reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter GG - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE › Section 3.7004 - Contract Reserves

Current through Reg. 49, No. 28; July 12, 2024
(a) General.
(1) Contract reserves are required, unless
				  otherwise specified in paragraph (2) of this subsection, for:
(A) all individual and group contracts with
				  which level premiums are used; or
(B) all individual and group contracts with
				  respect to which, due to the gross premium pricing structure at issue, the
				  value of the future benefits at any time exceeds the value of any appropriate
				  future valuation net premiums at that time. This evaluation may be applied on a
				  rating block basis if the total premiums for the block were developed to
				  support the total risk assumed and expected expenses for the block each year,
				  and a qualified actuary certifies the premium development. The values specified
				  in this subparagraph must be determined on the basis specified in subsection
				  (b) of this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter GG - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE › Section 3.7005 - Reinsurance

Current through Reg. 49, No. 28; July 12, 2024
Increases to, or credits against reserves carried, arising
					 because of reinsurance assumed or reinsurance ceded, must be determined in a
					 manner consistent with these minimum reserve standards and with all applicable
					 provisions of the reinsurance contracts which affect the insurer's
					 liabilities.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter GG - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE › Section 3.7006 - Specific Standards for Morbidity, Interest, and Mortality

Current through Reg. 49, No. 28; July 12, 2024
(a) Morbidity.
(1) Minimum morbidity standards for valuation
				  of specified individual contract health insurance benefits are as follows.
(A) Disability income benefits due to
				  accident or sickness.
(i) Contract reserves.
(I) Contracts issued on or after January 1,
				  1965, and prior to January 1, 1987: the 1964 Commissioners Disability Table (64
				  CDT). The 1964 Commissioners Disability Table (64 CDT) is adopted by reference
				  for use in the manner indicated in these sections.
(II) Contracts issued on or after January 1,
				  1994: the 1985 Commissioners Individual Disability Tables A (85CIDA); or the
				  1985 Commissioners Individual Disability Tables B (85CIDB). The 1985
				  Commissioners Individual Disability Tables A (85CIDA) and the 1985
				  Commissioners Individual Disability Tables B (85CIDB) are adopted by reference
				  for use in the manner indicated in these sections.
(III) Contracts issued during the years 1987
				  through 1993: optional use of either the 1964 table or the 1985
				  tables.
(IV) Each insurer shall
				  elect, with respect to all individual contracts issued in any one statement
				  year, whether it will use Tables A (85CIDA) or Tables B (85CIDB) as the minimum
				  standard. The insurer may, however, elect to use the other tables with respect
				  to any subsequent statement year.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter GG - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE › Section 3.7008 - Reserves for Waiver of Premium

Current through Reg. 49, No. 28; July 12, 2024
(a) This
				  section contains supplementary explanatory material.
(b) Waiver of premium reserves involve
				  several special considerations. First, the disability valuation tables
				  promulgated by the National Association of Insurance Commissioners are based on
				  exposures that include contracts on premium waiver as in-force contracts.
				  Hence, contract reserves based on these tables are not reserves on "active
				  lives" but rather reserves on contracts "in force." This is true for the 1964
				  CDT and for both the 1985 CIDA and CIDB tables. Accordingly, tabular reserves
				  using any of these tables should value reserves on the following basis.
(1) Claim reserves should include reserves
				  for premiums expected to be waived, valuing as a minimum the valuation net
				  premium being waived.
(2) Premium
				  reserves should include contracts on premium waiver as in-force contracts,
				  valuing as a minimum the unearned modal valuation net premium being
				  waived.
(3) Contract reserves
				  should include recognition of the waiver of premium benefit in addition to
				  other contract benefits provided for, valuing as a minimum the valuation net
				  premium to be waived.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter GG - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE › Section 3.7009 - Purchase or Assumption of Existing Business

Current through Reg. 49, No. 28; July 12, 2024
Notwithstanding any other provision of these sections,
					 including §
										3.7004 of this
					 title (relating to Contract Reserves), any company licensed in Texas purchasing
					 or assuming by assumption certificate any existing business on or after the
					 effective date of these rules must establish reserves based upon the original
					 dates of issue for such business in accordance with these
					 sections.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter GG - MINIMUM RESERVE STANDARDS FOR INDIVIDUAL AND GROUP ACCIDENT AND HEALTH INSURANCE › Section 3.7010 - Severability

