reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 4 - PARTICIPATION BY REGIONAL AND LOCAL HEALTH CARE PROGRAMS › Section 26.537 - Program Certification

Current through Reg. 49, No. 28; July 12, 2024
(a) At the time
					 of initial application, a regional or local health care program electing to
					 participate in Healthy Texas shall obtain from small employers participating in
					 its program written certification or information to ensure that the regional or
					 local health care program can provide written certification to the health
					 benefit plan issuer or to the commissioner, as applicable, that each employer
					 meets the eligibility requirements of the Insurance Code §
											1508.051
					 and the minimum employer participation requirements of the Insurance Code
					 §
											1508.053.
(b) A regional or local health care program
					 participating in the Healthy Texas Program under §26.534 of this division
					 (relating to Participation Through Direct Purchase of Health Benefit Plan)
					 shall, not later than the 90th day before the renewal date of the health
					 benefit plan, provide the health benefit plan issuer a written certification
					 that each employer continues to meet the eligibility requirements of the
					 Insurance Code §
											1508.051
					 and the minimum employer participation requirements of the Insurance Code
					 §
											1508.053.
(c) A regional or local health care program
					 participating in the Healthy Texas Program under §26.535 of this division
					 (relating to Participation Through Eligible Regional or Local Health Care
					 Program Implementation) shall, not later than the 90th day before the renewal
					 date of the health services contract, provide the commissioner a written
					 certification that each employer continues to meet the eligibility requirements
					 of the Insurance Code §
											1508.051
					 and the minimum employer participation requirements of the Insurance Code
					 §
											1508.053.
(d) The health benefit plan issuer may
					 require the submission of appropriate documentation to support a certification
					 described by subsection (a) or (b) of this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 4 - PARTICIPATION BY REGIONAL AND LOCAL HEALTH CARE PROGRAMS › Section 26.538 - Applicability of Other Subchapter Provisions

Current through Reg. 49, No. 28; July 12, 2024
Except as expressly provided in this division, the
						provisions of Division 3 of this subchapter (relating to Participation by Small
						Employers) apply to small employers and employees of small employers that
						participate in a regional or local health care program that elects to
						participate in the Healthy Texas Program.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 5 - RATING OF QUALIFIED HEALTH BENEFIT PLANS › Section 26.551 - Rating of Plans Eligible for Claims Reimbursements

Current through Reg. 49, No. 28; July 12, 2024
(a) Premium rates to be charged for
					 qualifying group health benefit plans must be filed with the department for
					 review and approval by the commissioner in a form and within the timeframe set
					 by the commissioner.
(1) In accordance with
					 the Insurance Code §
												1508.202(c),
					 a health benefit plan issuer may use only age and gender as case
					 characteristics, as defined in the Insurance Code §
												1501.201(2),
					 in setting premium rates for a qualifying health benefit plan.
(2) Pursuant to the Insurance Code §
												1508.202(d),
					 a health benefit plan issuer may use the geographic location of the employer's
					 place of business as an additional criterion in setting premium rates for a
					 qualifying health benefit plan.
(3)
					 A health benefit plan issuer may not use a "health status related factor" as
					 defined in the Insurance Code §
												1501.002(7)
					 in setting premium rates for a qualifying health benefit plan.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 5 - RATING OF QUALIFIED HEALTH BENEFIT PLANS › Section 26.552 - Reinsurance Permitted

Current through Reg. 49, No. 28; July 12, 2024
Participating health benefit plan issuers may reinsure
						their Healthy Texas business in whole or in part if they determine it would
						favorably impact premium rates. The impact of any such reinsurance shall be
						factored into the premium rates for affected qualifying group health benefit
						plan premiums.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 5 - RATING OF QUALIFIED HEALTH BENEFIT PLANS › Section 26.553 - Required Policy Form and Rate Filings

Current through Reg. 49, No. 28; July 12, 2024
Not later than 30 days from the effective date of any
						amendment to this subchapter, participating health benefit plan issuers shall
						submit the policy form amendments and premium rate adjustments necessitated by
						the amendments.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 6 - HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION FUND › Section 26.561 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
						Division, shall have the following meanings, unless the context clearly
						indicates otherwise.
(1) Claims
					 corridor--Claims paid on behalf of a covered person in excess of $5,000 and
					 less than $75,000 per calendar year.
(2) Claims paid--Claims paid by a
					 participating health benefit plan issuer pursuant to a qualifying health
					 benefit plan issued under the Healthy Texas Program as determined by the date
					 of payment rather than the date of service or date the claim was
					 incurred.
(3) Claims threshold--The
					 aggregate amount that a participating health benefit plan issuer must pay out
					 as claims paid before reaching the claims corridor and becoming eligible for
					 reimbursement on behalf of an enrollee in a given calendar year.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 6 - HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION FUND › Section 26.562 - Eligibility of Claims Paid for Reimbursement from the Fund

