SECTION 13.524. Applicability of Administrative Code Provisions to an Approved PEO, Plan, or Trust

(a) Applicable Administrative Code provisions. The following provisions of this title are applicable to an approved PEO, or to its plan and trust, as appropriate, to the same extent as the provisions apply to any entity TDI regulates under those provisions:

(1) Chapter 1 of this title (relating to General Administration);

(2) Chapter 3, Subchapter A of this title (relating to Submission Requirements for Filings and Departmental Actions Related to Such Filings);

(3) Chapter 3, Subchapter E of this title (relating to Group Life, and/or Accident and Health Insurance Policies and Certificates);

(4) Chapter 3, Subchapter G of this title (relating to Plain Language Requirements for Health Benefit Policies);

(5) Chapter 3, Subchapter M of this title (relating to Discretionary Clauses);

(6) Chapter 3, Subchapter U of this title (relating to Newborn Children Coverage);

(7) Section 3.3601 of this title (relating to Orthodontic Coverages);

(8) Chapter 3, Subchapter V of this title (relating to Coordination of Benefits);

(9) Chapter 3, Subchapter X of this title (relating to Preferred and Exclusive Provider Plans);

(10) Chapter 3, Subchapter BB of this title (relating to Pharmaceutical Services);

(11) Chapter 3, Subchapter HH of this title (relating to Standards for Reasonable Cost Control and Utilization Review for Chemical Dependency Treatment Centers);

(12) Chapter 7, Subchapter B of this title (relating to Insurance Holding Company Systems);

(13) Chapter 12 of this title (relating to Independent Review Organizations);

(14) Chapter 19, Subchapter R of this title (relating to Utilization Review for Health Care Provided Under a Health Benefit Plan or Health Insurance Policy);

(15) Chapter 21, Subchapter A of this title (relating to Unfair Competition and Unfair Practices of Insurers, and Misrepresentation of Policies);

(16) Chapter 21, Subchapter B of this title (relating to Advertising, Certain Trade Practices, and Solicitation);

(17) Chapter 21, Subchapter C of this title (relating to Unfair Claims Settlement Practices);

(18) Chapter 21, Subchapter E of this title (relating to Unfair Discrimination Based on Sex or Marital Status);

(19) Chapter 21, Subchapter H of this title (relating to Unfair Discrimination);

(20) Chapter 21, Subchapter K of this title (relating to Certification of Creditable Coverage);

(21) Chapter 21, Subchapter L of this title (relating to Medical Child Support, Unfair Practices);

(22) Chapter 21, Subchapter M of this title (relating to Mandatory Benefit Notice Requirements);

(23) Chapter 21, Subchapter P of this title (relating to Mental Health Parity);

(24) Chapter 21, Subchapter Q of this title (relating to Complaint Records to be Maintained);

(25) Chapter 21, Subchapter R of this title (relating to Diabetes);

(26) Chapter 21, Subchapter T of this title (relating to Submission of Clean Claims);

(27) Chapter 21, Subchapter V of this title (relating to Pharmacy Benefits);

(28) Chapter 21, Subchapter W of this title (relating to Coverage for Acquired Brain Injury);

(29) Chapter 21, Subchapter Y of this title (relating to Unfair Discrimination in Compensation for Women's Healthcare);

(30) Chapter 21, Subchapter Z of this title (relating to Data Collecting and Reporting Relating to Mandated Health Benefits and Mandated Offers of Coverage);

(31) Chapter 21, Subchapter AA of this title (relating to Consumer Choice Health Benefit Plans);

(32) Chapter 21, Subchapter BB of this title (relating to Dental Care Benefits);

(33) Chapter 21, Subchapter CC of this title (relating to Electronic Health Care Transactions);

(34) Chapter 21, Subchapter DD of this title (relating to Eligibility Statements);

(35) Chapter 21, Subchapter EE of this title (relating to High Deductible Health Plans);

(36) Chapter 21, Subchapter FF of this title (relating to Obligation to Continue Premium Payment and Coverage After Notice of Lost Group Eligibility);

(37) Chapter 21, Subchapter II of this title (relating to Recognition of National Certifying Organizations for Noninvasive Screening of Cardiovascular Disease);

(38) Chapter 21, Subchapter JJ of this title (relating to Autism Spectrum Disorder Coverage);

(39) Chapter 21, Subchapter KK of this title (relating to Health Care Reimbursement Rate Information);

(40) Chapter 21, Subchapter MM of this title (relating to Wellness Programs);

(41) Chapter 21, Subchapter NN of this title (relating to Noninsurance Benefits and Features);

(42) Chapter 21, Subchapter PP of this title (relating to Out-Of-Network Claim Dispute Resolution);

(43) Chapter 21, Subchapter RR of this title (relating to Standard Proof of Health Insurance for Medical Benefits for Injuries Incurred as a Result of a Motorcycle Accident);

(44) Chapter 21, Subchapter SS of this title (relating to Continuation and Conversion Provisions);

(45) Chapter 22 of this title (relating to Privacy); and

(46) Chapter 26 of this title (relating to Small Employer Health Insurance Regulations).

(b) Plan as large employer plan. For purposes of applying Chapter 21, Subchapter P or W of this title, a plan sponsored by an approved PEO is the equivalent of a large employer health benefit plan, regardless of the size of any of the approved PEO's clients.

(c) Approved PEO as insurer; client as group policyholder. For purposes of applying Chapter 21, Subchapter FF of this title, an approved PEO is the equivalent of a health insurer, and the approved PEO's client is the equivalent of a group policyholder.

(d) Approved PEO as large employer carrier and large employer. Except as provided in subsection (e) of this section, for purposes of applying Chapter 26 of this title, an approved PEO is the equivalent of both a large employer carrier and a large employer.

(e) Approved PEO as large employer carrier; client as large employer. For purposes of applying §26.303 and §§26.307 - 26.309 of this title, (relating to Coverage Requirements, Fair Marketing, Renewability of Coverage and Cancellation, and Refusal to Renew and Application to Reenter Large Employer Market), an approved PEO is the equivalent of a large employer carrier, and the approved PEO's client is the equivalent of a large employer.

Source Note: The provisions of this §13.524 adopted to be effective May 17, 2016, 41 TexReg 3479