reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter PP - OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION › Division 5 - EXPLANATION OF BENEFITS › Section 21.5040 - Required Explanation of Benefits and Enrollee Identification Card Information

Current through Reg. 49, No. 28; July 12, 2024
(a) General
					 requirements for explanation of benefits. A health benefit plan issuer or
					 administrator subject to Insurance Code §
											1271.008, concerning
					 Balance Billing Prohibition Notice; §1275.003, concerning Balance Billing
					 Prohibition Notice; §1301.010, concerning Balance Billing Prohibition
					 Notice; §1551.015, concerning Balance Billing Prohibition Notice;
					 §1575.009, concerning Balance Billing Prohibition Notice; or
					 §1579.009, concerning Balance Billing Prohibition Notice must provide
					 written notice in accordance with this section in an explanation of benefits in
					 connection with a health care or medical service or supply or transport
					 provided by a non-network provider or an out-of-network provider:
(1) to the enrollee and physician or
					 provider, which must include:
(A) a statement
					 of the billing prohibition, as applicable; and
(B) the total amount the physician or
					 provider may bill the enrollee under the health benefit plan and an itemization
					 of in-network copayments, coinsurance, deductibles, and other amounts included
					 in that total; and
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter PP - OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION › Division 6 - BENCHMARKING › Section 21.5050 - Submission of Information

Current through Reg. 49, No. 28; July 12, 2024
(a) Required
					 submission. A health benefit plan issuer or administrator must submit
					 information to the benchmarking database organization selected by the
					 Commissioner as required by this section.
(b) Information required. For each geozip in
					 Texas, a health benefit plan issuer or administrator must submit information
					 necessary for the benchmarking database organization to calculate a health care
					 or medical service or supply, as determined by the benchmarking database
					 organization, including:
(1) the 80th
					 percentile of billed charges of all physicians or health care providers who are
					 not facilities; and
(2) the 50th
					 percentile of rates paid to participating providers who are not facilities.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter PP - OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION › Division 7 - SUBMISSION REQUIREMENTS FOR ELECTION BY ERISA PLANS › Section 21.5060 - Election Submission Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A
					 plan sponsor of a self-insured or self-funded plan may elect to participate
					 under Insurance Code Chapter 1275, concerning Balance Billing Prohibitions and
					 Out-of-Network Claim Dispute Resolution for Certain Plans, by providing
					 identifying information to the Texas Department of Insurance as specified on
					 the department's website at
www.tdi.texas.gov
, including:
(1) the name and contact information of the
					 plan sponsor;
(2) the name and
					 contact information of the administrator of the health benefit plan, if
					 applicable;
(3) the health benefit
					 plan year start and end dates;
(4)
					 the requested effective date, which, except as provided in subsection (d) of
					 this section, must be the same as the start date of the relevant plan year and
					 at least 30 days after the date the identifying information is
					 submitted;
(5) the group number of
					 the health benefit plan; and
(6)
					 the number of enrollees covered under the health benefit plan.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter PP - OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION › Division 8 - EMERGENCY MEDICAL SERVICE RATE SUBMISSION AND PAYMENT REQUIREMENTS › Section 21.5070 - Rate Database for Emergency Medical Services Providers

Current through Reg. 49, No. 28; July 12, 2024
(a) Consistent with Insurance Code §
											38.006, concerning
					 Emergency Medical Services Provider Balance Billing Rate Database, this section
					 applies to:
(1) a political subdivision that
					 sets, controls, or regulates a rate charged for a health care service, supply,
					 or transport provided by an emergency medical services (EMS) provider, other
					 than an air ambulance; and
(2) an
					 EMS provider or its designee that provides a health care service, supply, or
					 transport on behalf of a political subdivision that sets, controls, or
					 regulates a rate.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter PP - OUT-OF-NETWORK CLAIM DISPUTE RESOLUTION › Division 8 - EMERGENCY MEDICAL SERVICE RATE SUBMISSION AND PAYMENT REQUIREMENTS › Section 21.5071 - Payments to Emergency Medical Services Providers

