policies, or similar statistical
					 information relating to an insurer or policy may not contain irrelevant facts,
					 and shall accurately reflect the relevant facts. The advertisement may not
					 imply that the statistics are derived from the type of product advertised
					 unless it is a fact, and when applicable to other types of products shall
					 specifically so state.
(b) The
					 source of statistics or citations used in an advertisement shall be identified
					 or made apparent in the advertisement. Such source must include the publication
					 name and date. A source shall not be more than five years old unless the
					 advertiser certifies to the department through a statement in the transmittal
					 letter that is required to be provided pursuant to §21.120(a) of this
					 division (relating to Filing for Review) that the source is the most recent
					 available.
(c) Where "average"
					 costs or savings are referenced in an advertisement, the advertisement must
					 indicate whether such statistics are national or regional and, if regional,
					 must identify the region.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.109 - Unlawful Inducement

Current through Reg. 49, No. 28; July 12, 2024
(a) An
					 advertisement may not state or imply anything offering or tending to offer a
					 good, service, or other guarantee or contractual right of pecuniary value
					 outside of the express terms of the policy offered by the advertisement.
(1) This subsection does not prohibit, in
					 connection with an accident and health insurance policy or health maintenance
					 organization contract, the provision of health-related services or
					 health-related information, or the disclosure in advertising of the
					 availability of such additional services and information, to prospective policy
					 or certificate holders, or prospective enrollees or contract holders. If there
					 is a separate charge required to access such additional services or
					 information, an advertisement referencing the services or information must
					 disclose that fact.
(2) In this
					 subsection:
(A) "Health-related services" are
					 defined in accordance with the Insurance Code §
													541.058.
(B) "Health-related information" is defined
					 in accordance with the Insurance Code §
													541.058.
(3) An advertisement referencing
					 noncontractual health-related services or health-related information must
					 disclose that such services or information are not a part of the policy, may be
					 discontinued at any time and, as appropriate, may be subject to geographic
					 availability.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.110 - Disparagements

Current through Reg. 49, No. 28; July 12, 2024
(a) An advertisement may not directly or
					 indirectly unfairly disparage competitors, their policies, services, or
					 business methods, and may not unfairly disparage or minimize competing methods
					 of marketing insurance.
(b) An
					 advertisement may not contain statements that are untrue in fact or that are
					 misleading by implication in respect of another insurer's assets, corporate
					 structure, financial standing, age, or relative position of the insurer in the
					 insurance business.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.111 - Comparisons

Current through Reg. 49, No. 28; July 12, 2024
(a) An advertisement may not directly or
					 indirectly make an unfair or incomplete comparison of policies, benefits,
					 dividends, or rates, or compare noncomparable policies.
(b) An advertisement containing a comparison
					 of policies of different insurers shall prominently state the following: the
					 description of (the other insurance company's (fill in appropriate name))
					 policy was not furnished by (the insurance company (fill in appropriate name)).
					 If there are questions regarding the illustration, please contact a
					 representative of (the other insurance company (fill in the appropriate
					 name)).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.112 - General Prohibition

Current through Reg. 49, No. 28; July 12, 2024
Failure to abide by §§21.101 - 21.122 of this
						division (relating to Insurance Advertising) is prohibited. An omission of
						information, false implication, or impression which is misleading or deceptive
						or has the tendency or capacity to be misleading or deceptive is prohibited.
						The requirements of this division apply to either or both insurers and agents
						irrespective of whether acts or practices are performed directly or indirectly
						by the insurers or agents or in conjunction with or through non-insurers or
						non-agents.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.113 - Rules Pertaining Specifically to Accident and Health Insurance Advertising and Health Maintenance Organization Advertising

Current through Reg. 49, No. 28; July 12, 2024
(a) Coverage details. An invitation to
					 inquire that specifies either the dollar amount of benefit payable or the
					 period of time during which the benefit is payable must contain a provision in
					 effect as follows: "For specific costs and further details of the coverage,
					 including exclusions, any reductions or limitations and the terms under which
					 the policy may be continued in force, see your agent or write to the
					 company."
(b) Illustration of
					 rates. Subject to Insurance Code Chapter 1214, concerning Advertising for
					 Certain Health Benefits, and Insurance Code Chapter 541, Subchapter B,
					 concerning Unfair Methods of Competition and Unfair or Deceptive Acts or
					 Practices Defined, an invitation to inquire concerning a health benefit plan
					 may include rate information without including information about all benefit
					 exclusions and limitations so long as any rate mentioned in any advertisement
					 disseminated under this subsection indicates the age, gender, and geographic
					 location on which that rate is based and so long as the advertisement includes
					 prominent disclaimers clearly indicating that:
(1) the rates are illustrative
					 only;
(2) a person should not send
					 money to the issuer of the health benefit plan in response to the
					 advertisement;
(3) a person cannot
					 obtain coverage under the health benefit plan until the person completes an
					 application for coverage; and
(4)
					 benefit exclusions and limitations may apply to the health benefit
					 plan.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.114 - Rules Pertaining Specifically to Life Insurance and Annuity Advertising

