Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 13 - MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES › Subchapter F - PROFESSIONAL EMPLOYER ORGANIZATIONS SPONSORING SELF-FUNDED EMPLOYEE HEALTH BENEFIT PLANS › Division 2 - APPLICABILITY OF INSURANCE CODE AND ADMINISTRATIVE CODE PROVISIONS › Section 13.523 - Applicable Insurance Code Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 The following provisions of the Insurance Code are applicable to an approved
					 PEO to the same extent as the provisions apply to any entity TDI regulates
					 under those provisions:
(1) Insurance Code
					 Chapter 36, Subchapter C, concerning General Subpoena Powers; Witnesses and
					 Production of Records;
(2)
					 Insurance Code Chapter 36, Subchapter D, concerning Judicial Review;
(3) Insurance Code §
												38.001, concerning
					 Inquiries;
(4) Insurance Code
					 Chapter 38, Subchapter F, concerning Data Collecting and Reporting Relating to
					 Mandated Health Benefits and Mandated Offers of Coverage;
(5) Insurance Code Chapter 38, Subchapter H,
					 concerning Health Care Reimbursement Rate Information;
(6) Insurance Code Chapter 40, concerning
					 Duties of State Office of Administrative Hearings and Commissioner in Certain
					 Proceedings; Rate Setting Proceedings;
(7) Insurance Code Chapters 82, concerning
					 Sanctions;
(8) Insurance Code
					 Chapter 83, concerning Emergency Cease and Desist Orders;
(9) Insurance Code Chapter 84, concerning
					 Administrative Penalties;
(10)
					 Insurance Code Chapter 101, concerning Unauthorized Insurance;
(11) Insurance Code Chapter 461, concerning
					 General Provisions;
(12) Insurance
					 Code §
												521.005,
					 concerning Notice to Accompany Policy;
(13) Insurance Code Chapter 541, Subchapter
					 A, concerning General Provisions;
(14) Insurance Code Chapter 541, Subchapter
					 B, concerning Unfair Methods of Competition and Unfair or Deceptive Acts or
					 Practices Defined;
(15) Insurance
					 Code Chapter 541, Subchapter B-1, concerning Advertising
					 Requirements;
(16) Insurance Code
					 Chapter 542, concerning Processing and Settlement of Claims;
(17) Insurance Code Chapter 543, concerning
					 Prohibited Practices Related to Policy or Certificate of Membership;
(18) Insurance Code Chapter 544, Subchapter
					 A, concerning General Prohibitions Against Discrimination by an Insurer or
					 Health Maintenance Organization;
(19) Insurance Code Chapter 544, Subchapter
					 B, concerning Other General Prohibitions Against Discrimination by
					 Insurers;
(20) Insurance Code
					 Chapter 544, Subchapter C, concerning English Fluency;
(21) Insurance Code Chapter 544, Subchapter
					 D, concerning Family Violence;
(22)
					 Insurance Code Chapter 544, Subchapter E, concerning Fibrocystic Breast
					 Condition;
(23) Insurance Code
					 Chapter 545, concerning HIV Testing;
(24) Insurance Code Chapter 546, concerning
					 Use of Genetic Testing Information;
(25) Insurance Code §
												550.002,
					 concerning Increase in Certain Premium Payments;
(26) Insurance Code Chapter 558, concerning
					 Refund of Unearned Premium;
(27)
					 Insurance Code Chapter 560, concerning Prohibited Rates;
(28) Insurance Code Chapter 601, concerning
					 Privacy;
(29) Insurance Code
					 Chapter 602, concerning Privacy of Health Information;
(30) Insurance Code Chapter 701, concerning
					 Insurance Fraud Investigations;
(31) Insurance Code Chapter 705, concerning
					 Misrepresentations by Policyholders;
(32) Insurance Code Chapter 801, concerning
					 Certificate of Authority;
(33)
					 Insurance Code Chapter 803, concerning Location of Books, Records, Accounts,
					 and Offices Outside of this State;
(34) Insurance Code Chapter 804, concerning
					 Service of Process;
(35) Insurance