Current through Reg. 49, No. 28; July 12, 2024
(a) For each health benefit plan eligible for
					 reimbursement from the fund, a participating health benefit plan issuer shall
					 record and aggregate claims paid on a per-covered-person basis. Reimbursement
					 from the fund shall be calculated based on such per-covered-person
					 aggregates.
(b) A participating
					 health benefit plan issuer shall be eligible for reimbursement of 80 percent of
					 eligible claims paid within the claims corridor on behalf of each person
					 covered under a qualifying group health benefit plan.
(c) A participating health benefit plan
					 issuer shall not be entitled to any reimbursement on behalf of an enrollee if
					 the claims paid on behalf of that person in a given calendar year do not, in
					 the aggregate, reach the claims threshold. Additionally, claims paid on behalf
					 of an enrollee which exceed the claims corridor in a given calendar year shall
					 not be eligible for reimbursement from the fund.
(d) Claims paid within a calendar year shall
					 be determined by the date of payment rather than the date of service or date
					 the claim was incurred. A participating health benefit plan issuer may not
					 delay or defer payment of a claim solely for the purpose of causing the date of
					 payment to fall into a subsequent calendar year.
(e) Claims paid shall not include interest
					 paid by a participating health benefit plan issuer in connection with any
					 claim.
(f) Claims paid that are not
					 submitted for reimbursement prior to April 1 of the calendar year following the
					 calendar year in which they are paid shall not be eligible for reimbursement
					 from the fund and shall not be credited as paid claims in any year for the
					 purpose of determining whether the claims threshold has been reached.
(1) If the commissioner determines that the
					 claims data submitted in conjunction with a reimbursement request is
					 insufficient to make a reimbursement determination, the commissioner or the
					 fund administrator shall make a request for clarification of the data or for
					 the submission of additional data.
(2) Participating health benefit plan issuers
					 shall comply with all such requests within 15 business days of the date of the
					 request.
(3) If a participating
					 health benefit plan issuer fails to comply with such a request from the
					 commissioner or the fund administrator within 15 business days, the
					 commissioner has discretion to deem any affected claims ineligible for
					 reimbursement.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 6 - HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION FUND › Section 26.563 - Fund Administration

Current through Reg. 49, No. 28; July 12, 2024
(a) The
					 commissioner shall establish the fund and oversee its administration. The
					 functions of the commissioner may include the following:
(1) choosing a firm or firms, to administer
					 the fund, based on an evaluation of competitive bids received in a public
					 procurement process;
(2) granting
					 approval of the general systems and procedures used by the firm or firms to
					 administer the fund, including procedures utilized to verify the
					 appropriateness of payments from the fund to any participating health benefit
					 plan issuer;
(3) making payment of
					 reasonable fees from the fund to the firm or firms for administration of the
					 fund;
(4) changing the
					 administrating firm or firms, or the administrative systems and procedures, if
					 necessary;
(5) collecting necessary
					 data from participating health benefit plan issuers;
(6) arranging for periodic audits of
					 participating health benefit plan issuers and for the payment of reasonable
					 fees for such audits from the fund; and
(7) reviewing and approving the format and
					 content of the annual report of the administrating firm or firms regarding the
					 affairs and operation of the fund, and requiring such other reports as are
					 deemed necessary by the commissioner.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 6 - HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION FUND › Section 26.564 - Data Filing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Each
					 participating health benefit plan issuer or regional or local health care
					 program shall submit to the commissioner necessary claims data in connection
					 with its annual submission of requests for reimbursement from the fund. Each
					 participating health benefit plan issuer or regional or local health care
					 program also shall provide the commissioner with such additional data, as
					 deemed necessary by the commissioner, to oversee the operation of the fund and
					 the Healthy Texas Program. Reports pertaining to reimbursement or loss ratio
					 shall be certified, by an officer of the submitting entity, as to their
					 accuracy and completeness. Data to be submitted may include the following:
(1) the total number of plans issued or
					 groups enrolled in a regional or local health care program within the reporting
					 period and the total number of plans in force or groups enrolled in a regional
					 or local health care program that are covered by the fund;
(2) the total number of primary insured
					 persons or primary covered persons, the total number of dependents covered, and
					 the total number of child dependents covered; the commissioner may require that
					 such totals be specified by geographic region;
(3) total premium earned, and per-enrollee
					 per-month premium earned, for all plans covered by the fund for the reporting
					 period;
(4) claims payment data,
					 reported individually for each enrollee and/or for each enrollee for whom the
					 participating health benefit plan issuer has paid claims eligible for
					 reimbursement;
(5) total claims
					 eligible for reimbursement year-to-date; and
(6) other data and information as necessary
					 to determine continuing program compliance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 28 - SUPERVISION AND CONSERVATION › Subchapter A - GENERAL PROVISIONS REGARDING SUPERVISION AND CONSERVATION › Section 28.1 - Stay of Time Periods

