reglab/statecodes huggingface dataset:
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 4 - CONDUCT OF APPROVED PEO › Section 13.544 - Marketing Materials; Offers of Enrollment

Current through Reg. 49, No. 28; July 12, 2024
(a) Marketing material. An approved PEO's
					 marketing material discussing the plan and trust must be fair and accurate, and
					 must not represent the plan or a prospective client's projected contributions
					 to be assessed for coverage under the plan in a way that is materially
					 inaccurate or misleading.
(b) Offer
					 of enrollment. An approved PEO must offer enrollment in the plan to the covered
					 employees of any client that agrees to meet the terms and conditions of the
					 PEO's professional employer services agreement and elects to enroll its covered
					 employees in the plan.
(c)
					 Guaranteed renewability. A PEO may not deny a client whose employees are
					 covered under the plan continued access to coverage under the terms of the
					 plan, other than:
(1) for nonpayment of
					 contributions;
(2) for fraud or
					 other intentional misrepresentation of material fact by the client;
(3) for noncompliance with material plan
					 provisions;
(4) because the plan is
					 ceasing to offer any coverage in a geographic area;
(5) in the case of a plan that offers
					 benefits through a network plan, there is no longer any individual enrolled
					 through the client who lives, resides, or works in the service area of the
					 network plan and the plan applies this paragraph uniformly without regard to
					 the claims experience of clients or any health status-related factor in
					 relation to such individuals or their dependents; or
(6) for failure to meet the terms of an
					 applicable collective bargaining agreement, to renew a collective bargaining or
					 other agreement requiring or authorizing contributions to the plan, or to
					 employ employees covered by such an agreement.
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 4 - CONDUCT OF APPROVED PEO › Section 13.545 - Representations to Clients and Participants

Current through Reg. 49, No. 28; July 12, 2024
(a) Pricing and billing. An approved PEO must
					 be fair and accurate in its pricing and billings with respect to the plan, and
					 may not make any materially inaccurate, knowingly or recklessly misleading, or
					 fraudulent misrepresentations of the projected contributions to be assessed for
					 plan coverage for a client's covered employees or participants.
(b) Notice of increased contribution. An
					 approved PEO may not increase a client's contribution amount without giving the
					 client at least 60 days' advance notice of the amount of the
					 increase.
(c) PEO solely
					 responsible if trust assets insufficient. An approved PEO's professional
					 employer services agreement must provide that the PEO, and not the client, will
					 be responsible for funding any additional asset amount needed to equal the
					 liabilities owed by the plan. An approved PEO may not contractually obligate
					 its clients to make up any shortfall in trust assets.
(d) Agreement in conflict with this
					 subchapter. An approved PEO's professional employer services agreement is
					 unenforceable to the extent that it conflicts with the requirements of this
					 subchapter.
(e) Summary plan
					 description. An approved PEO must provide each participant an evidence of
					 coverage and a summary plan description specific to the participant's plan. The
					 summary plan description must contain the following statement: "The benefits
					 and coverages described in this document are provided through a self-funded
					 health benefit plan and trust fund established and funded by your employers,
					 {insert the name of the covered employer and the approved PEO}. The plan and
					 trust are established in compliance with Chapter 91 of the Texas Labor Code and
					 the Employee Retirement Income Security Act of 1974,
					 29 U.S.C.
					 §§1001 -
					 1191c. This is not an
					 insurance contract, and you are not protected by an insurance guarantee fund or
					 other protective governmental program."
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.550 - Plan Formation

Current through Reg. 49, No. 28; July 12, 2024
(a) Establishing
					 the plan. A PEO applying for a certificate of approval must establish its plan
					 in compliance with the Employee Retirement Income Security Act of 1974,
					 29 U.S.C.
					 §1102, concerning Establishment of
					 Plan.
(b) Required plan provisions.
					 The plan:
(1) must be a nonprofit
					 entity;
(2) must hold all plan
					 assets in a trust as established under §
												13.551
					 of this title (relating to Trust Formation);
(3) must accept as participants the covered
					 employees or dependents of covered employees of every client that elects to
					 allow its covered employees to participate in the plan; and
(4) may not condition participation on a
					 client's claims history or its covered employees' health status-related
					 factors.
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.551 - Trust Formation