Current through Reg. 49, No. 28; July 12, 2024
(a) This section applies to a health benefit
					 plan issuer or administrator that is subject to one of the following statutes:
(1) Insurance Code §
												1271.159, concerning
					 Non-Network Emergency Medical Services Provider;
(2) Insurance Code §
												1275.054, concerning
					 Out-of-Network Emergency Medical Services Provider Payments;
(3) Insurance Code §
												1301.166, concerning
					 Out-of-Network Emergency Medical Services Provider;
(4) Insurance Code §
												1551.231, concerning
					 Out-of-Network Emergency Medical Services Provider Payments;
(5) Insurance Code §
												1575.174, concerning
					 Out-of-Network Emergency Medical Services Provider Payments; or
(6) Insurance Code §
												1579.112, concerning
					 Out-of-Network Emergency Medical Services Provider Payments.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter RR - STANDARD PROOF OF HEALTH INSURANCE FOR MEDICAL BENEFITS FOR INJURIES INCURRED AS A RESULT OF A MOTORCYCLE ACCIDENT › Section 21.5201 - Identification Cards - Health Coverage for Motorcycle Injuries

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
(1) This subchapter is applicable to an
				  individual, group, blanket, or franchise insurance policy, insurance agreement,
				  health maintenance organization evidence of coverage, group hospital services
				  contract, or employee benefit plan that provides benefits for health care
				  services or for medical or surgical expenses incurred as a result of an
				  accident while operating or riding on a motorcycle.
(2) This subchapter is not applicable to:
(A) credit-only coverage;
(B) disability coverage;
(C) specified disease coverage;
(D) long-term care coverage;
(E) dental or vision-only coverage;
(F) single-service health maintenance
				  organization coverage;
(G)
				  accidental death and dismemberment coverage;
(H) hospital indemnity coverage;
(I) workers' compensation coverage;
				  or
(J) medical payments or personal
				  injury protection coverage provided under an automobile policy.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 1 - GENERAL PROVISIONS › Section 21.5301 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to:
(1) address continuation requirements; and
(2) establish minimum standards
					 for conversion coverage.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 1 - GENERAL PROVISIONS › Section 21.5302 - 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) COBRA--Title X of the
					 Consolidated Omnibus Budget Reconciliation Act of 1985, as amended
					 (29 U.S.C. Part
					 6).
(2) COBRA continuation coverage--Coverage
					 that satisfies an applicable COBRA continuation provision.
(3) Carrier--
(A) An insurer or a group hospital service
					 corporation subject to Insurance Code Chapter 842 that issues policies
					 providing hospital, surgical, or major medical expense insurance coverage or
					 any combination of those coverages on an expense-incurred basis; and
(B) An HMO subject to Insurance Code Chapter
					 1271.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 2 - GROUP CONTINUATION PROVISIONS › Section 21.5310 - Mandatory Group Continuation Privilege

Current through Reg. 49, No. 28; July 12, 2024
(a)
					 Applicability.
(1) The provisions of this
					 section apply to:
(A) an insurer or a group
					 hospital service corporation subject to Insurance Code Chapter 842 that issues
					 policies providing hospital, surgical, or major medical expense insurance
					 coverage or any combination of those coverages on an expense-incurred
					 basis;
(B) an HMO subject to
					 Insurance Code Chapter 1271.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 2 - GROUP CONTINUATION PROVISIONS › Section 21.5312 - Continuation Election and Effective Dates

Current through Reg. 49, No. 28; July 12, 2024
(a) An employee, member, dependent, or
					 enrollee electing state continuation coverage under §
											21.5310
					 of this title must make a written election to the employer or group policy or
					 contract holder not later than the 60th day after the later of:
(1) the date of the termination of coverage
					 under the group policy or contract; or
(2) the date the person is given notice of
					 the right to continuation of group coverage.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 2 - GROUP CONTINUATION PROVISIONS › Section 21.5313 - Continuation Premium

Current through Reg. 49, No. 28; July 12, 2024
(a) Under Insurance
					 Code §
											1251.254
					 and §
											1271.303,
					 the premium for state continuation coverage elected under §
											21.5310
					 of this title must be the same premium charged for active employees, members,
					 dependents, or enrollees, including any amount contributed by the employer or
					 group policy or contract holder, plus 2 percent.
(b) The employee, member, dependent, or
					 enrollee electing state continuation coverage under §
											21.5312
					 of this title must pay the initial premium not later than the 45th day after
					 the date of the initial election for coverage.
(c) After the first payment following the
					 initial election for coverage under §
											21.5312
					 of this title, the employee, member, dependent, or enrollee must pay the
					 premium on the due date of each payment. However, a payment under this
					 subsection must be considered timely if made on or before the 30th day after
					 the date on which the payment is due.
(d) The premium for state continuation
					 coverage elected under Insurance Code Chapter 1251, Subchapter G, may not be
					 more than the premium charged under the group policy or contract for the person
					 had the family relationship not been severed, except as provided by Insurance
					 Code §
											1551.064.
					 Under Insurance Code §
											1251.306, the
					 group policyholder or contract holder may require the person to pay a monthly
					 fee of not more than $5 for administrative costs.
(e) A person covered under state continuation
					 coverage elected under Insurance Code Chapter 1251, Subchapter G, must pay the
					 premium for the coverage directly to the group policyholder or contract
					 holder.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 2 - GROUP CONTINUATION PROVISIONS › Section 21.5314 - Mandatory Group Continuation Provisions