Current through Reg. 49, No. 28; July 12, 2024
If any provision of §§
										3.7001-3.7009
					 of this title (relating to Introduction; Claim Reserves; Premium Reserves;
					 Contract Reserves; Reinsurance; Specific Standards for Morbidity, Interest, and
					 Mortality; Glossary of Technical Terms Used; Reserves for Waiver of Premium;
					 and Purchase or Assumption of Existing Business) or the applicability of those
					 sections to any person or circumstance is held invalid for any reason, the
					 invalidity shall not affect the other provisions or any other application of
					 those sections which can be given effect without the invalid provisions or
					 application. To this end, any and all provisions of these sections are declared
					 to be severable.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8001 - Chemical Dependency Treatment Standards

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. This
				  section implements Insurance Code §
										1368.007, concerning
				  Treatment Standards.
(b)
				  Applicability. This section applies to a group health benefit plan that is
				  subject to Insurance Code Chapter 1368, concerning Availability of Chemical
				  Dependency Coverage.
(c) Treatment
				  standards. For the purpose of this section, the department adopts the treatment
				  standards in the 27th edition of the MCG Care Guidelines; the 3rd edition of
				  the American Society of Addiction Medicine (ASAM) Criteria; and the 4th edition
				  Volume I, Adults, of the ASAM Criteria.
(d) Coverage required. For any treatment for
				  which coverage is required under Insurance Code Chapter 1368, a group health
				  benefit plan must use the MCG Care Guidelines or ASAM Criteria, as applicable
				  to the treatment and care provided.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8002

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8003

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8004

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8005

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8007

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8008

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8009

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8010

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8011

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8012

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8013

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8014

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8015

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8016

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8017

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8018

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8019

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8020

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8021

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8022

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8023

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8024

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8025

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8026

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8027

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8028

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8029

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter HH - STANDARDS FOR REASONABLE COST CONTROL AND UTILIZATION REVIEW FOR CHEMICAL DEPENDENCY TREATMENT CENTERS › Section 3.8030

Current through Reg. 49, No. 28; July 12, 2024
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter II - INSURANCE SOLD IN CONNECTION WITH PREPAID FUNERAL CONTRACTS › Section 3.9001 - Introduction to Joint Memorandum of Understanding

Current through Reg. 49, No. 28; July 12, 2024
(a) Occupations Code §
										651.159
				  mandates the Texas Department of Insurance, the Texas Funeral Service
				  Commission, and the Texas Department of Banking to adopt by rule a joint
				  memorandum of understanding relating to prepaid funeral services and
				  transactions that:
(1) outlines the
				  responsibilities of each agency in regulating these services and
				  transactions;
(2) establishes
				  procedures to be used by each agency in referring complaints to one of the
				  other agencies;
(3) establishes
				  procedures to be used by each agency in investigating complaints;
(4) establishes procedures to be used by each
				  agency in notifying the other agencies of a complaint or of the investigation
				  of a complaint;
(5) describes
				  actions the agencies regard as deceptive trade practices;
(6) specifies the information the agencies
				  provide consumers and when that information is to be provided; and
(7) sets the administrative penalties each
				  agency imposes for violations.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter II - INSURANCE SOLD IN CONNECTION WITH PREPAID FUNERAL CONTRACTS › Section 3.9002 - Joint Memorandum of Understanding

