reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1601 - Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as otherwise provided by this
				  subchapter or the Insurance Code Chapter 4151, this subchapter applies to a
				  person acting as or holding itself out as an administrator in any capacity,
				  regardless of whether the person holds another authorization under the
				  Insurance Code or the Labor Code.
(b) In accordance with the Insurance Code
				  §
										1272.058
				  and the Labor Code § 407A.009, an administrator performing administrative
				  services on behalf of an HMO or a workers' compensation self-insurance group
				  shall meet the same requirements under the Insurance Code Chapter 4151 and this
				  subchapter as an administrator performing administrative services on behalf of
				  an insurer or plan sponsor.
(c) A
				  person acting as or holding itself out as an administrator must meet the
				  requirements of the Insurance Code Chapter 4151 and this subchapter in addition
				  to any other requirements applicable to that person under the Insurance Code
				  Chapters 1272 or 1305 or the Labor Code Chapters 407 or 407A and any rules
				  adopted thereunder.
(d) This
				  subchapter does not apply to a person acting as or holding itself out as an
				  administrator for an ERISA qualified employee welfare benefit plan that is
				  exempt from regulation by this state with respect to that particular employee
				  welfare benefit plan.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1603 - Certificate of Authority Required

Current through Reg. 49, No. 28; July 12, 2024
(a) Unless
				  a person meets an exemption under Insurance Code §§
										4151.002, concerning
				  Exemptions, 4151.004, concerning Applicability to Certain Insurers and Health
				  Maintenance Organizations, or 4151.0021, concerning Applicability to Certain
				  Processing Agents, a person acting as or holding themselves out as an
				  administrator must hold a certificate of authority under Insurance Code Chapter
				  4151, concerning Third-Party Administrators.
(b) An administrator contractor and an
				  administrator subcontractor must hold a certificate of authority under
				  Insurance Code Chapter 4151.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1604 - Application for Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Filing of Application. An applicant who seeks a certificate of authority under
				  the Insurance Code Chapter 4151 must file an application with the department,
				  accompanied by the non-refundable fee of $1,000. The applicant must verify the
				  application by attesting to the truth and accuracy of the information in the
				  application.
(b) Forms and Fee.
(1) The commissioner adopts by reference the
				  following forms, which comprise the application for a certificate of authority
				  under the Insurance Code Chapter 4151, and which are available at
				  http://www.tdi.state.tx.us/forms/form5tpa.html:
(A) Form Number FIN 489, Application for a
				  Certificate of Authority;
(B) Form
				  Number FIN 306, Officers and Directors Form;
(C) Form Number LHL 081, Biographical
				  Affidavit; and
(D) Form Number LHL
				  082, Service of Process Form.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1605 - Notification Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An insurer
				  or HMO that is acting as or holding itself out as an administrator and that is
				  not exempt under the Insurance Code §
										4151.002(3) or
				  (4) is subject to all provisions of this
				  subchapter, except §§
										7.1603,
				  7.1604, and
				  7.1609(c) and (d)(1) and (2) of
				  this subchapter (relating to Certificate of Authority Required, Application for
				  Certificate of Authority, and Annual Report).
(b) An insurer or HMO meeting the
				  requirements of subsection (a) of this section must provide written
				  notification to the department that it will be acting as or holding itself out
				  as an administrator. The notice must include:
(1) the insurer's or HMO's contact
				  information, including its TDI company number;
(2) a narrative describing the insurer's or
				  HMO's facilities, personnel, and experience relating to the functions the
				  insurer or HMO will be performing as an administrator; and
(3) a list of any other states in which the
				  insurer or HMO will be acting as or holding itself out as an
				  administrator.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1606 - Requirements Related to Ownership Interest and Change of Control