Current through Reg. 49, No. 28; July 12, 2024
(a) Establishing
					 the trust. A PEO applying for a certificate of approval must establish a trust
					 in compliance with both Texas Property Code Title 9, Subtitle B, concerning
					 Texas Trust Code: Creation, Operation, and Termination of Trusts; and the
					 Employee Retirement Income Security Act of 1974,
					 29 U.S.C.
					 §1103, concerning Establishment of
					 Trust, in which all funds used to administer and pay claims and expenses
					 arising from the plan must be held.
(b) Powers of the trust. Except as otherwise
					 provided in the trust document, the powers of the trust must be exercised by a
					 board of trustees elected to carry out the purposes established by the
					 organizational documents of the trust.
(c) Trust agreement. The trust agreement or
					 other document establishing the trust must:
(1) include the names of the persons creating
					 the trust and the names and signatures of each of the initial
					 trustees;
(2) state that all plan
					 assets will be kept continuously in a qualified financial
					 institution;
(3) outline the powers
					 and duties of the board of trustees;
(4) provide that board decisions must be made
					 by at least a simple majority;
(5)
					 give the trustees exclusive authority and discretion to manage and control plan
					 assets;
(6) provide that the
					 trustees will not be subject to the direction of a named fiduciary;
					 and
(7) provide that plan assets
					 will never inure to the benefit of any employer and will be held for the
					 exclusive purposes of providing benefits to plan participants and defraying
					 reasonable expenses of administering the plan.
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.552 - Required Filings

Current through Reg. 49, No. 28; July 12, 2024
(a) Plan amendment.
					 An approved PEO must file each plan amendment with the Life and Health Lines
					 Office of TDI for prior approval by the commissioner. An amendment will not be
					 effective until approved by the commissioner. The approved PEO's filing must
					 include a statement by the approved PEO certifying that, to the best of the
					 signer's knowledge and belief, in adopting the plan amendment, the approved PEO
					 and the plan will remain in compliance with this subchapter and all applicable
					 provisions of the Employee Retirement Income Security Act of 1974 (ERISA),
					 29 U.S.C.
					 §§1001 -
					 1191c.
(b) Trust amendment. An approved PEO must
					 file each amendment to the trust agreement or any other organizational document
					 of the trust with the Company Licensing and Registration Office of TDI for
					 prior approval by the commissioner. An amendment will not be effective until
					 approved by the commissioner. The approved PEO's filing must include a
					 statement by the plan's trustees certifying that, to the best of the trustees'
					 knowledge and belief, in adopting the trust amendment the plan and the trust
					 will remain in compliance with this subchapter and all applicable provisions of
					 ERISA,
					 29 U.S.C.
					 §§1001 -
					 1191c.
(c) Transactions between parties. Agreements
					 and transactions between or among the approved PEO, an affiliate, and the trust
					 are subject to Insurance Code Chapter 823, Subchapters B and C, including the
					 filing requirements of these subchapters. For the purposes of this subchapter,
					 an affiliate and a trust are each considered members of an insurance holding
					 company system as described in Insurance Code §
											823.006,
					 concerning Description of Insurance Holding Company System.
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.553 - Plan and Trust Governance and Operation

Current through Reg. 49, No. 28; July 12, 2024
(a) Fiduciary duty. A fiduciary must
					 discharge his or her duties with respect to a plan solely in the interest of
					 the participants, and:
(1) for the exclusive
					 purposes of:
(A) providing benefits to
					 participants; and
(B) defraying
					 reasonable expenses of administering the plan;
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.554 - Board of Trustees

Current through Reg. 49, No. 28; July 12, 2024
(a) Appointment. An
					 approved PEO may appoint members of the board of trustees.
(b) Number of members. The board of trustees
					 must have no fewer than three members.
(c) Ineligible individuals. An owner,
					 officer, or employee of a third party administrator or contracted regulated
					 entity that provides services to the approved PEO, or any other person that has
					 received compensation from the plan or trust may not serve as a board
					 member.
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.555 - Trustees' Responsibility and Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) Responsible for operations and assets.
					 Members of the board of trustees are responsible for all operations of the
					 trust and must take all necessary precautions to safeguard plan
					 assets.
(b) Contract for plan
					 administration. Within 12 months of the establishment of the initial board of
					 trustees, the board of trustees must contract with a third party administrator
					 to perform the day-to-day operations of the plan.
(c) Insure payment of claims. Within 12
					 months of the establishment of the initial board of trustees, the board of
					 trustees, or an approved PEO acting as their agent, will contract for, and pay
					 for with plan assets, a stop-loss insurance agreement in the name of and for
					 the benefit of the plan and trust that complies with the requirements of §
											13.567 of
					 this title (relating to Stop-Loss Insurance) to insure payment of all claims
					 arising under the terms of the plan.
(d) Appointment of agents. The trustees may
					 appoint agents for the trust as necessary to meet the obligations of the plan
					 and trust. Each agent may only exercise the authority and perform the duties
					 required in the management of the trust and the affairs of the plan that is
					 delegated to them by the board of trustees.
(e) Service without compensation. A member of
					 the board of trustees serves without compensation except for actual and
					 necessary expenses.
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.556 - Protection of Plan and Trust Assets