Current through Reg. 49, No. 28; July 12, 2024
(a) In the event
				  that the commissioner, supervisor, or conservator is prevented from completing
				  his statutory duties due to judicial or administrative order or due to
				  operation of law, the statutory time period fixed for the completion of the
				  commissioner's, supervisor's, or conservator's duties is tolled for an amount
				  of time equivalent to the amount of time that the judicial or administrative
				  order or other existing controlling law is in effect. The status of the
				  affected company remains unchanged during the pendency of the judicial or
				  administrative order or other existing controlling law. The statutory time
				  period begins to run upon actual or constructive notice of the final
				  determination of the judicial or administrative order or other existing
				  controlling law.
(b) The
				  commissioner shall report to the board at the board's next regular meeting each
				  instance a statutory time limit is tolled as described in subsection (a) of
				  this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 28 - SUPERVISION AND CONSERVATION › Subchapter A - GENERAL PROVISIONS REGARDING SUPERVISION AND CONSERVATION › Section 28.2 - Decisions and Orders

Current through Reg. 49, No. 28; July 12, 2024
In the event that a compliance hearing is held pursuant to
					 the provisions of the Insurance Code, Article 21.28-A, §3 or §5, the
					 status of the affected company remains unchanged pending the issuance of a
					 decision or order by the commissioner pursuant to the statutory time periods as
					 provided in Texas Civil Statutes, Article 6252-13a, §16. The statutory
					 time period as provided in the provisions of the Administrative Procedure and
					 Texas Register Act governs where an ambiguity or difference exists between this
					 section and the Texas Insurance Code.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 28 - SUPERVISION AND CONSERVATION › Subchapter A - GENERAL PROVISIONS REGARDING SUPERVISION AND CONSERVATION › Section 28.3 - The Encouragement of the Merger of Insurers in Weak Financial Condition with Insurers in a Stronger Financial Condition

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose and applicability. The purpose of
				  this section is to provide the basis for encouragement of the merger of
				  financially weak insurers with financially stronger insurers, as provided in
				  the Insurance Code, Article 21.28-A, §1, in circumstances where
				  rehabilitation or conservation of an insurer would be inefficient or
				  impracticable. The provisions of this section shall be utilized in conjunction
				  with authority granted and duties required in the Insurance Code, Articles
				  1.15-1.19, 1.32, 9.48, 21.28, 21.28-A, 21.28-C, 21.28-D, and 21.49-1. If a
				  financially weak insurer, as provided in this section, indicates it does not
				  wish to be merged with a potential merger partner, the provisions of this
				  section shall not apply.
(b)
				  Threshold criteria for merger. The commissioner of insurance, in determining
				  whether to pursue a merger alternative under this section, shall consider the
				  following threshold criteria:
(1) whether the
				  corporate form of the financially weak insurance carrier is one which legally
				  accommodates a merger alternative; and
(2) whether conservation or rehabilitation of
				  the financially weak insurer is inefficient or impracticable.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 28 - SUPERVISION AND CONSERVATION › Subchapter A - GENERAL PROVISIONS REGARDING SUPERVISION AND CONSERVATION › Section 29.1 - Guaranty Associations' Public Interest Information