Current through Reg. 49, No. 28; July 12, 2024
(a) For purposes of this section only,
				  control:
(1) means the power to direct, or
				  cause the direction of, the management and policies of a person, other than the
				  power that results from an official position with or corporate office held by
				  the person;
(2) may be possessed by
				  various means, including through:
(A)
				  ownership of voting securities;
(B)
				  ownership by contract; or
(C)
				  direct or indirect control of one or more persons that control an
				  administrator; and
(3)
				  exists if an individual or a member of an individual's immediate family,
				  directly or indirectly, owns, controls, or holds with the power to vote 10
				  percent or more of the voting securities or authority of:
(A) an administrator; or
(B) another person that directly or
				  indirectly controls an administrator, including when a person holds proxies
				  representing 10 percent or more of the voting securities or authority of the
				  person.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1607 - Facts and Circumstances Affecting Issuance of Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) For purposes of this section only, a
				  material change in fact or circumstance means any fact or circumstance that
				  impacts the accuracy or completeness of the information filed in an applicant's
				  or administrator's initial application for a certificate of authority under the
				  Insurance Code Chapter 4151, including:
(1) a
				  change in an applicant's or administrator's mailing address;
(2) a felony conviction of any executive
				  officer or other comparable responsible person of an applicant or administrator
				  or of any other person who directly or indirectly controls the applicant or
				  administrator; and
(3) any
				  administrative action, order, or judgment issued against an applicant or
				  administrator.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1608 - Fidelity Bond

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant
				  must obtain, and an administrator must maintain, a fidelity bond that complies
				  with the requirements of the Insurance Code §
										4151.055
				  and this section.
(b) Applicants
				  and administrators may only obtain a fidelity bond from a surety company
				  authorized to engage in business in this state as a surety or an eligible
				  surplus lines insurer in compliance with the Insurance Code Chapter 981 and
				  rules adopted thereunder.
(c) An
				  applicant or administrator whose fidelity bond is cancelled or terminated and
				  not replaced with new coverage that meets the requirements of the Insurance
				  Code §
										4151.055
				  and this section and that is effective concurrently upon the date of the
				  cancellation or termination shall immediately inform the commissioner in
				  writing, which in no event shall be later than ten business days from the date
				  the applicant or administrator first becomes aware of the cancellation or
				  termination.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1609 - Annual Report

Current through Reg. 49, No. 28; July 12, 2024
(a) Filing of
				  Annual Report. An administrator must file an annual report with the department
				  no later than June 30 each year, accompanied by the non-refundable fee of
				  $200.
(b) Forms and Fee.
(1) The commissioner adopts by reference the
				  following forms, which are available at
				  www.tdi.state.tx.us/forms/form5tpa.html:
(A)
				  Form Number FIN 486, Annual Report Form for Administrators Holding a
				  Certificate of Authority under TIC 4151;
(B) Form Number FIN 487, Annual Report Form
				  for Insurers and HMOs Subject to 28 TAC §
												7.1605;
(C) Form Number FIN 488, Annual Report
				  Exhibits A-E; and
(D) Form Number
				  FIN 490, Certification of Financial Statement.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1610 - Financial Statements under the Education Code

Current through Reg. 49, No. 28; July 12, 2024
(a) This section applies only to an insurer
				  or HMO that:
(1) meets the requirements of
				  §
											7.1605
				  of this subchapter (relating to Notification Requirements); and
(2) is subject to the requirements of the
				  Education Code §
											22.004(g).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1611 - Operational Review and On-Site Audit

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  No less than two times each fiscal year, an insurer shall review the operations
				  of each of its administrators that, in the aggregate, administers benefits in
				  Texas on behalf of the insurer for more than 100 certificate holders, injured
				  employees, plan participants, or policyholders. A review may be conducted on
				  the premises of the insurer or at another location designated by the insurer
				  and may be conducted by electronic means.
(b) No less than once every two fiscal years,
				  an insurer shall conduct an on-site audit of each of its administrators that,
				  in the aggregate, administers benefits in Texas on behalf of the insurer for
				  more than 100 certificate holders, injured employees, plan participants, or
				  policyholders.
(c) Notwithstanding
				  subsection (a) of this section, an insurer is not required to review the
				  operations of an administrator under subsection (a) of this section more than
				  one time in the same fiscal year in which the insurer conducts an on-site audit
				  of that administrator pursuant to subsection (b) of this section.
(d) Both a review and on-site audit required
				  under subsections (a) and (b) of this section must:
(1) assess the business practices and
				  procedures of the administrator to ensure competent administration, including
				  evaluating:
(A) the administrator's
				  compliance with the Insurance Code, the Labor Code, and any rules adopted
				  thereunder, as applicable;
(B) the
				  administrator's compliance with the provisions of the written agreement with
				  the insurer;
(C) the
				  administrator's performance of claims adjudication and payment;
(D) the adequacy of the financial security
				  maintained by the administrator, if any; and
(E) the administrator's practices and
				  procedures for establishing the adequacy of the insurer's reserves, if any;
				  and
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1612 - Fiduciary Bank Accounts