Current through Reg. 49, No. 28; July 12, 2024
Each group accident and health policy, certificate,
						contract, and evidence of coverage required to provide state continuation
						coverage must contain provisions addressing the state continuation coverage
						options available to an employee, member, dependent, or
						enrollee.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 3 - GENERAL PROVISIONS › Section 21.5320 - Offer of Conversion

Current through Reg. 49, No. 28; July 12, 2024
(a) An insurer or
					 group hospital service corporation must offer to any employee, member, or
					 dependent whose insurance under a group policy has been terminated for any
					 reason (except involuntary termination for cause), including discontinuance of
					 the group policy in its entirety or with respect to any insured class, and who
					 has been continuously insured under the group policy (and under any policy
					 providing similar benefits which it replaces) for at least three consecutive
					 months immediately prior to termination:
(1)
					 a conversion policy providing the same coverage and benefits as provided under
					 the group policy or plan, for an insurance policy or evidence of coverage that
					 was delivered, issued for delivery, or renewed prior to June 1, 1996;
(2) a conversion policy providing
					 similar coverage and benefits as provided under the group policy or plan, for
					 an insurance policy or evidence of coverage that was delivered, issued for
					 delivery, or renewed on or after June 1, 1996, and before July 1, 1997.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 3 - GENERAL PROVISIONS › Section 21.5321 - Notice of Conversion Options

Current through Reg. 49, No. 28; July 12, 2024
(a) An
					 insurer or group hospital service corporation must provide notice of conversion
					 privileges, if any, available to each employee, member, or dependent whose
					 coverage is terminating, at least 30 days and no more than 60 days prior to
					 actual termination of coverage.
(b) An HMO must provide notice of conversion
					 privileges, if any, available to each enrollee whose COBRA or state
					 continuation period is expiring, at least 30 days and no more than 60 days
					 prior to the expiration of the COBRA or state continuation coverage
					 period.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 3 - GENERAL PROVISIONS › Section 21.5322 - Coverage for Children

Current through Reg. 49, No. 28; July 12, 2024
A conversion policy or contract must provide for the
						addition of newborn children, adopted children, and children for whom a court
						or administrative order has mandated coverage. The policy or contract may
						provide that coverage terminates when the converted person's coverage
						terminates.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter TT - ALL-PAYOR CLAIMS DATABASE › Section 21.5403 - Texas APCD Common Data Layout and Submission Guide

Current through Reg. 49, No. 28; July 12, 2024
(a) Payors must submit complete and accurate
				  data files for all applicable plans as required by this subchapter and
				  consistent with the Texas APCD CDL v1.09, released May 20, 2022. The Texas APCD
				  CDL is available on the Center's website and:
(1) is modeled on the "All-Payer Claims
				  Database Common Data Layout" published by the National Association of Health
				  Data Organizations and used with permission;
(2) identifies which data elements payors are
				  required to submit in each data file and which data elements are optional,
				  consistent with Insurance Code §
											38.404(c),
				  concerning Establishment and Administration of Database; and
(3) identifies the record specifications,
				  definitions, code tables, and threshold levels for each required data
				  element.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter TT - ALL-PAYOR CLAIMS DATABASE › Section 21.5404 - Data Submission Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Payors must submit the data files required by subsection (c) of this section to
				  the Center according to the schedule provided in § 21.5405 of this title
				  (relating to Timing and Frequency of Data Submissions). Payors are responsible
				  for submitting or arranging to submit all applicable data under this
				  subchapter, including data with respect to benefits that are administered or
				  adjudicated by another contracted or delegated entity, such as carved-out
				  behavioral health benefits or pharmacy benefits administered by a pharmacy
				  benefit manager. Payors may arrange for a third-party administrator or
				  delegated or contracted entity to submit data on behalf of the payor, but may
				  not submit data that duplicates data submitted by a third party.
(1) The Texas Health and Human Services
				  Commission may submit data on behalf of all applicable payors participating in
				  a plan or program identified in §21.5401(b)(17) - (b)(20) of this title
				  (relating to Applicability).
(2) A
				  payor that acts as an administrator on behalf of a health benefit plan or
				  dental plan for which reporting is optional per Insurance Code § 38.407,
				  concerning Certain Entities Not Required to Submit Data, may ask the plan
				  sponsor whether it elects or declines to participate in or submit data to the
				  Center and may include data for such plans within the payor's data submission.
				  Both the inquiry to and response from the plan sponsor should be in
				  writing.
(3) A payor providing
				  Medicare Supplement benefit plans may elect to submit Medicare Supplement
				  benefit plan data to the Center.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter TT - ALL-PAYOR CLAIMS DATABASE › Section 21.5405 - Timing and Frequency of Data Submissions