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Trustees' fidelity coverage. The board of trustees must maintain a fidelity
					 bond or a zero-deductible crime policy that complies with the requirements of
					 §
											13.568
					 of this title (relating to Standards for Fidelity Coverage). The fidelity bond
					 or zero-deductible crime policy must cover each person responsible for handling
					 or administering plan assets, including the board of trustees, the approved
					 PEO, its directors, officers, agents and employees, or any other individual
					 responsible for servicing the plan.
(b) Errors and omissions insurance. The board
					 of trustees must purchase an errors and omissions policy in the amount of
					 $500,000 to cover the performance of their duties to the plan and trust. The
					 policy must be purchased from a company that satisfies the requirements of
					 §
											13.568(a)(2)
					 of this title.
(c) Ensuring
					 existence of PEO's fidelity coverage. The trustees must annually require that
					 the approved PEO provide them with documentation that it has maintained and is
					 maintaining in effect fidelity coverage that complies with §
											13.542 of
					 this title (relating to PEO's Fidelity Coverage).
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 5 - FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST › Section 13.557 - Disputes Arising Under the Plan or Trust

Current through Reg. 49, No. 28; July 12, 2024
Benefit claims or other disputes arising under an
						approved PEO's plan are subject to the Insurance Code, including utilization
						review and independent review under Insurance Code Title 14, concerning
						Utilization Review and Independent Review, and to resolution under state law in
						the same manner as are benefit claims or disputes arising under a large
						employer health benefit plan issued under Insurance Code Chapter 1501,
						concerning the Health Insurance Portability and Availability Act, to the extent
						not inconsistent with the Employee Retirement Income Security Act of 1974
						(ERISA) as provided in ERISA,
						29
						U.S.C. §1144.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.560 - Annual and Quarterly Reserves

Current through Reg. 49, No. 28; July 12, 2024
The financial statements filed by an approved PEO under
						§
											13.570
						of this title (relating to Financial Filing Requirements) must report the
						trust's reserves as described below:
(1) the trust's year-end reserves must be
					 calculated as the difference between the trust's total claim distributions and
					 the aggregate limit attachment point of its stop-loss insurance agreement for
					 each plan year;
(2) the total claim
					 distributions number used in paragraph (1) of this section must be the amount
					 of paid claims reduced by any amount either received or recoverable by the
					 trust associated with the specific attachment point included in its stop-loss
					 insurance agreement;
(3) the
					 trust's quarterly reserves must equal the total amount of its known unpaid
					 claims as the end of the respective calendar quarter; and
(4) the known unpaid claims number used in
					 paragraph (3) of this section is the amount of reserve established for a claim
					 when it is received, reduced by any amount recoverable by the trust associated
					 with the specific attachment point included in its stop-loss insurance
					 agreement.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.561 - Authorized Investments

Current through Reg. 49, No. 28; July 12, 2024
The trust must invest its assets in compliance with
						Insurance Code Chapter 425, Subchapter C, concerning Authorized Investments and
						Transactions for Capital Stock, Life, Health, and Accident
						Insurers.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.562 - Deposit or Letter of Credit Required