Current through Reg. 49, No. 28; July 12, 2024
(a) Pursuant to the
				  Insurance Code §
										4151.106(b),
				  an administrator shall hold all premium in a fiduciary capacity.
(b) An administrator collecting or receiving
				  any premium shall comply with the Insurance Code §§
										4151.105,
				  4151.106,
				  4151.107,
				  and
				  4151.108
				  and this section. An administrator who receives any premium on behalf of an
				  insurer, HMO, plan sponsor, or group shall report the receipt of that premium
				  to the insurer, HMO, plan sponsor, or group within a reasonable amount of
				  time.
(c) An administrator shall
				  establish at least one fiduciary bank account to hold any premium collected or
				  received pursuant to this section.
(d) A fiduciary bank account required by
				  subsection (c) of this section must be established and styled as an escrow
				  account.
(e) An administrator shall
				  maintain each fiduciary bank account at a financial institution that is
				  organized under the laws of the United States or any state thereof, and is
				  regulated, supervised, and examined by United States federal or state
				  authorities having regulatory authority over banks and trust companies. A
				  fiduciary bank account may only consist of one or more of the following types
				  of investments:
(1) cash and cash
				  equivalents, including savings accounts, checking accounts, money market
				  accounts, and certificates of deposit;
(2) non-assessable money market mutual funds
				  that are primarily invested in United States government securities;
				  and
(3) other investments of
				  substantially similar quality, as approved by the commissioner.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1613 - Written Agreements Between Administrators and Insurers

Current through Reg. 49, No. 28; July 12, 2024
(a) An administrator may not provide
				  administrative services in Texas on behalf of an insurer unless the
				  administrator has entered into a written agreement with the insurer that meets
				  the requirements of the Insurance Code Chapter 4151 and this section.
(b) An administrator subcontractor may meet
				  the requirements of this section by entering into a written agreement with the
				  administrator contractor only, provided the written agreement meets the
				  requirements of the Insurance Code Chapter 4151 and this section, as
				  applicable.
(c) A written agreement
				  entered into under this section may not be construed to limit, in any way, an
				  insurer's ultimate accountability and responsibility for compliance with all
				  statutory and regulatory requirements under the Insurance Code, the Labor Code,
				  and rules adopted thereunder.
(d) A
				  written agreement entered into under this section shall include:
(1) a requirement that the administrator must
				  comply with all statutory, contractual, and regulatory requirements related to
				  a function assumed or carried out by the administrator and related to a plan
				  for which the administrator performs or offers to perform administrative
				  services;
(2) a description of the
				  administrative services the administrator is expected to provide and any
				  applicable instructions related to the performance of those services, including
				  references to an insurer's claims handling practices or procedures;
(3) a provision relating to the continuity of
				  services and addressing the obligations of the administrator and the insurer
				  under §
											7.1615
				  of this subchapter (relating to Transfer of Books and Records), including the
				  method and manner in which the insurer and administrator will meet those
				  requirements; and
(4) a provision
				  addressing an insurer's obligation to review and audit the performance of its
				  administrators under §
											7.1611
				  of this subchapter (relating to Operational Review and On-Site Audit),
				  including the method and manner in which the insurer will meet those
				  requirements.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1614 - Prohibited Acts