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions. The following words and
				  terms, when used in this section, shall have the following meanings unless the
				  context clearly indicates otherwise:
(1)
				  Commissioner--The Commissioner of Insurance.
(2) Department--The Texas Department of
				  Insurance.
(3) Guaranty
				  Association(s)--The Texas Title Insurance Guaranty Association; Texas Property
				  and Casualty Insurance Guaranty Association; and the Life, Accident, Health,
				  and Hospital Service Insurance Guaranty Association.
(4) Plan of Operation--The guidelines and
				  regulations necessary or suitable to assure the fair, reasonable, and equitable
				  administration of the Guaranty Association, pursuant to Texas Insurance Code
				  Annotated, Articles 9.48, §14(d); 21.28-C, §9; and 21.28-D,
				  §10.
(5) Public interest
				  information--The Plan of Operation and any procedures and/or policies adopted
				  and used by any office(s) of the Guaranty Associations that pertain to claim
				  filing (including the procedure for appealing denial of claims), investments,
				  and assessments.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.201 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to prescribe the audit
					 requirements for, and audit coverages applicable to, the Title Insurance
					 Guaranty Association established under the Insurance Code Article 9.48; the
					 Property and Casualty Insurance Guaranty Association established under the
					 Insurance Code Article 21.28-C; and the Life, Accident, Health and Hospital
					 Service Insurance Guaranty Association established under the Insurance Code
					 Article 21.28-D.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.202 - Applicability

Current through Reg. 49, No. 28; July 12, 2024
The provisions of this subchapter apply to any guaranty
					 association established under the Insurance Code, Articles 9.48, 21.28-C and
					 21.28-D.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.203 - Qualification of Accountant

Current through Reg. 49, No. 28; July 12, 2024
The independent certified public accountant for the
					 financial audit required by §
										31.204(1)
					 of this title (relating to the Nature of Audits) must be selected by a
					 competitive process. An independent certified public accountant may not perform
					 the financial audit required by §31.204(1) for more than seven consecutive
					 years. An independent certified public accountant responsible for performing
					 the financial audit for seven consecutive years may not perform the financial
					 audit during the two years following the seventh year.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.204 - Nature of Audits

Current through Reg. 49, No. 28; July 12, 2024
Audits applicable to the guaranty associations subject to
					 the provisions of this subchapter shall take the form of financial, performance
					 or operational audits, and may include, but not be limited to, the types of
					 audits which are described in paragraphs (1)-(4) of this section.
(1) Financial audits. The financial audit
				  shall be undertaken annually by an independent certified public accountant to
				  determine whether the financial statements of the audited entity present fairly
				  the financial position and the results of financial operations in accordance
				  with generally accepted accounting principles. The financial audits shall be
				  conducted in accordance with generally accepted auditing standards.
(2) Compliance audit. A compliance audit may
				  be undertaken to determine whether the following objectives are being met:
(A) the audited entity has obligated,
				  expended, received, and used funds in accordance with the purpose for which
				  those funds have been authorized by law;
(B) the audited entity has obligated,
				  expended, received, and used funds in accordance with any limitations,
				  restrictions, conditions, or mandatory directions imposed by law on those
				  obligations, expenditures, receipts, or uses;
(C) the audited entity has maintained its
				  books, records, and accounts in a manner which accurately reflects its
				  financial and fiscal operations relating to the obligation, receipt,
				  expenditure, and use of funds including, but not limited to, funds collected
				  for a public purpose;
(D) the
				  audited entity has collected all revenues and receipts in accordance with the
				  applicable laws and regulations of this state; and
(E) the audited entity has properly and
				  legally handled or administered any money, negotiable securities, or similar
				  assets received in accordance with the entity's governing statute.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.205 - Scope and Frequency of Audits