Current through Reg. 49, No. 28; July 12, 2024
(a) Initial deposit or letter of credit.
					 Before receiving a certificate of approval, a PEO applying for a certificate of
					 approval must establish a deposit of at least 25 percent of the attachment
					 point of the aggregate limit included in the plan's stop-loss insurance
					 agreement or establish a letter of credit for that amount.
(b) Proof of deposit. The commissioner adopts
					 by reference both Statutory Deposit Transaction Form, Form No. FIN407
					 (rev.1115), and Declaration of Trust Form, Form No. FIN453 (rev.1115). Both
					 forms are available on TDI's website. An applicant must give proof of its
					 deposit on both TDI's Statutory Deposit Transaction Form and TDI's Declaration
					 of Trust Form.
(c) Continuing
					 deposit or letter of credit. An approved PEO sponsoring a plan must maintain a
					 deposit or letter of credit of at least 25 percent of the attachment point of
					 the aggregate limit included in the plan's stop-loss insurance
					 agreement.
(d) Deposit to be held
					 for TDI's control. Any deposit must be held for TDI's control and may not be
					 withdrawn or substituted without the commissioner's approval.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.563 - Form of Deposit

Current through Reg. 49, No. 28; July 12, 2024
A deposit must consist of funds in the form of:
(1) money of the United States including
					 certificates of deposit issued by a qualified financial institution, but the
					 amount of total deposits by the approved PEO in the qualified financial
					 institution may not exceed the greater of:
(A)
					 the limits of federal insurance coverage for the deposits; or
(B) ten percent of the issuing qualified
					 financial institution's net worth, provided that its net worth is in excess of
					 $25 million;
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.564 - Annual Recalculation; Changes to Deposit

Current through Reg. 49, No. 28; July 12, 2024
(a) Annual recalculation. An approved PEO
					 must recalculate its deposit required every year, not later than 60 days after
					 negotiating the plan's stop-loss insurance agreement for the current plan year,
					 using the formula stated in §
											13.562(b)
					 of this title (relating to Deposit or Letter of Credit Required).
(b) Changes to deposit.
(1) An approved PEO may request to change its
					 deposit by submitting both the Statutory Deposit Transaction Form, Form No.
					 FIN407 (rev.1115), and the Declaration of Trust Form, Form No. FIN453
					 (rev.1115), and must submit a safekeeping receipt showing that the securities
					 are pledged to TDI.
(2) If the
					 commissioner approves the release of any portion of a deposit, TDI's bond and
					 securities officer will execute a release of any pledge, and the funds will be
					 returned to the approved PEO.
(3)
					 An approved PEO that requests a release of any part of its deposit because the
					 deposit amount exceeds the amount calculated under §
												13.562(b)
					 of this title must provide supporting documentation that justifies the release,
					 including:
(A) the reasons for the release;
					 and
(B) evidence satisfactory to
					 the commissioner that its deposit exceeds the amount required in §
													13.562(b)
					 of this title.
(4) All
					 interest income due on its deposit funds may be paid directly to the approved
					 PEO by the bank.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.565 - Letter of Credit

Current through Reg. 49, No. 28; July 12, 2024
(a) Requirements.
					 Instead of a deposit, an approved PEO may maintain a letter of credit. A letter
					 of credit must comply with the following requirements:
(1) the letter of credit cannot be supported
					 or collateralized by a guaranty;
(2) the letter of credit and all amendments
					 to the letter of credit must be filed with TDI; and
(A) be clean, irrevocable, unconditional, and
					 issued by a qualified financial institution;
(B) contain an issue date;
(C) stipulate that the beneficiary is the
					 commissioner, that the commissioner need only draw a draft under the letter of
					 credit and present it to obtain funds, and that no other document need be
					 presented;
(D) show only one amount
					 on the letter of credit;
(E) state
					 that the letter of credit is not subject to any conditions or qualifications
					 outside of the letter of credit and must not contain reference to any other
					 agreements, documents, or entities;
(F) contain a statement to the effect that
					 the obligation of the qualified financial institution under the letter of
					 credit is in no way contingent on reimbursement; and
(G) state that the letter of credit is
					 subject to and governed by either the laws of this state or the laws of the
					 state in which the issuing qualified financial institution is domiciled, and
					 that all drafts drawn on the letter of credit will be presentable at any office
					 in the United States of the issuing qualified financial institution.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.566 - Annual Recalculation; Changes to Letter of Credit