Current through Reg. 49, No. 28; July 12, 2024
(a) Pursuant to Occupations Code §
										651.159
				  the Texas Funeral Service Commission (TFSC), the Texas Department of Insurance
				  (TDI), and the Texas Department of Banking (DOB) adopt the following joint
				  memorandum of understanding (JMOU) relating to prepaid funeral benefits as
				  defined in Finance Code Chapter 154. The TFSC, TDI, and DOB intend this
				  memorandum of understanding to assist the three agencies in their regulatory
				  activities, and to make it as easy as possible for a consumer with a complaint
				  to have the complaint acted upon by all three agencies, where appropriate. To
				  accomplish this, where not statutorily prohibited, the three agencies will
				  share information among the agencies that may not be available to the public
				  generally under the Public Information Act, Government Code Chapter 552. Such
				  information will be transmitted among agencies with the understanding that it
				  is considered confidential, is being furnished to the other agencies in
				  furtherance of their joint responsibilities as state agencies in enforcing
				  their respective statutes, and that it may not be disseminated to others except
				  as required.
(b) Responsibilities
				  of each agency in regulating prepaid funeral benefits.
(1) The Texas Funeral Service Commission is
				  responsible for the following:
(A) licensing
				  funeral directors, embalmers, provisional funeral directors, provisional
				  embalmers, crematory, and funeral establishments. The TFSC may refuse to
				  license a person or establishment that violates Finance Code Chapter 154, under
				  Occupations Code §
												651.460(b)(3);
(B) taking action under Occupations Code
				  §
												651.460(b)(3)
				  against any licensee violating Finance Code Chapter 154; and
(C) taking action under Occupations Code
				  §
												651.460(b)(3)
				  against any funeral director in charge, crematory owner, and/or funeral
				  establishment owner for violations of Finance Code Chapter 154 by persons
				  directly or indirectly connected to the crematory or funeral
				  establishment.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter JJ - 2001 CSO MORTALITY TABLE › Section 3.9101 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to recognize, permit, and
					 prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality
					 Table in accordance with Insurance Code §
										425.058(c)(3)
					 and § 1105.055(h) and §
										3.4505
					 of this title (relating to General Calculation Requirements for Basic Reserves
					 and Premium Deficiency Reserves). For policies issued on or after January 1,
					 2017, the valuation manual adopted under Insurance Code Chapter 425, Subchapter
					 B, provides applicable mortality tables.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter JJ - 2001 CSO MORTALITY TABLE › Section 3.9102 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, shall have the following meanings, unless the context clearly
					 indicates otherwise.
(1) 2001 CSO
				  Mortality Table--mortality tables, consisting of separate rates of mortality
				  for male and female lives, developed by the American Academy of Actuaries CSO
				  Task Force from the Valuation Basic Mortality Table developed by the Society of
				  Actuaries Individual Life Insurance Valuation Mortality Task Force, and adopted
				  by the National Association of Insurance Commissioners in December 2002. Unless
				  the context indicates otherwise, the 2001 CSO Mortality Table includes both the
				  ultimate form of that table and the select and ultimate form of that table and
				  includes both the smoker and nonsmoker mortality tables and the composite
				  mortality tables. It also includes both the age-nearest-birthday and
				  age-last-birthday bases of the mortality tables.
(2) 2001 CSO Mortality Table (F)--mortality
				  table consisting of the rates of mortality for female lives from the 2001 CSO
				  Mortality Table.
(3) 2001 CSO
				  Mortality Table (M)--mortality table consisting of the rates of mortality for
				  male lives from the 2001 CSO Mortality Table.
(4) Composite mortality tables--mortality
				  tables with rates of mortality that do not distinguish between smokers and
				  nonsmokers.
(5) Smoker and
				  nonsmoker mortality tables--mortality tables with separate rates of mortality
				  for smokers and nonsmokers.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter JJ - 2001 CSO MORTALITY TABLE › Section 3.9103 - 2001 CSO Mortality Table