Current through Reg. 49, No. 28; July 12, 2024
(a) Payors must submit monthly data files
				  according to the following schedule:
(1)
				  January data must be submitted no later than May 7 of that year;
(2) February data must be submitted no later
				  than June 7 of that year;
(3) March
				  data must be submitted no later than July 7 of that year;
(4) April data must be submitted no later
				  than August 7 of that year;
(5) May
				  data must be submitted no later than September 7 of that year;
(6) June data must be submitted no later than
				  October 7 of that year;
(7) July
				  data must be submitted no later than November 7 of that year;
(8) August data must be submitted no later
				  than December 7 of that year;
(9)
				  September data must be submitted no later than January 7 of the following
				  year;
(10) October data must be
				  submitted no later than February 7 of the following year;
(11) November data must be submitted no later
				  than March 7 of the following year; and
(12) December data must be submitted no later
				  than April 7 of the following year;
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter TT - ALL-PAYOR CLAIMS DATABASE › Section 21.5406 - Stakeholder Advisory Group Terms

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Except as provided by subsections (b) and (c) of this section, members of the
				  stakeholder advisory group designated under Insurance Code §
										38.403(b)(2) -
				  (4), concerning Stakeholder Advisory Group,
				  serve fixed terms of three years.
(b) Initial terms of the stakeholder advisory
				  group will end December 31, 2024.
(c) Subsequent designations of the
				  stakeholder advisory group will begin January 1, 2025, and will be staggered as
				  follows:
(1) two members representing the
				  business community, as provided by Insurance Code §
											38.403(b)(4)(A),
				  and two members representing consumers, as provided by Insurance Code §
											38.403(b)(4)(B),
				  with terms to expire December 31, 2026;
(2) the member designated by the Teacher
				  Retirement System of Texas; two members representing hospitals, as provided by
				  Insurance Code §
											38.403(b)(4)(C);
				  and two members representing health benefit plan issuers, as provided by
				  Insurance Code §
											38.403(b)(4)(D),
				  with terms to expire December 31, 2027; and
(3) the member designated by the Employees
				  Retirement System; two members representing physicians, as provided by
				  Insurance Code §
											38.403(b)(4)(E);
				  and two members not professionally involved in the purchase, provision,
				  administration, or review of health care services, supplies, or devices, or
				  health benefit plans, as provided by Insurance Code §
											38.403(b)(4)(F),
				  with terms to expire December 31, 2028.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter UU - MACHINE-READABLE FILES › Section 21.5501 - Applicability and Effective Date

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Except as provided in subsections (b) and (c) of this section, this subchapter
				  applies to issuers of health benefit plans as specified in Insurance Code
				  § 1662.003, concerning Applicability of Chapter, that provide major
				  medical coverage for which federal reporting requirements under 26 C.F.R. Part
				  54 , concerning Pension Excise Taxes; 29 C.F.R. Part 2590 , concerning Rules
				  and Regulations for Group Health Plans; 45 C.F.R. Part 147 , concerning Health
				  Insurance Reform Requirements for the Group and Individual Health Insurance
				  Markets; and 45 C.F.R. Part 158 , concerning Issuer Use of Premium Revenue:
				  Reporting and Rebate Requirements, do not apply, including:
(1) issuers providing short-term
				  limited-duration insurance, as defined in Insurance Code Chapter 1509,
				  concerning Short-Term Limited-Duration Insurance;
(2) issuers providing grandfathered health
				  plan coverage, as defined in
				  45 C.F.R.
				  §
												147.140, concerning Preservation of
				  Right to Maintain Existing Coverage; and
(3) a regional or local health care program
				  operated under Health and Safety Code §
											75.104,
				  concerning Health Care Services.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter UU - MACHINE-READABLE FILES › Section 21.5502 - Form and Method of Publishing Machine-Readable Files