Current through Reg. 49, No. 28; July 12, 2024
(a) Annual recalculation. An approved PEO
					 must recalculate the required amount of its letter of credit every year, not
					 later than 60 days after negotiating the plan's stop-loss insurance agreement
					 for the current plan year, using the formula stated in §
											13.562(b)
					 of this title (relating to Deposit or Letter of Credit Required).
(b) Changes to letter of credit.
(1) If a letter of credit is not renewed or
					 replaced, the commissioner must not be prevented from withdrawing the balance
					 of the letter of credit and placing that sum in trust to secure continuing
					 obligations until the commissioner has received a renewal letter of credit or
					 an acceptable substitute.
(2) If a
					 letter of credit is not renewed or replaced, or if it is suspended, the
					 approved PEO and the issuing qualified financial institution must give the
					 commissioner immediate notice of the nonrenewal, replacement, or
					 suspension.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.567 - Stop-Loss Insurance

Current through Reg. 49, No. 28; July 12, 2024
(a) Minimum
					 specific and aggregate coverage. The plan and trust must maintain specific and
					 aggregate stop-loss insurance that is not less than the recommended minimum
					 level included in the annual actuarial opinion required by §
											13.570(c)(2)
					 of this title (relating to Financial Filing Requirements).
(b) Terms of contract for stop-loss
					 insurance. The trustees, or an approved PEO acting on behalf of the trustees,
					 must contract for stop-loss insurance in the name of and for the benefit of the
					 plan and trust, as evidenced by a written commitment, binder, or policy for
					 stop-loss insurance issued by an unaffiliated insurer authorized to do business
					 in this state, which must include the following:
(1) no less than 30 days' notice to the
					 commissioner of any amendment, cancellation, or nonrenewal of
					 coverage;
(2) provide both specific
					 and aggregate coverage with an aggregate retention of no more than 125 percent
					 of the amount of expected claims for the subsequent plan year and the specific
					 retention amount as determined by the actuarial opinion required by §
												13.570(c)(2)
					 of this title;
(3) both the
					 specific and aggregate coverage must require all claims to be submitted within
					 90 days after the claim is reported; and
(4) a requirement that the stop-loss carrier
					 provide the trustees and the PEO any renewal quote at least 90 days before the
					 expiration of the current policy.
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 6 - FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS › Section 13.568 - Standards for Fidelity Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Fidelity bond or crime policy. A fidelity bond or crime policy required by any
					 section of this rule must be for an amount of at least $500,000. The
					 commissioner will consider information of all interested parties and determine
					 any amount required in excess of $500,000. The bond or policy must:
(1) obligate the surety to pay any loss of
					 money or other property the plan or trust sustains because of an act of fraud
					 or dishonesty by a person covered by the bond or policy, acting alone or in
					 concert with others; and
(2) be
					 issued by an unaffiliated insurer that holds a certificate of authority in this
					 state, and that is a corporate surety company that is an acceptable surety on
					 Federal bonds under authority granted by the Secretary of the Treasury under 31
					 U.S. Code Chapter 93. If the commissioner determines, after reviewing
					 information from the approved PEO or the plan and trust's board of trustees,
					 that a fidelity bond or a zero-deductible crime policy is not available from a
					 qualified unaffiliated insurer that holds a certificate of authority in this
					 state, the approved PEO or board of trustees may obtain a fidelity bond or a
					 zero-deductible crime policy from a surplus lines agent in this state in
					 compliance with Insurance Code Chapter 981, concerning Surplus Lines Insurance,
					 or from a corporate surety company which is an acceptable surety on Federal
					 bonds under authority granted by the Secretary of the Treasury under 31 U.S.
					 Code Chapter 93.
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 7 - QUARTERLY AND ANNUAL FILINGS; EXAMINATIONS; HAZARDOUS CONDITIONS › Section 13.570 - Financial Filing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Approved quarterly filing form. TDI adopts by reference PEO Quarterly Report,
					 Form No. FIN409 (rev. 1115). The form is available on TDI's website. An
					 approved PEO must submit its quarterly filings as described in subsection (c)
					 of this section on PEO Quarterly Report, Form No. FIN409, using generally
					 accepted accounting principles of the United States as modified by this
					 subchapter.
(b) Approved annual
					 filing form. TDI adopts by reference PEO Annual Report, Form No. FIN410 (rev.
					 1115). The form is available on TDI's website. An approved PEO must submit its
					 annual filings as described in subsection (d)(1) of this section on PEO Annual
					 Report, Form No. FIN410, using generally accepted accounting principles of the
					 United States as modified by this subchapter.
(c) Quarterly filings. An approved PEO must
					 file electronically with the commissioner within 45 days of the end of each
					 calendar quarter an unaudited quarterly financial statement of the plan and
					 trust, certified by an appropriate officer or agent of:
(1) the trustees; or
(2) the approved PEO.
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 7 - QUARTERLY AND ANNUAL FILINGS; EXAMINATIONS; HAZARDOUS CONDITIONS › Section 13.571 - Annual Fee