Current through Reg. 49, No. 28; July 12, 2024
(a) At the
				  election of the company for any one or more specified plans of insurance and
				  subject to the conditions stated in this subchapter, the 2001 CSO Mortality
				  Table may be used as the minimum standard for policies issued on or after May
				  1, 2003, and before the date specified in subsection (b) of this section to
				  which Insurance Code §
										425.058(c)(3)
				  and § 1105.055(h) and §
										3.4505
				  of this title (relating to General Calculation Requirements for Basic Reserves
				  and Premium Deficiency Reserves) are applicable. If the company elects to use
				  the 2001 CSO Mortality Table, it must do so for both valuation and
				  nonforfeiture purposes.
(b) Subject
				  to the conditions stated in this subchapter, the 2001 CSO Mortality Table must
				  be used in determining minimum standards for policies issued on and after
				  January 1, 2009, and before January 1, 2017, to which Insurance Code §
										425.058(c)
				  and § 1055.055(h) and §
										3.4505
				  of this title (relating to General Calculation Requirements for Basic Reserves
				  and Premium Deficiency Reserves) are applicable, except as provided in
				  §§
										3.9601-
				  3.9606
				  of this title (relating to Preneed Life Insurance Minimum Mortality Standards
				  for Determining Reserve Liabilities and Nonforfeiture Values) for preneed life
				  insurance policies and certificates. For policies issued on or after January 1,
				  2017, the valuation manual adopted under Insurance Code Chapter 425, Subchapter
				  B, provides applicable mortality tables.
(c) The minimum basis for computation of
				  values related to extended term benefits will be the 2001 CSO Mortality Table
				  pursuant to the requirements of this subchapter.
(d) The Commissioner of Insurance adopts by
				  reference the 2001 CSO Mortality Table. The table is available from the Texas
				  Department of Insurance, Financial Regulation Division, Actuarial Office,
				  MC-FRD, P.O. Box 12030, Austin, Texas 78711-2030 or on the internet by
				  accessing the department's website at
www.tdi.texas.gov/reports/life/ficso.html
.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter JJ - 2001 CSO MORTALITY TABLE › Section 3.9104 - Conditions

Current through Reg. 49, No. 28; July 12, 2024
(a) For each plan of insurance with separate
				  rates for smokers and nonsmokers, an insurer may use:
(1) Composite mortality tables to determine
				  minimum reserve liabilities and minimum cash surrender values and amounts of
				  paid-up nonforfeiture benefits;
(2)
				  Smoker and nonsmoker mortality tables to determine the valuation net premiums
				  and additional minimum reserves, if any, required by Insurance Code §
											425.068,
				  and use composite mortality tables to determine the basic minimum reserves,
				  minimum cash surrender values, and amounts of paid-up nonforfeiture benefits;
				  or
(3) Smoker and nonsmoker
				  mortality tables to determine minimum reserve liabilities and minimum cash
				  surrender values and amounts of paid-up nonforfeiture benefits.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter JJ - 2001 CSO MORTALITY TABLE › Section 3.9106 - Gender-Blended Tables

Current through Reg. 49, No. 28; July 12, 2024
(a) For any
				  ordinary life insurance policy delivered or issued for delivery in this state
				  on and after May 1, 2003, that utilizes the same premium rates and charges for
				  male and female lives or is issued in circumstances where applicable law does
				  not permit distinctions on the basis of gender, a mortality table that is a
				  blend of the 2001 CSO Mortality Table (M) and the 2001 CSO Mortality Table (F)
				  may, at the option of the company for each plan of insurance, be substituted
				  for the 2001 CSO Mortality Table for use in determining minimum cash surrender
				  values and amounts of paid-up nonforfeiture benefits. No change in minimum
				  valuation standards is implied by this subsection. For any ordinary life
				  insurance policy delivered or issued for delivery in Texas on or after January
				  1, 2017, the valuation manual adopted under Insurance Code Chapter 425,
				  Subchapter B, provides the applicable mortality tables.
(b) The company may choose from among the
				  blended tables developed by the American Academy of Actuaries CSO Task Force
				  and adopted by the National Association of Insurance Commissioners in December
				  2002. These blended tables are available from the Texas Department of
				  Insurance, Actuarial Office, Financial Regulation Division, MC-FRD, P.O. Box
				  12030, Austin, Texas 78711-2030 or on the internet by accessing the
				  department's website at
www.tdi.texas.gov/reports/life/ficso.html
.
(c) It is not, in and of itself, a violation
				  of Insurance Code Chapter 541 for an insurer to issue the same kind of policy
				  of life insurance on both a sex-distinct and sex-neutral basis.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9201 - Application