Current through Reg. 49, No. 28; July 12, 2024
(a) Required machine-readable files. Issuers
				  must publish the following machine-readable files consistent with Insurance
				  Code Chapter 1662, Subchapter C, concerning Required Public Disclosures, and
				  the rules under this subchapter:
(1) an
				  in-network negotiated rates file, containing in-network provider negotiated
				  rates for all covered health care services and supplies, consistent with
				  Insurance Code § 1662.103(a)(1), concerning Required Information, and
				  §1662.104, concerning Network Rate Disclosures;
(2) an out-of-network allowed amounts file,
				  containing billed charges and allowed amounts for covered health care services
				  or supplies provided by out-of-network providers, consistent with Insurance
				  Code § 1662.103(a)(2) and § 1662.105, concerning Out-of-Network
				  Allowed Amounts; and
(3) an
				  in-network prescription drugs file, containing in-network historical net prices
				  and negotiated rates for prescription drugs, consistent with Insurance Code
				  § 1662.103(a)(3) and § 1662.106, concerning Historical Net
				  Price.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter UU - MACHINE-READABLE FILES › Section 21.5503 - Data Schemas

Current through Reg. 49, No. 28; July 12, 2024
(a) In-network
				  negotiated rate file schema. For the "in-network-rates" file published under
				  this subchapter, an issuer must include data elements consistent with the
				  In-Network File Schema contained in Machine-Readable Files: Data Schemas
				  (version 1.1), published on the department's website.
(b) Out-of-network allowed amount file
				  schema. For the "allowed-amounts" file published under this subchapter, an
				  issuer must include data elements consistent with the Out-of-Network Allowed
				  Amount File Schema contained in Machine-Readable Files: Data Schemas (version
				  1.1), published on the department's website.
(c) In-network prescription drugs file
				  schema. For the "prescription-drugs" file published under this subchapter, an
				  issuer must include data elements consistent with the Rx File Schema contained
				  in Machine-Readable Files: Data Schemas (version 1.1), published on the
				  department's website.
(d) Table of
				  contents file schema. If an issuer chooses to include multiple plans in a
				  single file, as permitted under § 21.5502(h) of this title (relating to
				  Form and Method of Publishing Machine-Readable Files), the issuer must publish
				  a "table-of-contents" file, consistent with the Table of Contents File Schema
				  contained in Machine-Readable Files: Data Schemas (version 1.1), published on
				  the department's website.
(e)
				  Provider reference file schema. If an issuer chooses to include an external
				  file of provider references, the issuer must include a "Provider Reference"
				  file, consistent with the Provider Reference File Schema contained in the
				  Machine-Readable Files: Data Schemas (version 1.1), published on the
				  department's website.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.1 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose. This
				  subchapter governs the treatment of nonpublic personal financial information
				  about individuals by all covered entities. This subchapter:
(1) requires a covered entity to provide
				  notice to individuals about its privacy policies and practices;
(2) describes the conditions under which a
				  covered entity may disclose nonpublic personal financial information about
				  individuals to nonaffiliated third parties; and
(3) provides methods for individuals to
				  prevent a covered entity from disclosing that information to nonaffiliated
				  third parties.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.3 - Exceptions to Applicability of Subchapter

Current through Reg. 49, No. 28; July 12, 2024
(a) A covered entity is not subject to the
				  notice and opt out requirements for nonpublic personal financial information
				  set out in this subchapter if the covered entity is an employee, agent, or
				  other representative of another covered entity (a principal) and:
(1) the principal otherwise complies with,
				  and provides the notices required by, the provisions of this subchapter;
				  and
(2) the covered entity does not
				  disclose any nonpublic personal financial information to any person other than
				  the principal or its affiliates in a manner permitted by this
				  subchapter.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.4 - Determination of Consumer Status