Current through Reg. 49, No. 28; July 12, 2024
(a) An
				  administrator is prohibited from:
(1)
				  misrepresenting the terms or nature of an agreement with an insurer, HMO, plan
				  sponsor, or group;
(2) making
				  false, misleading, or incomplete comparisons to the agreements of other
				  administrators or persons in order to induce any person to enter into,
				  continue, or discontinue an agreement;
(3) accepting or rejecting risk, other than
				  under the authority of, and in accordance with, a written agreement with an
				  insurer, HMO, plan sponsor, or group;
(4) publishing or circulating any advertising
				  or informational material, benefit descriptions, certificates, booklets, or
				  brochures pertaining to business underwritten by an insurer, HMO, plan sponsor,
				  or group without advance written approval of the insurer, HMO, plan sponsor, or
				  group;
(5) pursuant to the Labor
				  Code §
											415.0036,
				  offering to pay, paying, soliciting, or receiving an improper inducement
				  relating to the delivery of benefits to an injured employee, if the
				  administrator performs administrative services on behalf of a person who is a
				  participant in the workers' compensation system of this state; and
(6) pursuant to the Labor Code §
											415.0036,
				  improperly attempting to influence the delivery of benefits to an injured
				  employee, including through the making of improper threats, if the
				  administrator performs administrative services on behalf of a person who is a
				  participant in the workers' compensation system of this state.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1615 - Transfer of Books and Records

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Unless otherwise approved by the commissioner, no later than 30 days from the
				  date of the termination of the relationship or written agreement between an
				  insurer, HMO, plan sponsor, or group and an administrator, the administrator
				  shall provide a complete and accurate original set or a complete and accurate
				  copy or image of the original set of the insurer's, HMO's, plan sponsor's, or
				  group's books and records:
(1) to a successor
				  administrator; or
(2) if there is
				  not a successor administrator or if the successor administrator is unknown at
				  the time of the required transfer, to the insurer, HMO, plan sponsor, or
				  group.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1616 - Hazardous or Injurious Operating Conditions

Current through Reg. 49, No. 28; July 12, 2024
(a) An applicant or administrator may be
				  considered to be operating or conducting business in a hazardous or injurious
				  manner if the administrator or applicant:
(1)
				  has failed to file financial statements, documents, records, or reports
				  required under the Insurance Code Chapter 4151 or this subchapter within the
				  time periods prescribed by the Insurance Code Chapter 4151, this subchapter, or
				  as requested by the department pursuant to law;
(2) has filed any false or misleading
				  financial information;
(3) is
				  unable to pay its obligations as they become due and payable;
(4) has not maintained records sufficient to
				  permit examiners to determine its financial condition or compliance with the
				  Insurance Code, the Labor Code, and rules adopted thereunder;
(5) does not employ management staff with the
				  experience, competence, or trustworthiness to conduct its operations in a safe
				  or sound manner;
(6) employs
				  management staff that has engaged in any unlawful activity;
(7) has not complied or is not complying with
				  the terms of a written agreement with an insurer, HMO, plan sponsor, or
				  group;
(8) has engaged or is
				  engaged in a pattern of failing to settle claims in accordance with
				  contractual, regulatory, or statutory requirements; or
(9) has engaged or is engaged in fraudulent
				  or dishonest practices or acts.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1617 - Examinations

Current through Reg. 49, No. 28; July 12, 2024
(a) As authorized by the Insurance Code
				  §
										4151.206(a)(2),
				  the commissioner adopts a fee of $500 to be paid by an administrator for an
				  examination under the Insurance Code §
										4151.201.
				  The fee is non-refundable.
(b)
				  Pursuant to the Insurance Code §
										4151.202,
				  prior to an examiner entering the property of an administrator, written notice
				  shall be given to the administrator. The written notice shall include the date
				  and estimated time the examiner will enter the property of the
				  administrator.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1618 - Severability