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Annual audit required. Each guaranty association subject to the provisions of
				  this subchapter shall undergo an annual financial audit at the end of each
				  calendar year as required by §
										31.204(1)
				  of this title (relating to Nature of Audits).
(b) Audit plan. The boards of directors of
				  each guaranty association subject to the provisions of this subchapter shall
				  annually adopt an audit plan. In developing the plan, the boards shall consider
				  utilizing the audits described in §31.204(2) - (4). The plan may be
				  modified at the discretion of the boards. The plan and any modifications of the
				  plan shall be filed with the commissioner.
(c) Commissioner may order audit. No
				  provision of this subchapter prohibits or precludes the commissioner from
				  ordering any entity subject to the provisions of this subchapter to submit to
				  one or more audits at a frequency determined by the commissioner, based upon
				  facts and circumstances.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.206 - Audit Reporting Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Report
				  required. A written report shall be prepared in connection with any audit
				  authorized or required pursuant to this subchapter.
(b) Contents of report. The written report
				  must include a management letter containing the following items, as applicable:
(1) the criteria selected to measure
				  effectiveness and efficiency;
(2)
				  internal controls;
(3) compliance
				  with state or federal laws;
(4)
				  conditions found by auditors and the effects of such conditions; and
(5) any recommendations for improving
				  operations or program effectiveness.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 31 - LIQUIDATION › Subchapter C - AUDIT COVERAGES REQUIRED FOR GUARANTY ASSOCIATIONS › Section 31.207 - Cost of Audits

Current through Reg. 49, No. 28; July 12, 2024
The cost of audits required by this subchapter shall be
					 paid by the audited entity.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.1 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The provisions of this chapter implement the Texas
					 Continuing Care Facility Disclosure and Rehabilitation Act, Health and Safety
					 Code, Chapter 246.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.2 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this chapter,
					 have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Act--The Texas
				  Continuing Care Facility Disclosure and Rehabilitation Act, Health and Safety
				  Code, Chapter 246.
(2) Actuarial
				  funded status--The ratio of actuarial assets plus net accounting assets to
				  actuarial liabilities plus actuarial refund liabilities.
(3) Actuarial review--An analysis performed
				  by a qualified actuary in accordance with actuarial standards of practice of
				  the current actuarial balance of the financial condition of a facility and of
				  the provider's continuing care in residence operations, if any. An actuarial
				  review includes, but is not limited to, the following:
(A) an actuarial report;
(B) a statement of actuarial
				  opinion;
(C) an actuarial balance
				  sheet;
(D) a cash flow projection;
				  and
(E) disclosure of the actuarial
				  methodology, formulas, and assumptions, including justification for continuing
				  care in residence entrance fee escrow account amortization schedules.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.3 - Scope

Current through Reg. 49, No. 28; July 12, 2024
This chapter applies to a provider if the provider:
(1) provides continuing care under a
				  continuing care contract agreement;
(2) enters into, offers, or solicits a
				  continuing care contract; or
(3)
				  enters into, offers, or solicits a reservation agreement on or after September
				  1, 1993.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.4 - Severability

Current through Reg. 49, No. 28; July 12, 2024
Where any terms or sections of this chapter are determined
					 by a court of competent jurisdiction to be invalid, the remaining terms and
					 sections of this chapter will continue in effect.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.5 - Violation of Rules

Current through Reg. 49, No. 28; July 12, 2024
A violation of any provision of this chapter or of any
					 order of the Commissioner or the department entered under this chapter may
					 subject the violator to penalties, including those stated in Insurance Code
					 Chapter 82.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.6 - Fees for Filing Application for Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
An applicant filing for a certificate of authority under
					 Health and Safety Code §
										246.022
					 must pay the department a nonrefundable filing fee of $10,000. No fee is
					 required for a §33.102 application for authority for continuing care in
					 residence.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.7 - Fiscal Year

Current through Reg. 49, No. 28; July 12, 2024
A fiscal year is a period of 12 months ending on the last
					 day of any month. The department will recognize a fiscal year only if it is
					 established as the certificate-of-authority-holder's annual accounting period,
					 and the books and records are kept corresponding to that period. The
					 Commissioner must be notified of any change of fiscal year under §
										33.508
					 of this title (Relating to Occasional Required Filings).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.8 - Forms