Current through Reg. 49, No. 28; July 12, 2024
(a) The term
				  consumer includes, but is not limited to:
(1)
				  an individual who provides nonpublic personal financial information to a
				  covered entity in connection with obtaining or seeking to obtain financial,
				  investment or economic advisory services relating to an insurance product or
				  service regardless of whether the covered entity establishes an ongoing
				  relationship.
(2) an applicant for
				  insurance prior to the inception of insurance coverage.
(3) an individual, if the covered entity
				  discloses nonpublic personal financial information about the individual to a
				  nonaffiliated third party other than as permitted under §
											22.17
				  of this title (relating to Exception to Opt Out Requirements for Disclosure of
				  Nonpublic Personal Financial Information for Service Providers and Joint
				  Marketing), §
											22.18
				  of this title (relating to Exceptions to Notice and Opt Out Requirements for
				  Disclosure of Nonpublic Personal Financial Information for Processing and
				  Servicing Transactions) and §
											22.19
				  of this title (relating to Other Exceptions to Notice and Opt Out Requirements
				  for Disclosure of Nonpublic Personal Financial Information), and:
(A) the individual is a beneficiary of a life
				  insurance policy underwritten by the covered entity;
(B) the individual is a claimant under an
				  insurance policy issued by the covered entity;
(C) the individual is an insured or an
				  annuitant under an insurance policy or an annuity, respectively, issued by the
				  covered entity; or
(D) the
				  individual is a mortgagor of a mortgage covered under a mortgage insurance
				  policy.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.5 - Examples of Continuing Relationship

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The following examples illustrate situations where a consumer has a continuing
				  relationship with a covered entity:
(1) the
				  consumer is a current policyholder of an insurance product issued by or through
				  the covered entity; or
(2) the
				  consumer obtains financial, investment or economic advisory services relating
				  to an insurance product or service from the covered entity for a fee.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.6 - Notice Requirements

Current through Reg. 49, No. 28; July 12, 2024
Any notice required by this subchapter must comply with the
					 following standards.
(1) Designed to
				  call attention. A covered entity designs its notice to call attention to the
				  nature and significance of the information in it, if:
(A) with regard to all notices, the covered
				  entity:
(i) uses a plain-language heading to
				  call attention to the notice;
(ii)
				  uses a typeface and type size that are easy to read;
(iii) provides wide margins and ample line
				  spacing;
(iv) uses boldface or
				  italics for key words; and
(v) uses
				  distinctive type size, style, and graphic devices, such as shading or sidebars,
				  when the covered entity combines its notice in a form with other information,
				  in order to emphasize the privacy component of the form.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.7 - Determination of Reasonable Basis

Current through Reg. 49, No. 28; July 12, 2024
(a) For
				  purposes of determining if information is publicly available as defined in this
				  subchapter:
(1) a covered entity has a
				  reasonable basis to believe that information is lawfully made available to the
				  general public if the covered entity has taken steps to determine:
(A) that the information is of the type that
				  is available to the general public; and
(B) whether an individual can direct that the
				  information not be made available to the general public, and
(C) if an option as described in subparagraph
				  (1)(B) of this section is available, that the covered entity's consumer has not
				  made such a direction.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.8 - Initial Privacy Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) Initial notice
				  requirement. A covered entity shall provide a clear and conspicuous notice that
				  accurately reflects its privacy policies and practices to:
(1) an individual who becomes the covered
				  entity's customer, not later than when the covered entity establishes a
				  customer relationship, except as provided in subsection (e) of this section;
				  and
(2) a consumer, before the
				  covered entity discloses any nonpublic personal financial information about the
				  consumer to any nonaffiliated third party, if the covered entity makes a
				  disclosure other than as authorized by §
											22.18
				  of this title (relating to Exceptions to Notice and Opt Out Requirements for
				  Disclosure of Nonpublic Personal Financial Information for Processing and
				  Servicing Transactions) and §
											22.19
				  of this title (relating to Other Exceptions to Notice and Opt Out Requirements
				  for Disclosure of Nonpublic Personal Financial Information).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.9 - Annual Privacy Notice