Current through Reg. 49, No. 28; July 12, 2024
This subchapter applies to an exclusive provider benefit
					 plan (EPP) written by an issuer which has contracted with the Health and Human
					 Services Commission (HHSC) to provide services under the Texas Children's
					 Health Insurance Program (CHIP), Medicaid or with the Statewide Rural Health
					 Care System (the System). An issuer may only use an EPP in the System and/or by
					 contract with HHSC for CHIP or Medicaid. This subchapter applies to new or
					 renewed contracts on or after the effective date of this
					 subchapter.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9202 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise:
(1) Adverse
				  determination--A determination by a utilization review agent that the health
				  care services furnished or proposed to be furnished to a patient are not
				  medically necessary or not appropriate.
(2) Complaint--Any dissatisfaction, expressed
				  by a complainant orally or in writing to the issuer, with any aspect of the
				  issuer's operation, including plan administration; the denial, or termination
				  of a service for reasons not related to medical necessity; the way a service is
				  provided; or disenrollment decisions, expressed by a complainant. The term does
				  not include a misunderstanding or problem of misinformation that is resolved
				  promptly by clearing up the misunderstanding or supplying the appropriate
				  information to the satisfaction of the insured and does not include a
				  provider's or insured's oral or written dissatisfaction with an adverse
				  determination.
(3)
				  Credentialing--The process of collecting, assessing, and validating
				  qualifications and other relevant information pertaining to a health care
				  provider to determine eligibility to deliver health care services.
(4) Emergency care--Health care services
				  provided in a hospital emergency facility or comparable facility to evaluate
				  and stabilize medical conditions of a recent onset and severity, including but
				  not limited to severe pain, that would lead a prudent layperson possessing an
				  average knowledge of medicine and health to believe that his or her condition,
				  sickness, or injury is of such a nature that failure to get immediate medical
				  care could result in:
(A) placing the
				  patient's health in serious jeopardy;
(B) serious impairment to bodily
				  functions;
(C) serious dysfunction
				  of any bodily organ or part;
(D)
				  serious disfigurement; or
(E) in
				  the case of a pregnant woman, serious jeopardy to the health of the
				  fetus.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9203 - Policy and Premium Rates

Current through Reg. 49, No. 28; July 12, 2024
(a) Disclosure
				  of complaint system. An EPP policy or certificate must contain the Complaints
				  and Appeals Process found in this subchapter. This information must include a
				  clear and understandable description of the issuer's methods for resolving
				  complaints. An issuer must provide any subsequent changes to the complaint
				  system to insureds, which it may include in a separate document issued to the
				  insured.
(b) Medically necessary
				  covered services. If medically necessary covered services are not available
				  through exclusive providers, the issuer, on the request of an exclusive
				  provider, must allow referral within a reasonable period to a non-network
				  health care provider and must fully reimburse the non-network health care
				  provider at the usual and customary or an agreed rate. The policy must provide
				  for a review by a health care provider of the same specialty or a similar
				  specialty as the type of health care provider to whom a referral is requested
				  before the issuer may deny a referral.
(c) Schedule of premiums. An issuer must file
				  the schedule of premium rates and formula or method for calculating the
				  schedule of premium rates for covered health care services along with
				  supporting documentation with the commissioner before it is used in conjunction
				  with any EPP. The issuer must establish the formula or method in accordance
				  with accepted actuarial principles and must produce premium rates that are not
				  excessive, inadequate, or unfairly discriminatory, as well as premium rates
				  that are reasonable with respect to benefits. An issuer may not alter the
				  premium rates resulting from the application of the formula or method for an
				  individual insured based on the status of that insured's health.
(1) An issuer must accompany each schedule of
				  premium rates and formula or method for calculating the schedule of premium
				  rates with the certification of a qualified actuary that, based on reasonable
				  assumptions, the formula is appropriate to produce premium rates that are not
				  excessive, inadequate, or unfairly discriminatory. An actuary is considered
				  qualified if he or she:
(A) is a member of the
				  American Academy of Actuaries; or
(B) is a Fellow of the Society of
				  Actuaries.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9205 - Compliance of Limited Provider Network

