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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 28. INSURANCE |
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PART 1. TEXAS DEPARTMENT OF INSURANCE |
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CHAPTER 13. MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES |
| SUBCHAPTER A. STATEWIDE MUTUAL ASSESSMENT COMPANIES, LOCAL MUTUAL AID ASSOCIATIONS, AND BURIAL ASSOCIATIONS |
| § 13.1. Creation of New Groups, Clubs or Classes |
| § 13.2. Voting by Proxy |
| § 13.3. Policy Approval |
| § 13.4. Requirement of Certain Descriptive Words as a Part of the Corporate Name |
| § 13.5. Organization of a Local Mutual Aid Association or Local Mutual Burial Association |
| § 13.6. Movement of Home Office |
| § 13.7. Membership Fees |
| § 13.8. Operation and Management of Companies and Associations |
| § 13.9. Books and Records, Minimum Requirements |
| § 13.10. Merger under the Insurance Code, Article 14.13 |
| § 13.11. Status of Exempt Associations |
| § 13.12. Assessments and Rate Schedules |
| § 13.13. The Use of Mortuary Funds for the Purpose of Defending Contested Claims |
| § 13.14. Ownership and Investment of Assets |
| § 13.15. Beneficiaries under Burial Policies |
| § 13.16. Connection Between Two or More Companies Through Common Management |
| § 13.17. Conversion or Reinsurance of Entire Membership into Legal Reserve Companies under the Insurance Code, Article 14.61 |
| § 13.18. Reinsurance Agreements under the Insurance Code, Article 14.62 |
| § 13.19. Certain Prohibited Practices |
| § 13.20. Availability of Company Records to the Membership |
| § 13.21. Liabilities |
| § 13.22. Minutes of Directors and Membership Meetings |
| § 13.23. Rate Increases |
| § 13.24. Procedure for Amending Constitution and Bylaws |
| § 13.25. Conversion or Change of Name From a Burial Association to a Local Mutual Aid Association |
| § 13.26. Computation of Time |
| § 13.27. Reserve Requirements |
| § 13.28. Uncollected Premiums |
| § 13.29. Establishment and Maintenance of Permissive Deficiency Reserves |
| SUBCHAPTER B. STIPULATED PREMIUM INSURANCE COMPANIES |
| § 13.101. Establishment and Maintenance of Permissive Deficiency Reserve |
| § 13.102. Life Policy Forms |
| SUBCHAPTER C. LLOYD'S PLAN INSURERS |
| § 13.201. Approval of Attorney in Fact |
| § 13.202. Distinction between Attorney in Fact and Deputy Attorney in Fact |
| SUBCHAPTER D. RISK RETENTION GROUPS AND PURCHASING GROUPS |
| § 13.301. Purpose |
| § 13.302. Definitions |
| § 13.303. Scope |
| § 13.304. General Prohibition |
| § 13.305. Registration |
| § 13.306. Operation by Members Only |
| § 13.307. Providing Other Than Liability Insurance |
| § 13.308. Requirement of Similar or Related Liability Exposure |
| § 13.309. Sanctions |
| § 13.310. Cease and Desist Orders |
| § 13.311. Deceptive Acts or Practices |
| § 13.312. Regulatory Fees |
| § 13.313. Forms Required for Risk Retention Groups and Purchasing Groups |
| SUBCHAPTER E. HEALTH CARE COLLABORATIVES |
| DIVISION 1. GENERAL PROVISIONS |
| § 13.401. Purpose |
| § 13.402. Definitions |
| § 13.403. Filing and Required Forms; How to Obtain Forms |
| § 13.404. Use of the Term "HCC;" Service Mark; Trademarks; d/b/a |
| DIVISION 2. APPLICATION FOR CERTIFICATE OF AUTHORITY |
| § 13.411. Filing Fee; Annual Assessments; Open Records |
| § 13.412. Revisions During Review Process |
| § 13.413. Contents of the Application |
| § 13.414. Limited Exemption from Certain Information Filing Requirements |
| § 13.415. Documents to be Available for Quality of Care and Financial Examinations |
| § 13.416. Review of Original or Renewal Application; Commissioner Discretion |
| § 13.417. Withdrawal of an Application |
| DIVISION 3. EXAMINATIONS; REGULATORY REQUIREMENTS FOR AN HCC AFTER ISSUANCE OF CERTIFICATE OF AUTHORITY; AND ADVERTISING AND SALES MATERIAL |
| § 13.421. Examination; Fee for Expenses |
| § 13.422. Filing Requirements That Apply After Issuance of Certificate of Authority |
| § 13.423. Service Area Change Applications |
| § 13.424. Certificate of Authority Renewal Requirements |
| § 13.425. Compensation Arrangements |
| § 13.426. Confidentiality |