Current through Reg. 49, No. 28; July 12, 2024
(a) A covered
				  entity must provide a clear and conspicuous notice to customers that accurately
				  reflects its privacy policies and practices not less than annually during the
				  continuation of the customer relationship, except as provided in subsection (d)
				  of this section. "Annually" means at least once in any period of 12 consecutive
				  months during which that relationship exists. A covered entity may define the
				  12-consecutive-month period, but the covered entity must apply it to the
				  customer on a consistent basis. A covered entity provides a notice annually if
				  it defines the 12-consecutive-month period as a calendar year and provides the
				  annual notice to the customer once in each calendar year following the calendar
				  year in which the covered entity provided the initial notice. For example, if a
				  customer opens an account on any day of year 1, the covered entity must provide
				  an annual notice to that customer by December 31 of year 2.
(b) A covered entity is not required to
				  provide an annual notice to a former customer. A former customer is an
				  individual with whom a covered entity no longer has a continuing relationship.
				  A covered entity no longer has a continuing relationship with an individual:
(1) if the individual no longer is a current
				  policyholder of an insurance product or no longer obtains insurance services
				  with or through the covered entity;
(2) if the individual's policy is lapsed,
				  expired, or otherwise not in force, and the covered entity has not communicated
				  with the customer about the relationship for a period of 12 consecutive months,
				  other than to provide annual privacy notices, material required by law or
				  regulation, communication at the direction of a state or federal authority, or
				  promotional materials;
(3) for the
				  purposes of this subchapter, if:
(A) the
				  covered entity sends mail to the individual's last known address, according to
				  the covered entity's records, and the postal authorities return that mail as
				  undeliverable, and
(B) subsequent
				  attempts by the covered entity to obtain a current valid address for the
				  individual are unsuccessful; or
(4) in the case of providing real estate
				  settlement services, at the later of the following events:
(A) the customer completes execution of all
				  documents related to the real estate closing;
(B) payment for those services has been
				  received; or
(C) the covered entity
				  has completed all of its responsibilities with respect to the settlement,
				  including filing documents in the public record.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.10 - Information to be Included in Privacy Notices

Current through Reg. 49, No. 28; July 12, 2024
(a) Simplified nondisclosure notice
				  requirements. A covered entity that does not disclose, and does not reserve the
				  right to disclose, nonpublic personal financial information about customers or
				  former customers to nonaffiliated third parties except as authorized under
				  §
										22.18
				  of this title (relating to Exceptions to Notice and Opt Out Requirements for
				  Disclosure of Nonpublic Personal Financial Information for Processing and
				  Servicing Transactions) and §
										22.19
				  of this title (relating to Other Exceptions to Notice and Opt Out Requirements
				  for Disclosure of Nonpublic Personal Financial Information), may comply with
				  this subchapter by providing a simplified notice that expresses:
(1) the nondisclosure policy stated in this
				  subsection, and
(2) the information
				  required by subsections (b)(1), (b)(8), (b)(9), and (c) of this
				  section.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.11 - Form of Opt Out Notice to Consumers and Opt Out Methods

Current through Reg. 49, No. 28; July 12, 2024
(a) Clear and conspicuous notice. If a
				  covered entity is required to provide an opt out notice under §
										22.14(a)
				  of this title (relating to Limits on Disclosure of Nonpublic Personal Financial
				  Information to Nonaffiliated Third Parties), it must provide a clear and
				  conspicuous notice to each of its consumers that accurately explains the right
				  to opt out. The notice must state:
(1) that
				  the covered entity discloses or reserves the right to disclose nonpublic
				  personal financial information about its consumer to a nonaffiliated third
				  party;
(2) that the consumer has
				  the right to opt out of that disclosure; and
(3) a reasonable means by which the consumer
				  may opt out.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.12 - Revised Privacy Notices

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  otherwise authorized in this subchapter, a covered entity shall not, directly
				  or through an affiliate, disclose any nonpublic personal financial information
				  about a consumer to a nonaffiliated third party other than as described in the
				  initial notice that the covered entity provided to that consumer under §
										22.8 of
				  this title (relating to Initial Privacy Notice), unless:
(1) the covered entity has provided to the
				  consumer a clear and conspicuous revised notice that accurately describes its
				  policies and practices;
(2) the
				  covered entity has provided to the consumer a new opt out notice;
(3) the covered entity has given the consumer
				  a reasonable opportunity, before the covered entity discloses the information
				  to the nonaffiliated third party, to opt out of the disclosure; and
(4) the consumer does not opt out.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.13 - Delivery