Current through Reg. 49, No. 28; July 12, 2024
An issuer that uses subcontractors to perform one or more
					 function(s) remains responsible for ensuring compliance with all applicable
					 regulatory compliance requirements. A limited provider network shall comply
					 with all statutory and regulatory requirements.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9206 - Quality Improvement and Utilization Management

Current through Reg. 49, No. 28; July 12, 2024
(a) An issuer must establish and maintain
				  procedures to assure that the health care services provided to insureds are
				  rendered under reasonable standards of quality of care consistent with
				  prevailing professionally recognized standards of medical practice. These
				  procedures must include:
(1) mechanisms to
				  assure availability, accessibility, quality, and continuity of care;
(2) an ongoing internal quality improvement
				  program to monitor and evaluate its health care services, including primary and
				  specialist physician services, and ancillary and preventive health care
				  services, in all institutional and non-institutional contexts;
(3) a record of formal proceedings of quality
				  improvement program activities and a means for maintaining documentation in a
				  confidential manner. Quality improvement program minutes must be made available
				  to the commissioner;
(4) a
				  physician review panel to assist in reviewing medical guidelines or criteria
				  and to assist in determining the prescription drugs to be covered by the EPP,
				  if the plan contains a prescription drug benefit;
(5) an adequate patient record system that
				  will facilitate documentation and retrieval of clinical information for the
				  purpose of the issuer's evaluation of continuity and coordination of patient
				  care and assessment of the quality of health care services provided to
				  insureds;
(6) a mechanism for
				  making available to the commissioner the clinical records of insureds for
				  examination and review. Such records are confidential and privileged, and are
				  not subject to Government Code, Chapter 552, Public Information, or to
				  subpoena, except to the extent necessary to enable the commissioner to enforce
				  this title; and
(7) a mechanism for
				  the periodic reporting of quality improvement program activities to its
				  governing body, providers, and appropriate organization staff. An issuer is
				  also subject to the same quality improvement requirements as outlined in §
											11.1901
				  of this title (relating to Quality Improvement Structure).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9207 - Credentialing Requirements for Health Care Providers

Current through Reg. 49, No. 28; July 12, 2024
An issuer is subject to the same credentialing criteria as
					 outlined in §
										11.1902(4)
					 of this title (relating to Quality Improvement Program).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9208 - Provider Network: Accessibility and Availability

Current through Reg. 49, No. 28; July 12, 2024
An issuer is subject to the same network accessibility and
					 availability requirements as outlined in §
										11.1607
					 of this title (relating to Accessibility and Availability Requirements).
					 Issuers must comply with this section; any requirements under a Medicaid
					 contract, subject to Government Code, Chapter 533; and any other applicable
					 law.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9210 - Complaints System

Current through Reg. 49, No. 28; July 12, 2024
(a) Complaints
				  System. Issuers must comply with this section; any requirements under a
				  Medicaid contract, subject to Government Code, Chapter 533; and any other
				  applicable law. The complaint system must provide reasonable procedures for the
				  resolution of oral and written complaints initiated by insureds or providers
				  concerning health care services, including a process for the notice and appeal
				  of complaints.
(1) If a complainant notifies
				  the issuer orally or in writing of a complaint, the issuer, not later than the
				  fifth business day after the date of the receipt of the complaint, shall send
				  to the complainant a letter acknowledging the date of receipt of the complaint
				  that includes a description of the organization's complaint procedures and time
				  frames. If the complaint is received orally, the issuer shall also enclose a
				  one-page complaint form. The one-page complaint form must prominently and
				  clearly state that the complaint form must be returned to the issuer for prompt
				  resolution of the complaint.
(A) The issuer
				  shall investigate each oral and written complaint received in accordance with
				  its policies and in compliance with this subchapter.
(B) Investigation and resolution of
				  complaints concerning emergencies or denials of continued stays for
				  hospitalization shall be concluded in accordance with the medical or dental
				  immediacy of the case and may not exceed one business day from receipt of the
				  complaint.
(C) For all other
				  complaints, the total time for acknowledgment, investigation, and resolution of
				  the complaint by the issuer may not exceed 30 calendar days after the date the
				  issuer receives the written complaint or one-page complaint form from the
				  complainant.
(D) After the issuer
				  has investigated a complaint, the issuer shall send a response letter to the
				  complainant explaining the issuer's resolution of the complaint within the time
				  frame as set forth in this section. The letter must include a statement of the
				  specific medical and contractual reasons for the resolution and the
				  specialization of any health care provider consulted. The response letter must
				  contain a full description of the process for appeal, including the time frames
				  for the appeal process and the time frames for the final decision on the
				  appeal.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9211 - Filing of Complaints