Current through Reg. 49, No. 28; July 12, 2024
If any section or portion of a section of this subchapter
					 is held to be invalid for any reason, all valid parts are severable from the
					 invalid parts and remain in effect. If any section or portion of a section is
					 held to be invalid in one or more of its applications, the part remains in
					 effect in all valid applications that are severable from the invalid
					 applications. To this end, all provisions of this subchapter (relating to
					 Administrators) are declared to be severable.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1801 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to provide orderly and
					 uniform procedures, as required by law and dictated by sound public policy, for
					 any authorized insurer or HMO filing a plan of withdrawal with the Commissioner
					 of Insurance under Insurance Code Chapter 827. Nothing in this subchapter
					 authorizes or allows an insurer or HMO to withdraw from any coverage if such
					 withdrawal would violate any federal or state law or any provisions contained
					 in a contract or evidence of coverage or a policy or certificate of insurance
					 itself.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1802 - 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) Annual
				  Statement--Annual statement most recently filed by the insurer or HMO with the
				  Texas Department of Insurance.
(2)
				  Association coverage--Coverage under a health benefit plan issued to an
				  association or bona fide association as those terms are defined in §
										21.2702 of
				  this title (relating to Association Plans).
(3) Commissioner--Commissioner of
				  Insurance.
(4) Department--Texas
				  Department of Insurance.
(5)
				  Individual coverage--Coverage issued by an HMO that provides an individual
				  health care plan as defined in Insurance Code §
										1271.004.
(6) Large employer coverage--Coverage under a
				  health benefit plan issued to a large employer as those terms are defined in
				  §
										26.4 of
				  this title (relating to Definitions).
(7) Line of insurance--Each line of business
				  as specified in §
										7.1803
				  of this title (relating to What Constitutes a Line of Insurance).
(8) HMO--A health maintenance organization
				  licensed under Insurance Code Chapter 843.
(9) Medicaid--The Medicaid program under
				  Title XIX of the Social Security Act of 1965.
(10) Medicare--Has the same meaning as
				  specified in §
										3.3303 of
				  this title (relating to Definitions).
(11) Medicare+Choice plan--Has the same
				  meaning as specified in §
										3.3303 of
				  this title.
(12) Small employer
				  coverage--Coverage under a health benefit plan issued to a small employer as
				  those terms are defined in §
										26.4 of
				  this title.
(13) Enrollees of
				  special circumstances--As described in Insurance Code §§
										1301.152
				  -
				  1301.154
				  and § 843.362.
(14) CHIP--The
				  Texas Children's Health Insurance Program under Texas Health and Safety Code
				  Chapter 62.
(15) Withdrawal--The
				  event that occurs when the actions of an insurer or HMO meets the criteria
				  under Insurance Code §
										827.003.
(16) Rating territory--A county in
				  Texas.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1803 - What Constitutes a Line of Insurance

Current through Reg. 49, No. 28; July 12, 2024
(a) For purposes of this subchapter, a line
				  of insurance is defined as each line of business as specified in paragraphs
				  (1)(A)-(P), (2)(A)-(PP), and (3)(A)-(K) of this subsection, and including any
				  line written in by the insurer or HMO on the annual statement pages specified
				  in this section, for which financial data was reported by the individual
				  withdrawing insurer or HMO filing any of the annual statement pages specified
				  in this section, or any duly promulgated equivalent pages, of the annual
				  statement forms specified in this section, or any duly promulgated equivalent
				  forms, and including any line of business that is duly promulgated to be added
				  to the annual statement pages specified in this section or to any duly
				  promulgated equivalent page.
(1) For an
				  insurer that is required to file the Life and Accident and Health Annual
				  Statement, Texas State Page 21, Reporting Direct Business in the State of Texas
				  During the Year, or the Health Statement, Exhibit of Premiums, Enrollment and
				  Utilization, reporting direct business in the State of Texas (page 34 of the
				  Health Statement), in addition to any line of insurance written in by the
				  insurer, each of the following is a line of insurance:
(A) ordinary life;
(B) group and individual credit
				  life;
(C) group life;
(D) industrial life;
(E) ordinary annuity;
(F) group annuity;
(G) ordinary annuity and other fund
				  deposits;
(H) group annuity and
				  other fund deposits;
(I) small
				  employer coverage;
(J) group and
				  individual credit accident and health;
(K) individual accident and health coverage
				  including collectively renewable accident and health, noncancellable accident
				  and health, guaranteed renewable accident and health, non-renewable for stated
				  reasons only accident and health, and other accident only;
(L) group accident and health other than
				  association, large employer or small employer coverage;
(M) Medicare+Choice plan;
(N) CHIP coverage;
(O) association coverage; or
(P) large employer coverage.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1804 - When a Withdrawal Plan is Required

Current through Reg. 49, No. 28; July 12, 2024
(a) Any
				  authorized insurer or HMO must file with the Commissioner of Insurance a plan
				  of orderly withdrawal before the insurer or HMO undertakes a withdrawal.
(1) The insurer or HMO undertakes a
				  withdrawal when it takes any action on its own initiative that will result in
				  the insurer or HMO meeting the criteria under Insurance Code §
											827.003.
(2) An insurer or HMO will not be held to
				  have acted on its own initiative in effecting a withdrawal when it acts under a
				  Commissioner disciplinary or administrative directive or order, or when the
				  insurer or HMO acts under a directive of a supervisor, conservator, or
				  receiver. If an out-of-state directive or order is not provided to the
				  Commissioner within 30 days of the issuance of such directive or order, the
				  insurer or HMO will be held to have acted on its own
				  initiative.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1806 - Withdrawal Plan Submission and Approval Procedures