Current through Reg. 49, No. 28; July 12, 2024
With its annual filings an approved PEO must pay to TDI
						an annual statement filing fee of $500. This fee does not include the form
						filing fees required under §
											13.521
						of this title (relating to Applicable Insurance Code and Administrative Code
						Terms).
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 7 - QUARTERLY AND ANNUAL FILINGS; EXAMINATIONS; HAZARDOUS CONDITIONS › Section 13.572 - Examination of Approved PEO, Plan, and Trust

Current through Reg. 49, No. 28; July 12, 2024
The commissioner or any person appointed by the
						commissioner has the power to examine the affairs of the approved PEO and the
						plan and trust as set forth in Insurance Code Chapter 401, concerning Audits
						and Examinations and §
											7.83
						and §
											7.84 of
						this title (relating to Appeal of Examination Reports and Examination
						Frequency), as those provisions apply to domestic insurers licensed to transact
						the business of insurance in this state.
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 7 - QUARTERLY AND ANNUAL FILINGS; EXAMINATIONS; HAZARDOUS CONDITIONS › Section 13.573 - Hazardous Condition; Violations of Statute

Current through Reg. 49, No. 28; July 12, 2024
(a) Hazardous conditions. An approved PEO's
					 plan and trust are considered to be in hazardous condition if any of the
					 following conditions exist with respect to the plan and trust:
(1) assets to liability ratio less than
					 1:1;
(2) negative financial
					 position;
(3) negative net income
					 combined with negative retained earnings;
(4) negative cash flow;
(5) failing to maintain minimum
					 reserves;
(6) the trust failing to
					 receive all monthly contributions paid by clients to the approved
					 PEO;
(7) transfers of funds between
					 the trust and the approved PEO not authorized under the trust agreement;
					 or
(8) mismanagement by the third
					 party administrator, trustees, or approved PEO that endanger the solvency or
					 operations of the plan and trust.
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 8 - MARKET EXIT › Section 13.580 - Withdrawal from Market

Current through Reg. 49, No. 28; July 12, 2024
(a) Withdrawal
					 plan. An approved PEO that undertakes of its own initiative or is required by
					 §
											13.581
					 or §
											13.582
					 of this title (relating to Limitation, Suspension, or Cancellation of
					 Certificate of Approval in Response to TDLR Action and Limitation, Suspension,
					 or Cancellation of Certificate of Approval in Response to TDI Action) to
					 terminate its health benefit plan must file a withdrawal plan for review by the
					 commissioner prior to terminating the plan. The withdrawal plan must include:
(1) the approved PEO's reasons for the
					 withdrawal;
(2) a timeline for
					 withdrawal, including the date on which the approved PEO intends to complete
					 the withdrawal process;
(3) a copy
					 of the proposed notice to be sent to client employers and plan participants
					 giving them at least 180 days' notice of the plan's termination;
(4) the number and names of clients and the
					 number of plan participants affected by the proposed withdrawal;
(5) a procedure for handling plan
					 participants' claims for benefits;
(6) a procedure for identifying plan
					 participants with special circumstances, as defined in Insurance Code §
												1301.153,
					 concerning Continuity of Care;
(7)
					 provisions for meeting all contractual obligations of the approved
					 PEO;
(8) provisions for meeting any
					 applicable statutory obligations; and
(9) verification of reserves to complete a
					 solvent resolution of the plan's obligations.
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 8 - MARKET EXIT › Section 13.581 - Limitation, Suspension, or Cancellation of Certificate of Approval in Response to TDLR Action