Current through Reg. 49, No. 28; July 12, 2024
The forms listed in this section are available on the
					 department's website. The department adopts and incorporates by reference the
					 forms listed in paragraphs (1) - (19) of this subsection, and their use is
					 required, where applicable, for compliance with the provisions of this chapter.
					 Forms that are on the department's letterhead will use the most current version
					 of that letterhead, as it may change from time to time. Bracketed information
					 in the forms is subject to change, including the department's physical,
					 mailing, and electronic addresses; submission locations; submission formats and
					 methods; and contact information. Persons submitting the forms should verify
					 that they are using the most recent online version before submitting.
(1) CCRC Form 1 (FIN382)--Application for
				  certificate of authority to do business in the State of Texas under Health and
				  Safety Code Section
				  246.022;
(2) CCRC Form 1a (FIN604)--Application for
				  authority to offer continuing care in residence in Texas under Health and
				  Safety Code Section
				  246.0025(b);
(3) CCRC Form 2 (FIN383)--Application for
				  Commissioner approval to release excess loan reserve escrow fund amounts under
				  Health and Safety Code Section 278.078;
(4) CCRC Form 3 (FIN384)--Officers and
				  directors page;
(5) CCRC Form 4
				  (FIN385)--Biographical data form;
(6) CCRC Form 4a (FIN386)--Biographical data
				  form for not-for-profit CCRC board members;
(7) CCRC Form 5 (FIN387)--Delivery of
				  disclosure statement;
(8) CCRC Form
				  6 (FIN388)--Format for disclosure statement for continuing care
				  facility;
(9) CCRC Form 6a
				  (FIN389)--Instructions for preparing a continuing care retirement community
				  disclosure statement for filing with the Texas Department of
				  Insurance;
(10) CCRC Form 6b
				  (FIN605)--Format for disclosure statement for continuing care in
				  residence;
(11) CCRC Form 7
				  (FIN390)--Change of control statement for CCRC;
(12) CCRC Form 8 (FIN391)--Certification of
				  changes to disclosure statement;
(13) CCRC Form 9 (FIN392)--Notice of request
				  to release entrance fee escrow funds;
(14) CCRC Form 10 (FIN393)--Notice of request
				  to release funds from the reserve fund escrow account;
(15) CCRC Form 11 (FIN394)--Notice by
				  provider of re-payment of previously released funds to the reserve fund escrow
				  account;
(16) CCRC Form 12
				  (FIN395)--Affidavit of re-payment of previously released funds to the reserve
				  fund escrow account;
(17) CCRC Form
				  13 (FIN396)--Notice of lien;
(18)
				  CCRC Form 14 (FIN397)--Calculations concerning conditions; and
(19) CCRC Form 14a (FIN607)--Provider request
				  for release of continuing care in residence entrance fee escrow
				  funds.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.9 - Address for Filings

Current through Reg. 49, No. 28; July 12, 2024
(a) All inquiries,
				  correspondence, applications, and other filings under this chapter must be sent
				  to the appropriate physical, mailing, or electronic address:
(1) specified on the applicable department
				  form being used; or
(2) listed on
				  the department website.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter A - GENERAL PROVISIONS › Section 33.10 - Unauthorized Providers Required to Respond to Inquiries

Current through Reg. 49, No. 28; July 12, 2024
If the Commissioner becomes aware of an unauthorized
					 provider and makes inquiries to determine the applicability of this chapter and
					 the Act to the provider, the recipient of an inquiry must respond within 30
					 days. The Commissioner may conduct any necessary investigation or examination
					 regarding the inquiry and, if warranted, take action against the
					 provider.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter B - CONTINUING CARE IN RESIDENCE › Section 33.101 - Scope

Current through Reg. 49, No. 28; July 12, 2024
This subchapter establishes the requirements and procedures
					 for certificates of authority, disclosure statements, and entrance fee escrow
					 accounts applicable to continuing care in residence under Health and Safety
					 Code §
										246.022.
					 With respect to continuing care in residence, this subchapter governs in case
					 of conflict with other provisions of this chapter.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter B - CONTINUING CARE IN RESIDENCE › Section 33.102 - Adding Authority for Continuing Care in Residence