Current through Reg. 49, No. 28; July 12, 2024
(a) The department will post forms and
				  instructions on its website to assist persons in complying with the
				  requirements of this subchapter. Any insurer or HMO filing a plan of orderly
				  withdrawal must submit the plan at the location specified on the department
				  website.
(b) The withdrawal plan
				  will be deemed approved if the Commissioner has not held a hearing within 60
				  days after the complete plan is filed or has not been denied approval within 60
				  days after the hearing.
(c) No plan
				  will be considered "filed" until such date as the withdrawing insurer or HMO
				  has provided to the Commissioner all information and material necessary to
				  constitute a completed plan of orderly withdrawal, as required under this
				  subchapter.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1807 - Filing of Annual Financial Statement and Other Required Data and Information

Current through Reg. 49, No. 28; July 12, 2024
Any insurer or HMO filing a withdrawal plan must continue
					 to file all annual financial statement data, other required statistical and
					 data filings, other reporting, and any other department-requested information
					 applicable to any withdrawn line until all policyholder obligations for such
					 line in this state are fulfilled. This section does not exempt an insurer or
					 HMO from any filings or information requests required by the
					 department.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1808 - Requirements to Resume Writing Insurance

Current through Reg. 49, No. 28; July 12, 2024
Any insurer or HMO withdrawing from writing all premium in
					 all lines of insurance in this state and required to file a plan of orderly
					 withdrawal under Insurance Code Chapter 827, may not resume writing the
					 withdrawn lines in this state before the fifth anniversary of the date of the
					 withdrawal without complying with all applicable statutory and regulatory
					 provisions governing authorization to write such lines of insurance in this
					 state and receiving the written approval of the Commissioner to resume such
					 writing. The five-year ban under Insurance Code §
										827.006,
					 for the resumption of writing insurance after a withdrawal, takes effect the
					 later of the date the insurer or HMO intends to begin its withdrawal as stated
					 in the plan approved by the Commissioner or discovery by the department of the
					 insurer's or HMO's failure to file a withdrawal plan.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter R - WITHDRAWAL PLAN REQUIREMENTS AND PROCEDURES › Section 7.1809 - Restriction Plan Contents and Submission Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) An insurer that meets the criteria under
				  Insurance Code §
										827.008 must
				  file a proposed restriction plan with the Commissioner for review and approval.
(b) The plan must be signed by at
				  least one officer of the insurer and must contain the following:
(1) identification, in accordance with the
				  line of insurance designations in §
											7.1803
				  of this title (relating to What Constitutes a Line of Insurance), as applicable
				  to personal automobile or residential property insurance being
				  restricted;
(2) the dates the
				  insurer intends to begin and complete its restriction;
(3) an explanation of the reasons for
				  restricting the writing of new business;
(4) a list of the affected rating
				  territories; and
(5) information on
				  Texas business, including any information necessary to assist the Commissioner
				  in determining how market availability of the line of business proposed to be
				  restricted may be affected including, but not limited to, the following:
(A) a description of how restricting writing
				  new business in a rating territory may affect other related residential
				  property or personal automobile insurance lines of business written by the
				  insurer, such as the potential effect of discounts no longer provided to
				  insureds;
(B) a list of any other
				  products within the line the insurer will continue to offer in Texas;
				  and
(C) any other information
				  related to the restriction plan that the Commissioner deems
				  necessary.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1901 - Scope and Applicability

