Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 7 - CORPORATE AND FINANCIAL REGULATION › Subchapter P - ADMINISTRATORS › Section 7.1602 - 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) Administrator--As
				  defined in the Insurance Code §
										4151.001(1).
				  The term includes administrator contractors and administrator subcontractors.
				  The term does not include a person described by the Insurance Code §
										4151.002 or §
										4151.0021.
(2) Administrative services--Services offered
				  or performed by an administrator.
(3) Administrator contractor--An
				  administrator as defined in the Insurance Code §
										4151.001(1)
				  who contracts or enters into an agreement with an administrator subcontractor
				  for the performance of all or a portion of the administrative services the
				  administrator contractor previously agreed to perform on behalf of an insurer,
				  HMO, plan sponsor, or group. The term does not include a person described by
				  the Insurance Code §
										4151.002 or §
										4151.0021.
(4) Administrator subcontractor--An
				  administrator as defined in the Insurance Code §
										4151.001(1)
				  who contracts or enters into an agreement with an administrator contractor for
				  the performance of all or a portion of the administrative services the
				  administrator contractor previously agreed to perform on behalf of an insurer,
				  HMO, plan sponsor, or group. The term does not include a person described by
				  the Insurance Code §
										4151.002 or §
										4151.0021.
(5) Authorization--A license, permit,
				  certificate of authority, certificate of approval, certificate of registration,
				  or other authorization issued by the department or the division of workers'
				  compensation to engage in an activity regulated under the Insurance Code or the
				  Labor Code.
(6) Claim--A demand for
				  payment, services, or benefits under a plan.
(7) ERISA--The Employee Retirement Income
				  Security Act of 1974,
				  29 United States
				  Code §1001, et seq., including all
				  implementing federal regulations.
(8) Fiduciary bank account--An account used
				  to hold a premium.
(9) Generally
				  Accepted Accounting Principles--As defined in §
										7.85(a)(6)
				  of this chapter (relating to Audited Financial Reports).
(10) Generally Accepted Auditing
				  Standards--As defined in §
										7.85(a)(7)
				  of this chapter.
(11) Group--A
				  workers' compensation self-insurance group under the Labor Code Chapter
				  407A.
(12) Health maintenance
				  organization (HMO)--As defined in the Insurance Code §
										843.002(14).
(13) Independent Certified Public
				  Accountant--A person meeting the standards prescribed in the Insurance Code
				  §
										401.011(a)
				  and (d).
(14) Insurer--As defined in the Insurance
				  Code §
										4151.001(2).
(15) Master services agreement--A written
				  agreement between an administrator and an insurer that generally describes the
				  administrative services to be performed by the administrator on behalf of the
				  insurer but which also addresses additional or customized administrative
				  services to be provided by the administrator for certain specified clients of
				  the insurer.
(16) Person--As
				  defined in the Insurance Code §
										4151.001(3).
(17) Plan--A plan, fund, or program
				  established, adopted, or maintained by an insurer, HMO, plan sponsor, or group
				  to the extent that the plan, fund, or program is established, adopted, or
				  maintained to provide:
(A) indemnification or
				  expense reimbursement for any type of life, health, accident, or pharmacy
				  benefit, including health care benefits, health care services, or health
				  insurance;
(B) an individual or
				  group annuity benefit; or
(C)
				  workers' compensation benefits, including a medical benefit, an income benefit,
				  a death benefit, or a burial benefit.