Current through Reg. 49, No. 28; July 12, 2024
(a) Sections
				  33.202,
				  33.203,
				  33.205, and
				  33.206 of
				  this title apply to continuing care in residence.
(b) A person must also hold a certificate of
				  authority to provide continuing care at a facility before the person is
				  eligible to receive authority to provide continuing care in residence. A
				  provider must have authority to provide continuing care in residence before
				  accepting any consideration or entering into any contracts for continuing care
				  in residence.
(c) To apply for
				  authority to provide continuing care in residence, an applicant must submit a
				  CCRC Form 1a (FIN 604), including the following:
(1) the provider's CCRC certificate of
				  authority license number;
(2)
				  format for disclosure statement for continuing care in residence (CCRC Form 6b
				  (FIN605));
(3) a business plan
				  which includes:
(A) a three-year financial
				  projection with associated assumptions;
(B) the geographic region proposed for
				  continuing care in residence services;
(C) evidence of the actuarial review for
				  entrance fee (and related amortization schedule) and service fee
				  amounts;
(D) information regarding
				  resident qualification;
(E)
				  information regarding marketing and advertising activities; and
(F) information regarding refund procedures
				  applicable before a resident receives continuing care in residence services;
				  and
(4) a certified copy
				  of assumed name certificate, if applicable.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter B - CONTINUING CARE IN RESIDENCE › Section 33.103 - Disclosure Statement Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Sections
				  33.302,
				  33.303,
				  33.305,
				  33.307,
				  and
				  33.308
				  of this title apply to continuing care in residence.
(b) The organization and elements of the
				  disclosure statement, including any revisions, must follow the format in CCRC
				  Form 6b (FIN605). The disclosure statement or revision must be submitted in
				  compliance with CCRC Form 6a (FIN389).
(c) The disclosure statement must be
				  submitted to the department before any of the following occur:
(1) the provider contracts to provide
				  continuing care in residence in Texas;
(2) the provider extends the term of an
				  existing contract to provide continuing care in residence in Texas;
				  or
(3) the provider or provider's
				  agent solicits a continuing care contract in Texas for an individual who
				  resides in Texas at the time of the solicitation. A continuing care contract is
				  considered solicited if, during the 12-month period preceding the date on which
				  the continuing care contract is signed or accepted by either party, information
				  concerning the availability of the continuing care in residence contract is
				  given:
(A) by personal, telephone, mail, or
				  other communication directed to and received by a person at a location in
				  Texas; or
(B) in paid
				  advertisements published or broadcast from within Texas, other than in a
				  publication in which more than two-thirds of the circulation is outside
				  Texas.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter B - CONTINUING CARE IN RESIDENCE › Section 33.104 - Entrance Fee Escrow Account Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Sections 33.401(b) - (e) and 33.402(a) of
				  this title apply to continuing care in residence.
(b) Entrance fees must be held in escrow as
				  set forth in Health and Safety Code §
										246.071.
				  An escrow agent cannot release, and the provider cannot request or accept,
				  entrance fee funds from the escrow agent without department approval. A
				  provider must file CCRC Form 14a (FIN607) to request release of entrance fee
				  escrow funds for identified residents. An escrow agent must file a CCRC Form 9
				  (FIN392) when a provider requests the agent release entrance fee escrow account
				  funds.
(c) To obtain department
				  approval:
(1) a provider must verify in Form
				  14a (FIN607) that:
(A) the identified
				  residents are receiving continuing care in residence;
(B) the requested amount complies with
				  amortization schedules contained in the continuing care in residence contracts;
				  and
(C) the provider's assets
				  exceed the actuarial present value of the expected costs of performing all
				  remaining obligations to all residents under continuing care contracts;
				  and
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter B - CONTINUING CARE IN RESIDENCE › Section 33.105 - Contract Requirements for Continuing Care in Residence

Current through Reg. 49, No. 28; July 12, 2024
(a) Providers must use a standard form to
				  contract with residents for continuing care in residence.
(b) The standard contract form must:
(1) contain an amortization schedule showing
				  when the provider will be entitled to release of a resident's entrance fee from
				  escrow;
(2) include or reference
				  all the provider's statutory duties and obligations, including the refund
				  provisions of Health and Safety Code §
											246.057;
				  and
(3) include the following
				  information about the resident's cancellation rights, in bold, capitalized, or
				  underlined type so as to be conspicuous: "You may cancel this contract at any
				  time before midnight of the seventh day, or a later day if specified in the
				  contract, after the date on which you sign this contract, or you receive the
				  provider's disclosure statement, whichever occurs later. If you elect to cancel
				  the contract, you must do so by written notice and you will be entitled to
				  receive a refund of all assets transferred other than periodic charges
				  applicable to your receiving continuing care in residence
				  services."
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter C - APPLICATION BY CONTINUING CARE PROVIDER FOR CERTIFICATE OF AUTHORITY › Section 33.201 - Scope

Current through Reg. 49, No. 28; July 12, 2024
This subchapter establishes the procedure for application
					 for certificate of authority under the Health and Safety Code, §
										246.022.
					 Providers owning or controlling more than one facility shall treat each
					 facility as separate and distinct in form and substance and shall apply for a
					 separate certificate of authority for each.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter C - APPLICATION BY CONTINUING CARE PROVIDER FOR CERTIFICATE OF AUTHORITY › Section 33.202 - Incorporated Entities Only