Current through Reg. 49, No. 28; July 12, 2024
(a) Notice of TDLR
					 action against approved PEO's license. The commissioner will limit, suspend, or
					 cancel an approved PEO's certificate of approval in response to an action by
					 TDLR against the approved PEO's license.
(b) Notice of TDLR's contemplated action. An
					 approved PEO must notify the commissioner through TDI's licensing section
					 within 10 business days of first receiving notice that TDLR is contemplating
					 taking action against its license. The approved PEO's notice to the
					 commissioner must include a copy of TDLR's notice.
(c) Limitation or suspension of certificate
					 of approval. If the commissioner receives notice that TDLR is contemplating
					 taking action against an approved PEO's license, at the commissioner's
					 discretion the approved PEO's certificate of approval may be limited or
					 suspended. While an approved PEO's certificate of approval is suspended, the
					 approved PEO cannot contract with a new client to allow enrollment of new plan
					 participants. When the commissioner receives satisfactory notice that all
					 outstanding issues between TDLR and the approved PEO are resolved to TDLR's
					 satisfaction, TDI will remove the limitation or suspension of the approved
					 PEO's certificate of approval.
(d)
					 Notice of TDLR action terminating license. If TDLR revokes an approved PEO's
					 license, the approved PEO must terminate its health benefit plan in compliance
					 with §
											13.580 of
					 this title (relating to Withdrawal from Market). An approved PEO must notify
					 the commissioner through TDI's licensing section within 10 business days of
					 receiving notice that TDLR has revoked its license. The approved PEO's notice
					 to the commissioner must include:
(1) a copy
					 of TDLR's notice of termination; and
(2) confirmation that the approved PEO will
					 file its withdrawal plan within 30 days.
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 8 - MARKET EXIT › Section 13.582 - Limitation, Suspension, or Cancellation of Certificate of Approval in Response to TDI Action

Current through Reg. 49, No. 28; July 12, 2024
(a) Commissioner's
					 authority. Nothing in this section limits the commissioner's authority under
					 Insurance Code Chapters 404, Financial Condition; 406, Special Deposits
					 Required Under Potentially Hazardous Conditions; 441, Supervision and
					 Conservatorship; or 443, the Insurer Receivership Act.
(b) Limitation, suspension, or cancellation
					 of certificate. The commissioner will limit, suspend, or cancel an approved
					 PEO's certificate of approval if the commissioner finds that the approved PEO
					 or its plan or trust do not meet the requirements of applicable Insurance Code
					 provisions or this subchapter.
(c)
					 Notice of limitation; commissioner's hearing. The commissioner will issue a
					 written notice to an approved PEO stating the basis for a limitation under
					 subsection (b) of this section. If within 30 days of receiving a notice of
					 limitation the approved PEO submits a written request for review by the
					 commissioner, the commissioner will schedule a hearing under Insurance Code
					 Chapter 40, at which the approved PEO will be given an opportunity to show
					 compliance with this subchapter. Hearings described in this subchapter will be
					 conducted as required by Government Code Chapter 2001, concerning
					 Administrative Procedure; Insurance Code Chapter 40, concerning Duties of State
					 Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate
					 Setting Proceedings; TDI's and State Office of Administrative Hearing's rules
					 of procedure; and any other applicable law and regulations.
(d) Notice of suspension or cancellation. The
					 commissioner will issue a written notice of suspension or of intent to cancel
					 to an approved PEO stating the basis for the suspension or cancellation under
					 subsection (b) of this section.
(e)
					 Hearing request in contested case. An approved PEO may submit a written request
					 to the commissioner for a hearing at the State Office of Administrative
					 Hearings under Government Code Chapter 2001, Administrative Procedure, within
					 30 days of receiving notice that its certificate of approval:
(1) remains limited after a commissioner's
					 hearing under subsection (c) of this section,
(2) is suspended under subsection (d) of this
					 section, or
(3) will be canceled
					 under subsection (d) of this section.
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 8 - MARKET EXIT › Section 13.583 - Cancellation of Certificate of Approval

Current through Reg. 49, No. 28; July 12, 2024
(a) Plan termination. If the commissioner
					 determines that an approved PEO's certificate of approval should be canceled,
					 the approved PEO must terminate its health benefit plan in compliance with
					 §
											13.580 of
					 this title (relating to Withdrawal from Market). The approved PEO must file its
					 withdrawal plan within 30 days of receiving the commissioner's written notice
					 of suspension.
(b) Cancellation of
					 certificate of approval. When an approved PEO has fulfilled all requirements of
					 its approved withdrawal plan, the commissioner will cancel the approved PEO's
					 certificate of approval.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 15 - SURPLUS LINES INSURANCE › Subchapter A - GENERAL REGULATION OF SURPLUS LINES INSURANCE › Section 15.1 - Applicability

