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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 19. LICENSING AND REGULATION OF INSURANCE PROFESSIONALS |
| SUBCHAPTER A. DISCIPLINARY HEARINGS IN RESPECT OF INSURANCE AGENTS |
| § 19.1. Purpose |
| § 19.2. Effect of Surrendering or Attempting To Surrender Agent's License |
| SUBCHAPTER B. MEDICARE ADVANTAGE PLANS, MEDICARE ADVANTAGE PRESCRIPTION DRUG PLANS, AND MEDICARE PART D PLANS |
| § 19.101. Definitions |
| § 19.102. Agent Authority to Market Medicare Advantage Plans, Medicare Advantage Prescription Drug Plans, and Medicare Prescription Drug Plans |
| § 19.103. Reporting Requirements |
| SUBCHAPTER G. LICENSING OF INSURANCE ADJUSTERS |
| § 19.601. Fees for Examination |
| § 19.602. Types of Adjuster's Licenses |
| § 19.603. Interpretations of the Act |
| SUBCHAPTER H. LICENSING OF PUBLIC INSURANCE ADJUSTERS |
| § 19.701. Definitions |
| § 19.702. Type of Public Insurance Adjuster Licenses |
| § 19.704. Public Insurance Adjuster Licensing |
| § 19.705. Financial Responsibility Requirement |
| § 19.706. Demonstrating Financial Responsibility |
| § 19.707. Type of Financial Responsibility |
| § 19.708. Public Insurance Adjuster Contracts |
| § 19.709. Nonresident Applicants and License Holders |
| § 19.710. Nonresidents Required to File Biographical Information |
| § 19.711. Fingerprint Requirement |
| § 19.712. Advertisement |
| § 19.713. Public Insurance Adjuster Code of Ethics |
| SUBCHAPTER I. GENERAL PROVISIONS REGARDING FEES, APPLICATIONS, AND RENEWALS |
| § 19.801. General Provisions |
| § 19.802. Amount of Fees |
| § 19.804. Application for a New Entity License |
| § 19.805. Application for a New Individual License |
| § 19.806. Application for a Provisional Permit |
| § 19.807. Application for a Temporary License |
| § 19.808. The Initial Term of a New License and Renewal License Expiration |
| § 19.809. Nonresident Licensees Relocating to Texas |
| § 19.810. License Renewal and Application for an Expired License |
| SUBCHAPTER J. STANDARDS OF CONDUCT FOR LICENSED AGENTS |
| § 19.901. Definitions Concerning Conduct of Licensed Agents |
| § 19.902. One Agent, One License |
| § 19.903. Concurrent Eligibility for Managing General Agent's License and Other Licenses |
| § 19.904. Joint Advertising by Similarly Licensed Agents |
| § 19.905. Referral Business and Insurance Company Appointments |
| § 19.906. Last Known Address |
| SUBCHAPTER K. CONTINUING EDUCATION, ADJUSTER PRELICENSING EDUCATION PROGRAMS, AND CERTIFICATION COURSES |
| § 19.1001. General Provisions |
| § 19.1002. Definitions |
| § 19.1003. Licensee Hour and Completion Requirements |
| § 19.1004. Licensee Exemption from and Extension of Time for Continuing Education |
| § 19.1005. Provider Registration, Instructor, and Speaker Criteria |
| § 19.1006. Course Criteria |
| § 19.1007. Course Certification Submission Applications, Course Expirations, and Resubmissions |
| § 19.1008. Certified Course Advertising, Modification, and Assignment |
| § 19.1009. Types of Courses |
| § 19.1010. Hours of Credit |
| § 19.1011. Requirements for Successful Completion of Continuing Education Courses |
| § 19.1012. Forms and Fees |
| § 19.1013. Licensee Record Maintenance |
| § 19.1014. Provider Compliance Records |
| § 19.1015. Failure to Comply |
| § 19.1016. Automatic Fines |
| § 19.1017. Adjuster Prelicensing Education Course Content and Examination Requirements |
| § 19.1018. Adjuster Prelicensing Examination Topics |
| § 19.1020. State and National Insurance Association Credit |
| § 19.1021. Flood Insurance Education Course |