Current through Reg. 49, No. 28; July 12, 2024
(a) How to provide notices. A covered entity
				  shall provide any notices that this subchapter requires so that each consumer
				  can reasonably be expected to receive actual notice in writing or, if the
				  consumer agrees, electronically.
(b) Examples of reasonable expectation of
				  actual notice. A covered entity satisfies the reasonable expectation that a
				  consumer will receive actual notice if the covered entity:
(1) hand-delivers a printed copy of the
				  notice to the consumer;
(2) mails a
				  printed copy of the notice to the last known address of the consumer
				  separately, or in a policy, billing or other written communication;
(3) for a consumer who conducts transactions
				  electronically, posts the notice on the electronic site and requires the
				  consumer to acknowledge receipt of the notice as a necessary step to obtaining
				  a particular insurance product or service; or
(4) for an isolated transaction with a
				  consumer, such as the covered entity providing an insurance quote or selling
				  the consumer single-event types of coverage including, but not limited to, auto
				  rental liability, travel, and short-term non-resident auto liability insurance,
				  presents the notice and requires the consumer to acknowledge receipt of the
				  notice as a necessary step to obtaining the particular insurance product or
				  service.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.14 - Limits on Disclosure of Nonpublic Personal Financial Information to Nonaffiliated Third Parties

Current through Reg. 49, No. 28; July 12, 2024
(a) Conditions for
				  disclosure. Except as otherwise authorized in this subchapter, a covered entity
				  may not, directly or through any affiliate, disclose any nonpublic personal
				  financial information about a consumer to a nonaffiliated third party unless:
(1) the covered entity has provided to the
				  consumer an initial notice as required under §
											22.8 of
				  this title (relating to Initial Privacy Notice);
(2) the covered entity has provided to the
				  consumer an opt out notice as required in §
											22.11
				  of this title (relating to Form of Opt Out Notice to Consumers and Opt Out
				  Methods);
(3) the covered entity
				  has given the consumer a reasonable opportunity, before it discloses the
				  information to the nonaffiliated third party, to opt out of the disclosure;
				  and
(4) the consumer does not opt
				  out.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.15 - Limits on Redisclosure and Reuse of Nonpublic Personal Financial Information

Current through Reg. 49, No. 28; July 12, 2024
(a) If a covered
				  entity receives nonpublic personal financial information from a nonaffiliated
				  financial institution under an exception in §
										22.18
				  of this title (relating to Exceptions to Notice and Opt Out Requirements for
				  Disclosure of Nonpublic Personal Financial Information for Processing and
				  Servicing Transactions) and §
										22.19
				  of this title (relating to Other Exceptions to Notice and Opt Out Requirements
				  for Disclosure of Nonpublic Personal Financial Information), the covered
				  entity's disclosure and use of that information is limited as follows:
(1) the covered entity may disclose the
				  information to the affiliates of the financial institution from which the
				  covered entity received the information;
(2) the covered entity may disclose the
				  information to its affiliates, but the covered entity's affiliates may, in
				  turn, disclose and use the information only to the extent that the covered
				  entity may disclose and use the information; and
(3) the covered entity may disclose and use
				  the information pursuant to an exception in §
											22.18
				  and §
											22.19
				  of this title in the ordinary course of business to carry out the activity
				  covered by the exception under which the covered entity received the
				  information.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 22 - PRIVACY › Subchapter A - INSURANCE CONSUMER FINANCIAL INFORMATION PRIVACY › Section 22.16 - Limits on Sharing Account Number Information for Marketing Purposes

Current through Reg. 49, No. 28; July 12, 2024
(a) A covered entity shall not, directly or
				  through an affiliate, disclose, other than to a consumer reporting agency, a
				  policy number or similar form of access number or access code for a consumer's
				  policy or transaction account to any nonaffiliated third party for use in
				  telemarketing, direct mail marketing or other marketing through electronic mail
				  to the consumer.
(b) Subsection (a)
				  of this section does not apply if a covered entity discloses a policy number or
				  similar form of access number or access code:
(1) to a service provider, including another
				  covered entity, solely for the purpose of marketing the sharing covered
				  entity's own products or services, so long as the receiving covered entity is
				  not authorized to initiate charges directly to the account; or
(2) to a participant in an affinity or
				  similar program as set forth in
				  12
				  CFR §
												40.12(b)(2),
				  12
				  CFR §
												216.12(b)(2),
				  12
				  CFR §332.12(b)(2),
				  12
				  CFR §
												573.12(b)(2), and
				  12
				  CFR §
												716.12(b)(2),
				  where the participants in the program are identified to the customer when the
				  customer enters into the program.