Current through Reg. 49, No. 28; July 12, 2024
(a) These
				  sections apply to any multiple-employer welfare arrangement which is subject to
				  provisions of the Insurance Code, Chapter 3, Subchapter I, concerning the
				  licensing and regulation of such arrangements.
(b) These sections do not apply to any
				  arrangement or plan that is established or maintained under or pursuant to one
				  or more agreements which the United States Secretary of Labor finds to be a
				  collective bargaining agreement, or to any arrangement or plan that is
				  established or maintained by a rural electric cooperative or a rural telephone
				  cooperative association, as those terms are defined in the Employee Retirement
				  Income Security Act of 1974 (29 United States Code
				  §1002(40)).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1902 - 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) Business
				  plan--The comprehensive, detailed plan by which the multiple-employer welfare
				  arrangement conducts or proposes to conduct its business.
(2) Employee welfare benefit plan--Any plan,
				  fund, or program established or maintained by an employer or employers as
				  members of an association or group of five or more businesses in the same trade
				  or industry, to the extent that such plan, fund, or program is established or
				  maintained for the purpose of providing for its participants or their
				  beneficiaries those benefits which are permitted under the Insurance Code,
				  Article 3.95-4. Such plan must, at a minimum, clearly set out the rights,
				  privileges, duties, and obligations of employers, employees, and beneficiaries
				  with respect to the multiple-employer welfare arrangement. The plan must
				  clearly set forth benefits intended to be provided under the plan, persons to
				  whom the benefits are intended to be provided, the source of funding for such
				  intended benefits, and a clear and complete procedure for the application for,
				  and collection of, such benefits by beneficiaries of the plan.
(3) Multiple-employer welfare arrangement--An
				  employee welfare benefit plan, or any other arrangement which is established or
				  maintained for the purpose of offering or providing any benefit described in
				  the Insurance Code, Article 3.95-4, and restated in §
										7.1908 of
				  this title (relating to Benefits Allowed To Be Provided by Multiple-Employer
				  Welfare Arrangements) to the employees of two or more employers (including one
				  or more self-employed individuals), or to their beneficiaries, provided that
				  the arrangement describes an entity which meets either or both of the following
				  criteria:
(A) one or more of the employer
				  members in the multiple-employer welfare arrangement is either domiciled in
				  this state or has its principal headquarters or principal administrative office
				  in this state; or
(B) the
				  multiple-employer welfare arrangement solicits an employer that is domiciled in
				  this state or has its principal headquarters or principal administrative office
				  in this state.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1903 - Forms and Documentation Required To Be Filed To Obtain an Initial Certificate of Authority as a Multiple-Employer Welfare Arrangement

Current through Reg. 49, No. 28; July 12, 2024
The Texas Department of Insurance adopts by reference
					 standard forms for use in the administrative regulation of multiple-employer
					 welfare arrangements. Applicants and licensed multiple-employer welfare
					 arrangements are required to utilize these forms in preparing applications,
					 statements, notices of required information, and other submissions required
					 under the Insurance Code, Articles 3.95-1-3.95-15, and this subchapter. These
					 forms are published by the Texas Department of Insurance and may be obtained
					 from the Insurer Services Section, Mail Code 305-2C, Texas Department of
					 Insurance, 333 Guadalupe, Austin, Texas 78701. These forms are more
					 specifically identified as follows:
(1) Form Number 1, Name
				  Application;
(2) Form A-120M--MEWA,
				  Application for Initial Certificate of Authority;
(3) Form A-120--MEWA, Application for
				  Permanent Certificate of Authority;
(4) Form Number 2--MEWA, Application to do
				  Business as a Multiple Employer Welfare Arrangement;
(5) Officers, Directors or Trustees
				  Page;
(6) Biographical
				  Affidavit;
(7) Form MEWA--SOP
				  (Service of Process).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1904 - Application for Initial Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) Entities which must file applications
				  under this subchapter are set out in paragraphs (1) and (2) of this subsection.
(1) Any person wishing to establish a
				  multiple-employer welfare arrangement which is not fully insured, as that term
				  is defined in the Insurance Code, Article 3.95-1(4), must apply for and obtain
				  a license after September 1, 1993.
(2) To avoid prosecution for engaging in the
				  unauthorized business of insurance, a multiple-employer welfare arrangement
				  which is not fully insured, as that term is defined in the Insurance Code,
				  Article 3.95-1(4), and which was in existence on June 1, 1993, and which has
				  continued after that date to provide any of the services regulated by Insurance
				  Code, Chapter 3, Subchapter I, shall complete its application for initial
				  certificate of authority by June 1, 1994, and timely file an application for
				  final certificate of authority.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1906 - Application for Final Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) A multiple-employer welfare arrangement
				  which has received its initial certificate of authority must apply for a final
				  certificate of authority no later than one year after the issuance of its
				  initial certificate of authority. The multiple-employer welfare arrangement
				  shall file an application on the prescribed form and furnish such information
				  as may be required by the commissioner. The application shall include only
				  those items described in paragraphs (1)-(4) of this subsection, as follow:
(1) the names and addresses of:
(A) the association or group of employers
				  sponsoring the multiple-employer welfare arrangement;
(B) the members of the board of trustees or
				  directors, as applicable, of the multiple-employer welfare
				  arrangement;
(C) at least five
				  employers, if the arrangement is not an association, which information shall be
				  retained by the commissioner as confidential;
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1907 - Denial of Final Certificate of Authority and Extension of Initial Certificate of Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) If the
				  commissioner refuses to grant a final certificate of authority to an applicant
				  that fails to meet the requirements of §
										7.1906
				  of this title (relating to Application for Final Certificate of Authority),
				  notice of refusal shall be in writing. Such notice shall set forth the basis
				  for the refusal, and shall also constitute 30 days' advance notice of
				  revocation of the initial certificate of authority.
(b) The initial certificate of authority may
				  be extended for up to one year at the discretion of the commissioner on a
				  determination that the multiple-employer welfare arrangement is likely to meet
				  the requirements of this subchapter within one year. No more than one extension
				  of the initial certificate of authority shall be granted, regardless of the
				  length of time for which an extension was granted.
(c) If the applicant submits a written
				  request for hearing within 30 days after mailing of the notice of refusal,
				  revocation of the initial certificate of authority shall be temporarily stayed.
				  The commissioner shall promptly conduct a hearing in which the applicant shall
				  be given an opportunity to show compliance with the requirements of this
				  subchapter.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1908 - Required Filing Fees