Current through Reg. 49, No. 28; July 12, 2024
As can be made applicable and as necessary the same or
						similar test or standard as is stated hereafter within paragraph (1)(B) of this
						section is to be used as the standard in the interpretation of the provisions
						of this section.
(1) Identification of
					 policy.
(A) The form number or numbers of the
					 policy advertised shall be clearly identified in an "invitation to
					 contract."
(B) An advertisement in
					 respect of a life policy, endowment, or an annuity may not include the term
					 "savings," "investment," or other similar terms if used in referring to the
					 current, projected, or guaranteed rate of interest paid or credited to such
					 contracts to imply that the product advertised is something other than
					 insurance or an annuity using as a standard how it would appear to or be
					 identified by a reasonably prudent person under the circumstances.
(C) No advertisement may use the term
					 "investment," "investment plan," "founder's plan," "charter plan," "expansion
					 plan," "profit," "profits," "profit sharing," "interest plan," "savings,"
					 "savings plan," or other similar terms in connection with a policy in a context
					 or under such circumstances or conditions that have the capacity or tendency to
					 mislead purchasers of such policy to believe they will receive or that it is
					 possible that they will receive something other than a policy or some other
					 benefit or advantage that is not available to other persons of the same class
					 and equal expectation of life nor to that class of persons to whom essentially
					 the same hazards are attributable.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.115 - Rules Pertaining Specifically to Property and Casualty Insurance Advertising

Current through Reg. 49, No. 28; July 12, 2024
(a) No
					 advertisement may use the word "dividends" or similar words or illustrations in
					 such a manner as to state or to imply that future dividends are guaranteed or
					 certain to occur.
(b) The word
					 "dividends" includes every return of premium and payment to policyholders on a
					 particular policy that is predicated on the financial performance or earnings
					 of the insurer, but does not include the return of premium under a
					 nondiscretionary provision or endorsement in a policy clearly providing for the
					 payment under a rating plan approved or promulgated by the Texas Department of
					 Insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.116 - Special Enforcement Procedures for Rules Governing Advertising and Solicitation of Insurance

Current through Reg. 49, No. 28; July 12, 2024
(a) Advertising
					 file. Each insurer, domestic and foreign, doing an insurance business in Texas
					 shall maintain at its home office or principal (executive) office, a complete
					 file containing a specimen of every institutional advertisement, invitation to
					 inquire advertisement, or invitation to contract advertisement disseminated in
					 this state, with a notation attached to each such advertisement indicating the
					 manner and extent of distribution and the form number of any policy advertised
					 in Texas. Foreign insurers that have established an office in Texas who
					 transact an insurance business in this state may maintain the advertising file
					 at that location. Each insurer shall notify the Texas Department of Insurance
					 where the advertising file is being maintained and that access thereto will be
					 provided, and each insurer shall also notify the Texas Department of Insurance
					 in the event the location of such file is planned to be changed and immediately
					 when changed. The advertising file is subject to regular and periodic
					 inspection by the Texas Department of Insurance. All advertisements shall be
					 maintained for a period of not less than three years.
(b) Statement of compliance. Each insurer,
					 domestic and foreign, filing an annual statement with the Texas Department of
					 Insurance is subject to the provisions of this division and shall file with its
					 annual statement a certificate or equivalent executed by an authorized officer
					 of the insurer whose duty it is to deal with or oversee the insurer's
					 advertising stating that to the best of the officer's knowledge, information,
					 and belief, the advertisements which were disseminated by the insurer during
					 the preceding statement year complied or were made to comply in all respects
					 with the provisions of this division and the insurance laws of this state as
					 respects its Texas advertising and as its Texas advertising relates to its
					 insureds in Texas.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.117 - Conflict with and Affect on Other Regulations

Current through Reg. 49, No. 28; July 12, 2024
This division is not intended to conflict with or
						supersede and are to be interpreted when possible as not to conflict with any
						sections except as stated in this section currently in force or subsequently
						adopted in this state and including without intending any limitation those
						rules that govern the specific aspects of the sale of annuities or the sale or
						replacement of insurance, and including, but not limited to, rules applicable
						to maximum guaranteed interest rates in the rules dealing with the life
						insurance cost comparison indices, deceptive practices in the sale of
						insurance, and other rules that are in effect that treat the replacement of
						life insurance policies.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.118 - Severability

Current through Reg. 49, No. 28; July 12, 2024
If any provision of this division or the application
						thereof to any person or circumstance is held invalid for any reason, the
						invalidity shall not affect the other provisions or any other application of
						this division which can be given effect without the invalid provisions or
						application. To this end all provisions of this division are declared to be
						severable.