Current through Reg. 49, No. 28; July 12, 2024
(a) This chapter applies to all surplus lines
				  insurance transactions if Texas is the home state of the insured.
(b) Texas Department of Insurance rules
				  applicable to licensing, regulation, and supervision of surplus lines agents
				  and surplus lines insurers and transactions in effect before the effective date
				  of an applicable section in this chapter apply in the adjudication of acts and
				  transactions occurring before the effective date of the section.
(c) Section 15.114 of this title is
				  applicable beginning January 1, 2019.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 15 - SURPLUS LINES INSURANCE › Subchapter A - GENERAL REGULATION OF SURPLUS LINES INSURANCE › Section 15.2 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
(a) The definitions in Insurance Code §
										981.002 and §
										981.071 apply to this
				  chapter.
(b) The following words
				  and terms, when used in this chapter, have the following meanings, unless the
				  context clearly indicates otherwise:
(1)
				  Client--Any person to whom a surplus lines agent sells or attempts to sell a
				  surplus lines insurance policy, or from whom an application for surplus lines
				  insurance is accepted, or to whom advice and counsel on a surplus lines
				  insurance policy is given for the purpose of selling a surplus lines insurance
				  policy.
(2) Commissioner--The Texas
				  Commissioner of Insurance.
(3)
				  Comptroller--The office of the Texas Comptroller of Public Accounts.
(4) Person--An individual or entity as
				  defined by Insurance Code §
											541.002(2).
(5) Stamping Office--The Surplus Lines
				  Stamping Office of Texas created under Insurance Code Subchapter D, Chapter
				  981, and operating under a plan of operation as specified by § 15.201 of
				  this title. The organization is also commonly referred to as a service office
				  by peer offices throughout the country.
(6) State--Any state, district, commonwealth,
				  territory, and insular possession of the United States and any area subject to
				  the legislative authority of the United States of America.
(7) Surplus lines agent--A person, whether an
				  individual or entity, holding a surplus lines license issued by TDI under
				  Insurance Code Chapter 981.
(8)
				  TDI--Texas Department of Insurance.
(9) Timely filed--A transaction filed with
				  the stamping office that meets the requirements of Insurance Code §
											981.105(a).
(10) Untimely filed--A transaction filed with
				  the stamping office that does not meet the requirements of Insurance Code
				  §
											981.105(a).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 15 - SURPLUS LINES INSURANCE › Subchapter A - GENERAL REGULATION OF SURPLUS LINES INSURANCE › Section 15.3 - Regulation of Policies

Current through Reg. 49, No. 28; July 12, 2024
A surplus lines insurance policy is subject to Texas
					 regulation if the insured's home state is Texas. Under Insurance Code §
										981.002(5),
					 an insured's home state is the insured's:
(1) principal place of business, which is the
				  location from which the officers of an insured that is not an individual
				  direct, control, and coordinate the insured's activities; generally, the
				  insured's main headquarters; or
(2)
				  principal residence, which is the state where the insured who is an individual
				  resides for the greatest number of days during a calendar year.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 15 - SURPLUS LINES INSURANCE › Subchapter A - GENERAL REGULATION OF SURPLUS LINES INSURANCE › Section 15.4 - Sanctions

Current through Reg. 49, No. 28; July 12, 2024
(a) The Commissioner may impose any sanction
				  or remedy in Insurance Code Chapter 82 or any other applicable laws or statutes
				  if the Commissioner determines, after notice and an opportunity for hearing,
				  that the applicant or license holder individually or through any officer,
				  director, or shareholder:
(1) committed any
				  action that would form the basis for sanctioning a general property and
				  casualty agent or a managing general agent, as applicable to the surplus lines
				  agent's other licenses, under the Insurance Code;
(2) failed to allow TDI or the comptroller to
				  examine the surplus lines agent's accounts and records or failed to maintain
				  surplus lines insurance business accounts and records as required by the
				  Insurance Code and this chapter;
(3) failed to make and file all reports when
				  due, as required by the Insurance Code and this chapter;
(4) failed to properly collect and pay
				  required taxes and stamping fees on surplus lines gross premium or failed to
				  submit tax reports as required by law or regulation;
(5) failed to otherwise maintain the
				  qualifications for a surplus lines agent license; or
(6) is in violation of, or has failed to
				  comply with the Insurance Code, this chapter, or any other applicable laws or
				  regulations of this state.