					 Code Chapter 823, Subchapter B, concerning Registration;
(36) Insurance Code Chapter 823, Subchapter
					 C, concerning Transactions of Registered Insurer;
(37) Insurance Code Chapter 823, Subchapter
					 D, concerning Control of Domestic Insurer; Acquisition or Merger;
(38) Insurance Code §
												1201.013,
					 concerning Programs Promoting Disease Prevention, Wellness, and
					 Health;
(39) Insurance Code §
												1201.059,
					 concerning Termination of Coverage Based on Age of Child in Individual,
					 Blanket, or Group Policy;
(40)
					 Insurance Code §
												1201.062,
					 concerning Coverage for Certain Children in Individual or Group Policy or in
					 Plan or Program;
(41) Insurance
					 Code §
												1201.063,
					 concerning Prohibition of Certain Criteria Relating to a Child's Coverage in
					 Individual or Group Policy;
(42)
					 Insurance Code §
												1201.064,
					 concerning Coverage for Child of Spouse in Individual or Group
					 Policy;
(43) Insurance Code Chapter
					 1203, concerning Coordination of Benefits Provisions;
(44) Insurance Code Chapter 1204, Subchapter
					 A, concerning Payments to Certain Public Hospitals;
(45) Insurance Code Chapter 1204, Subchapter
					 B, concerning Assignment of Benefit Payments;
(46) Insurance Code Chapter 1204, Subchapter
					 D, concerning Payments for Certain Publicly Provided Services;
(47) Insurance Code Chapter 1204, Subchapter
					 E, concerning Exclusionary Clauses;
(48) Insurance Code Chapter 1204, Subchapter
					 F, concerning Payment of Benefits to Conservator of Minor;
(49) Insurance Code Chapter 1205, concerning
					 Certificate of Creditable Coverage;
(50) Insurance Code Chapter 1206, concerning
					 Denial of Health Benefit Plan Enrollment Based on Existing Coverage
					 Prohibited;
(51) Insurance Code
					 Chapter 1207, concerning Enrollment of Medical Assistance Recipients and
					 Children Eligible for State Child Health Plan;
(52) Insurance Code Chapter 1208, concerning
					 Identity of Available Employee of Health Benefit Plan Issuer;
(53) Insurance Code Chapter 1210, concerning
					 Notice of Certain Policy Provisions;
(54) Insurance Code Chapter 1213, concerning
					 Electronic Health Care Transactions;
(55) Insurance Code Chapter 1214, concerning
					 Advertising for Certain Health Benefits;
(56) Insurance Code Chapter 1215, concerning
					 Reporting of Claims Information;
(57) Insurance Code Chapter 1216, concerning
					 Out-of-Country Coverage Prohibited;
(58) Insurance Code Chapter 1251, Subchapter
					 C, concerning Group Accident and Health Insurance: Required
					 Provisions;
(59) Insurance Code
					 Chapter 1251, Subchapter D, concerning Group Accident and Health Insurance:
					 Coverage for Dependents;
(60)
					 Insurance Code Chapter 1251, Subchapter E, concerning Group Accident and Health
					 Insurance: General Provisions;
(61)
					 Insurance Code Chapter 1251, Subchapter F, concerning Continuation or
					 Conversion Privilege on Termination of Coverage under Group Policy, except that
					 an approved PEO may not offer a conversion policy under Insurance Code §
												1251.256,
					 concerning Conversion of Group Policy;
(62) Insurance Code Chapter 1251, Subchapter
					 G, concerning Continuation of Group Coverage for Certain Family Members and
					 Dependents;
(63) Insurance Code
					 Chapter 1252, concerning Discontinuation and Replacement of Group and
					 Group-Type Health Benefit Plan Coverage;
(64) Insurance Code Chapter 1274, concerning
					 Electronic Transmission of Eligibility and Payment Status;
(65) Insurance Code Chapter 1301, concerning
					 Preferred Provider Benefit Plans, except that a small PEO plan is not subject
					 to §1301.009, concerning Annual Report;
(66) Insurance Code Chapter 1351, concerning
					 Home Health Services;
(67)