| § 13.429. HCCs Subject to Insurance Code Chapters 541 and 542 and Related Rules |
| DIVISION 4. FINANCIAL REQUIREMENTS |
| § 13.431. Reserves and Working Capital Requirements |
| § 13.432. Fiduciary Responsibility |
| DIVISION 5. HCC CONTRACT ARRANGEMENTS |
| § 13.441. General Provisions |
| DIVISION 6. CHANGE OF CONTROL BY ACQUISITION OF OR MERGER WITH HCC |
| § 13.451. Definitions |
| § 13.452. Determination of Control |
| § 13.453. Filing Requirements |
| § 13.454. Commissioner Action |
| § 13.455. Change of Control with Increased Market Share |
| DIVISION 7. ADMINISTRATIVE PROCEDURES |
| § 13.461. Commissioner's Authority to Require Additional Information |
| DIVISION 8. OTHER REQUIREMENTS |
| § 13.471. Notification of Change in Payment Arrangements |
| § 13.472. Requirements for Certain Delegation Contracts |
| § 13.473. Organization of an HCC |
| § 13.474. Requirements for HMO or Insurer Delegation of Functions to HCCs |
| DIVISION 9. QUALITY AND COST OF HEALTH CARE SERVICES |
| § 13.481. Quality Improvement Structure for HCCs |
| § 13.482. Quality Assurance and Quality Improvement |
| § 13.483. Credentialing |
| DIVISION 10. COMPLAINT SYSTEMS; RIGHTS OF PHYSICIANS; LIMITATIONS ON PARTICIPATION |
| § 13.491. Complaint Systems |
| § 13.492. Complaints; Deadlines for Response and Resolution |
| § 13.493. Rights of Physicians |
| § 13.494. Limitations and Prohibition |
| SUBCHAPTER F. PROFESSIONAL EMPLOYER ORGANIZATIONS SPONSORING SELF-FUNDED EMPLOYEE HEALTH BENEFIT PLANS |
| DIVISION 1. PURPOSE AND DEFINITIONS |
| § 13.510. Purpose |
| § 13.511. Regulated PEOs; Approval Required |
| § 13.512. ERISA's Applicability; Severability of Subchapter's Provisions |
| § 13.513. Definitions |
| DIVISION 2. APPLICABILITY OF INSURANCE CODE AND ADMINISTRATIVE CODE PROVISIONS |
| § 13.520. Applicability of Insurance Code Provisions to an Approved PEO, Plan, or Trust |
| § 13.521. Applicable Insurance Code and Administrative Code Terms |
| § 13.522. Delegation of Functions to a Contracting Regulated Entity |
| § 13.523. Applicable Insurance Code Provisions |
| § 13.524. Applicability of Administrative Code Provisions to an Approved PEO, Plan, or Trust |
| DIVISION 3. CERTIFICATE OF APPROVAL |
| § 13.530. Certificate of Approval Required |
| § 13.531. Forms and Fees |
| § 13.532. Application Requirements |
| § 13.533. Actuarial Opinion Requirements |
| § 13.534. Application Review, Approval, and Denial |
| DIVISION 4. CONDUCT OF APPROVED PEO |
| § 13.540. Governance and Operation of Approved PEO |
| § 13.541. Stop-Loss Insurance |
| § 13.542. PEO's Fidelity Coverage |
| § 13.543. Approved PEO's Conduct with Respect to the Plan and Trust |
| § 13.544. Marketing Materials; Offers of Enrollment |
| § 13.545. Representations to Clients and Participants |
| DIVISION 5. FORMATION, GOVERNANCE, AND OPERATION OF PLAN AND TRUST |
| § 13.550. Plan Formation |
| § 13.551. Trust Formation |
| § 13.552. Required Filings |
| § 13.553. Plan and Trust Governance and Operation |
| § 13.554. Board of Trustees |
| § 13.555. Trustees' Responsibility and Authority |
| § 13.556. Protection of Plan and Trust Assets |
| § 13.557. Disputes Arising Under the Plan or Trust |
| DIVISION 6. FINANCIAL SOLVENCY REQUIREMENTS FOR PEO PLANS |
| § 13.560. Annual and Quarterly Reserves |
| § 13.561. Authorized Investments |
| § 13.562. Deposit or Letter of Credit Required |
| § 13.563. Form of Deposit |
| § 13.564. Annual Recalculation; Changes to Deposit |
| § 13.565. Letter of Credit |
| § 13.566. Annual Recalculation; Changes to Letter of Credit |
| § 13.567. Stop-Loss Insurance |
| § 13.568. Standards for Fidelity Coverage |
| DIVISION 7. QUARTERLY AND ANNUAL FILINGS; EXAMINATIONS; HAZARDOUS CONDITIONS |
| § 13.570. Financial Filing Requirements |
| § 13.571. Annual Fee |
| § 13.572. Examination of Approved PEO, Plan, and Trust |
| § 13.573. Hazardous Condition; Violations of Statute |
| DIVISION 8. MARKET EXIT |
| § 13.580. Withdrawal from Market |
| § 13.581. Limitation, Suspension, or Cancellation of Certificate of Approval in Response to TDLR Action |
| § 13.582. Limitation, Suspension, or Cancellation of Certificate of Approval in Response to TDI Action |
| § 13.583. Cancellation of Certificate of Approval |