Current through Reg. 49, No. 28; July 12, 2024
The commissioner shall collect, and the applicant affected
					 shall pay to the commissioner, the following fees:
(1) filing fee for filing an application for
				  the initial certificate of authority--$5,000;
(2) filing fee for final certificate of
				  authority--$1,500;
(3) filing fee
				  for appointment of commissioner of insurance as the attorney for service of
				  process--$50; and
(4) annual filing
				  fee for filing audited financial statement and actuarial
				  opinion--$500.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1909 - Benefits Allowed to Be Provided by Multiple-Employer Welfare Arrangements

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  multiple-employer welfare arrangement licensed pursuant to the provisions of
				  Insurance Code Chapter 846, and these sections will be limited to providing any
				  one or more of the benefits described in paragraphs (1) - (3) of this
				  subsection, as follows:
(1) medical, dental,
				  optical, surgical, or hospital care;
(2) benefits in the event of sickness,
				  accident, disability, or death; and
(3) any other benefit authorized for health
				  insurers in this state
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter S - MULTIPLE-EMPLOYER WELFARE ARRANGEMENTS REQUIREMENTS FOR OBTAINING AND MAINTAINING CERTIFICATE OF AUTHORIZATION › Section 7.1910 - Required Notice to Participants

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  multiple-employer welfare arrangement, in connection with an employee welfare
				  benefit plan, shall provide to each participating employee or former employee
				  covered by the plan the written notice containing, at a minimum, the items
				  described in paragraphs (1)-(5) of this subsection, at the time the coverage of
				  such participating employee or former employee becomes effective:
(1) that individuals covered by the plan are
				  only partially insured;
(2) that in
				  the event the plan or the multiple-employer welfare arrangement does not
				  ultimately pay medical expenses that are eligible for payment under the plan
				  for any reason, the participating employer or its participating employee
				  covered by the plan may be liable for those expenses;
(3) that, if applicable, the plan does not
				  participate in the guaranty fund; such disclosure being provided in the same
				  notice format required of insurers and health maintenance organizations in
				  §
											1.1001
				  of this title (relating to Disclosure of Guaranty Fund
				  Nonparticipation);
(4) the
				  toll-free telephone number for the complaints section of the Texas Department
				  of Insurance consumer services division; and
(5) that a copy of the summary plan
				  description may be obtained from the plan administrator, employer, or trustee,
				  as applicable.