					 Insurance Code Chapter 1352, concerning Brain Injury;
(68) Insurance Code Chapter 1355, concerning
					 Benefits for Certain Mental Disorders;
(69) Insurance Code Chapter 1356, concerning
					 Low-Dose Mammography;
(70)
					 Insurance Code Chapter 1357, concerning Mastectomy;
(71) Insurance Code Chapter 1358, concerning
					 Diabetes;
(72) Insurance Code
					 Chapter 1359, concerning Formulas for Individuals with Phenylketonuria or Other
					 Heritable Diseases;
(73) Insurance
					 Code Chapter 1360, concerning Diagnosis and Treatment Affecting
					 Temporomandibular Joint;
(74)
					 Insurance Code Chapter 1361, concerning Detection and Prevention of
					 Osteoporosis;
(75) Insurance Code
					 Chapter 1362, concerning Certain Tests for Detection of Prostate
					 Cancer;
(76) Insurance Code Chapter
					 1363, concerning Certain Tests for Detection of Colorectal Cancer;
(77) Insurance Code Chapter 1364, concerning
					 Coverage Provisions Relating to HIV, Aids, or HIV-Related Illnesses;
(78) Insurance Code Chapter 1365, concerning
					 Loss or Impairment of Speech or Hearing;
(79) Insurance Code Chapter 1366, concerning
					 Benefits Related to Fertility and Childbirth;
(80) Insurance Code Chapter 1367, concerning
					 Coverage of Children;
(81)
					 Insurance Code Chapter 1368, concerning Availability of Chemical Dependency
					 Coverage;
(82) Insurance Code
					 Chapter 1369, concerning Benefits Related to Prescription Drugs and Devices and
					 Related Services;
(83) Insurance
					 Code Chapter 1370, concerning Certain Tests for Detection of Human
					 Papillomavirus, Ovarian Cancer, and Cervical Cancer;
(84) Insurance Code Chapter 1371, concerning
					 Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related
					 Services;
(85) Insurance Code
					 Chapter 1376, concerning Certain Tests for Early Detection of Cardiovascular
					 Disease;
(86) Insurance Code
					 Chapter 1377, concerning Coverage for Certain Amino Acid-Based Elemental
					 Formulas;
(87) Insurance Code
					 Chapter 1379, concerning Coverage for Routine Patient Care Costs for Enrollees
					 Participating in Certain Medical Trials;
(88) Insurance Code Chapter 1451, concerning
					 Access to Certain Practitioners and Facilities;
(89) Insurance Code Chapter 1453, concerning
					 Disclosure of Reimbursement Guidelines under Managed Care Plan;
(90) Insurance Code Chapter 1454, concerning
					 Equal Health Care for Women;
(91)
					 Insurance Code Chapter 1455, concerning Telemedicine and Telehealth;
(92) Insurance Code Chapter 1456, concerning
					 Disclosure of Provider Status;
(93)
					 Insurance Code Chapter 1460, concerning Standards Required Regarding Certain
					 Physician Rankings by Health Benefit Plans;
(94) Insurance Code Chapter 1467, concerning
					 Out-of-Network Claim Dispute Resolution;
(95) Insurance Code Chapter 1501, Subchapter
					 A, concerning General Provisions;
(96) Insurance Code Chapter 1501, Subchapter
					 C, concerning Provision of Coverage;
(97) Insurance Code Chapter 1501, Subchapter
					 M, concerning Large Employer Health Benefit Plans;
(98) Insurance Code Chapter 1502, concerning
					 Health Benefit Plans for Children;
(99) Insurance Code Chapter 1503, concerning
					 Coverage of Certain Students;
(100)
					 Insurance Code Chapter 1504, concerning Medical Child Support;
(101) Insurance Code Chapter 1507, Subchapter
					 A, concerning Consumer Choice of Benefits Health Insurance Plans;
(102) Insurance Code Chapter 1653, concerning
					 High Deductible Health Plan;
(103)
					 Insurance Code Chapter 1661, concerning Information Technology;
(104) Insurance Code Chapter 1701, concerning
					 Policy Forms;
(105) Insurance Code
					 Chapter 4201, concerning Utilization Review Agents; and
(106) Insurance Code Chapter 4202, concerning
					 Independent Review Organizations.