Current through Reg. 49, No. 28; July 12, 2024
Except for persons qualifying for a certificate of
					 authority under the Health and Safety Code, §
										246.023,
					 the Commissioner shall limit issuance of certificates of authority to
					 incorporated entities.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter C - APPLICATION BY CONTINUING CARE PROVIDER FOR CERTIFICATE OF AUTHORITY › Section 33.203 - Filing Requirements for Application for Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) The applicant shall submit the applicable
				  filing fee, as referenced in §
										33.6
				  of this title (relating to Fees for Filing Application for Certificate of
				  Authority).
(b) The applicant shall
				  provide the department with an original and two copies of the entire
				  application in three-ring binders with all pages clearly legible and
				  numbered.
(c) Each application
				  binder must contain a table of contents and must be divided with tabs
				  identified to correspond to the items listed in §
										33.204
				  of this title (relating to Contents of Application). If any item listed in that
				  section is inapplicable to the applicant, the applicant shall include a page
				  behind the tab for that item with a statement explaining the
				  inapplicability.
(d) The applicant
				  must submit all narrative material typed, double-spaced, and clearly
				  legible.
(e) The original of the
				  application becomes the charter file; therefore, all signatures on the required
				  forms in the original application must be original signatures.
(f) If the application is revised or
				  supplemented during the review process prior to hearing, the applicant must
				  submit an original and two copies of a transmittal letter describing the
				  revision or supplement plus an original and two copies of the specified
				  revision or supplement.
(g) If a
				  page is to be revised, two copies of the complete new page must be submitted
				  with the changed item or information clearly marked on the two copies. The
				  original page which is placed in the charter copy of the application must not
				  have any marks on it.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter C - APPLICATION BY CONTINUING CARE PROVIDER FOR CERTIFICATE OF AUTHORITY › Section 33.205 - Deficient Application

Current through Reg. 49, No. 28; July 12, 2024
If any of the items required under §
										33.204
					 of this title (relating to Contents of Application) is determined to be
					 insufficient by the department, the department shall notify the applicant and
					 give 30 days from the date of notice to correct the deficiencies. If the
					 deficiencies have not been corrected after the 30 days have expired, the
					 department may take either of the actions listed in paragraphs (1)-(2) of this
					 section:
(1) return the application,
				  and require the applicant to completely refile, except for the fee, in order to
				  be considered for a certificate of authority; or
(2) proceed to hearing on the
				  application.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter C - APPLICATION BY CONTINUING CARE PROVIDER FOR CERTIFICATE OF AUTHORITY › Section 33.206 - Hearing on Application

Current through Reg. 49, No. 28; July 12, 2024
Following review of the application by the commissioner or
					 the commissioner's designee, a hearing shall be held in accordance with the
					 Government Code, Chapter 2001, Administrative Procedure Act, for the
					 commissioner to make the determinations required under Health and Safety Code,
					 §
										246.022.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 33 - CONTINUING CARE PROVIDERS › Subchapter D - DISCLOSURE STATEMENT › Section 33.301 - Filing and Preparation of Disclosure Statement

Current through Reg. 49, No. 28; July 12, 2024
(a) Each provider subject to Health and
				  Safety Code, §
										246.041,
				  shall file an original and two copies of the disclosure statement with the
				  department, one in a three-ring binder and two copies in the same form as it is
				  distributed to a prospective resident, before one or more of the following
				  occurs:
(1) the provider contracts to provide
				  continuing care in a facility located or to be located in Texas;
(2) the provider extends the term of an
				  existing contract to provide continuing care in a facility located or to be
				  located in Texas;
(3) a provider or
				  provider's agent accepts a reservation agreement deposit;
(4) the provider or provider's agent solicits
				  a continuing care contract in this state for an individual who resides in this
				  state at the time of the solicitation. A continuing care contract is considered
				  solicited in this state if, during the 12-month period preceding the date on
				  which the continuing care contract is signed or accepted by either party,
				  information concerning the facility or the availability of the continuing care
				  contract is given:
(A) by personal, telephone,
				  mail, or other communication directed to and received by a person at a location
				  in this state; or
(B) in paid
				  advertisements published or broadcast from within this state, other than in a
				  publication in which more than two-thirds of the circulation is outside this
				  state.