Current through Reg. 49, No. 28; July 12, 2024
Any person, including a person who has attempted to resolve
					 complaints through an issuer complaint system process and who is dissatisfied
					 with the resolution, may report an alleged violation of this subchapter to the
					 Texas Department of Insurance at
www.tdi.texas.gov
or
					 1-800-252-3439.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter KK - EXCLUSIVE PROVIDER BENEFIT PLAN › Section 3.9212 - Appeal of Non-Medicaid Adverse Determinations

Current through Reg. 49, No. 28; July 12, 2024
An issuer must perform utilization review in compliance
					 with Insurance Code Chapter 4201 and must maintain procedures for notification,
					 review, and appeal of an adverse determination, as defined by this section. An
					 issuer must implement and maintain an internal appeal system for non-Medicaid
					 adverse determinations that provides reasonable procedures for the resolution
					 of an oral or written appeal initiated by an insured, a person acting on behalf
					 of an insured, or an insured's provider of record concerning dissatisfaction or
					 disagreement with an adverse determination.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter LL - HEALTH COVERAGE AWARENESS AND EDUCATION PROGRAM › Section 3.9301 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
This subchapter establishes procedures for the acceptance
					 of donations by the Texas Department of Insurance to assist with the funding of
					 the Health Coverage Awareness and Education Program and to establish procedures
					 to govern the relationships between employees of the department, offerees, and
					 donors regarding the acceptance of such donations, as authorized in the
					 Insurance Code §
										524.005.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter LL - HEALTH COVERAGE AWARENESS AND EDUCATION PROGRAM › Section 3.9302 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
For purposes of this subchapter, the following words and
					 terms shall have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Bid response--A
				  response to a departmental request for goods or services, including a formal
				  bid response, a formal bid proposal, an informal price quote, a submission of
				  specifications or qualifications, direct contract negotiations, or any other
				  similar submission or communication.
(2) Commissioner--The Commissioner of
				  Insurance.
(3) Department--The
				  Texas Department of Insurance.
(4)
				  Donation--Money, real or personal property, or any other tangible or intangible
				  thing of value delivered to the department by gift or grant.
(5) Donation agreement--A written document
				  executed by the commissioner or the commissioner's designee and an offeree that
				  includes the information required in §
										3.9306
				  of this subchapter (relating to Procedures for Acceptance of
				  Donations).
(6) Donor--An
				  individual, corporation, association, firm, partnership, committee, club
				  organization, person, group of persons, or other entity that has made a
				  donation to the department.
(7)
				  Employee--An individual employed by the department in a full or part time
				  capacity.
(8) Offeree--An
				  individual, corporation, association, firm, partnership, committee, club
				  organization, person, group of persons, or other entity that offers or seeks to
				  make a donation to the department.
(9) Program--The Health Coverage Awareness
				  and Education Program, as authorized in the Insurance Code Chapter
				  524.
(10) Seeking to
				  contract--Submitting a bid response to the department.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter LL - HEALTH COVERAGE AWARENESS AND EDUCATION PROGRAM › Section 3.9303 - Acceptance of Donations

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  commissioner or the commissioner's designee may accept a donation only for the
				  purposes authorized in the Insurance Code Chapter 524 in the manner authorized
				  in this subchapter. The commissioner or the commissioner's designee must accept
				  all donations on behalf of the department and not in an individual
				  capacity.
(b) The commissioner, in
				  the commissioner's sole discretion, may decline to accept any
				  donation.
(c) Donations the
				  commissioner or the commissioner's designee accept become state property and
				  are subject to all applicable federal and state laws and regulations.