| § 19.1022. Long-Term Care Partnership Certification Course |
| § 19.1023. Long-Term Care Partnership Continuing Education |
| § 19.1024. Medicare-Related Product Certification Course |
| § 19.1025. Medicare-Related Product Continuing Education |
| § 19.1026. Small Employer Health Benefit Plan Specialty Certification Course |
| § 19.1027. Small Employer Health Benefit Plan Specialty Continuing Education |
| § 19.1028. Annuity Certification Course |
| § 19.1029. Annuity Continuing Education |
| § 19.1030. Effect of License Expiration, Revocation, or Refusal to Renew on Certification Requirements |
| SUBCHAPTER L. SELECTION OF A TESTING SERVICES VENDOR FOR ADMINISTRATION OF LICENSING EXAMINATIONS |
| § 19.1101. Vendor Selection Process |
| § 19.1102. Evaluation |
| § 19.1103. Selection of Vendor |
| § 19.1104. Objection to Selection Process |
| SUBCHAPTER M. LICENSING AND REGULATION OF MANAGING GENERAL AGENTS |
| § 19.1201. General Provisions |
| § 19.1202. Definitions Concerning Licensing and Regulation of Managing General Agents |
| § 19.1203. Adoption by Reference of Forms Relating to Licensing and Regulation of Managing General Agents |
| § 19.1204. Contract Provisions |
| § 19.1205. Escrow Accounts |
| § 19.1206. Errors and Omissions Policies |
| SUBCHAPTER N. LICENSING AND REGULATION OF RISK MANAGERS |
| § 19.1301. Purpose, Scope, and Interpretation of This Subchapter |
| § 19.1302. Definitions |
| § 19.1304. Last Known Address |
| § 19.1305. License Requirement |
| § 19.1306. Qualifications for Risk Manager's License |
| § 19.1307. Exemption |
| § 19.1308. Application for License |
| § 19.1309. Place of Business |
| § 19.1310. Examination |
| § 19.1311. Examination and License Fees and Charges |
| § 19.1312. License Renewal; Renewal Fee |
| § 19.1313. Denial, Suspension, or Revocation of a License |
| § 19.1314. Duration of Suspension |
| § 19.1315. Reinstatement or Relicensing |
| § 19.1316. Nonresident License |
| § 19.1317. License by Endorsement |
| § 19.1318. Dual Compensation |
| § 19.1319. Penalty |
| SUBCHAPTER O. PROCEDURES AND REQUIREMENTS FOR REINSURANCE INTERMEDIARIES (BROKERS AND MANAGERS) |
| § 19.1401. Purpose and Scope |
| § 19.1402. Definitions |
| § 19.1403. Requirements for Bond or Errors and Omissions Policy |
| § 19.1404. Requirements for Interim Profit-Sharing by a Manager |
| § 19.1405. Requirements for Form of Audited Statements |
| § 19.1406. Fees for Examinations |
| § 19.1407. Approval of Reinsurance Intermediary Manager's Contracts |
| SUBCHAPTER P. FEES CHARGED BY LOCAL RECORDING AGENTS |
| § 19.1501. General Provisions |
| § 19.1502. Definitions |
| § 19.1503. Procedures for Charging Fees |
| SUBCHAPTER Q. DISCOUNT HEALTH CARE PROGRAM REGISTRATION AND RENEWAL REQUIREMENTS |
| § 19.1601. Definitions |
| § 19.1602. Registration Requirement |
| § 19.1603. Financial Responsibility Requirement |
| § 19.1604. Renewal |
| § 19.1605. Requirements Related to Discount Health Care Program Information |
| § 19.1606. Severability |
| SUBCHAPTER R. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER A HEALTH BENEFIT PLAN OR HEALTH INSURANCE POLICY |
| DIVISION 1. UTILIZATION REVIEWS |
| § 19.1701. General Provisions |
| § 19.1702. Applicability |
| § 19.1703. Definitions |
| § 19.1704. Certification or Registration of URAs |
| § 19.1705. General Standards of Utilization Review |
| § 19.1706. Requirements and Prohibitions Relating to Personnel |
| § 19.1707. URA Contact with and Receipt of Information from Health Care Providers |
| § 19.1708. On-Site Review by a URA |
| § 19.1709. Notice of Determinations Made in Utilization Review |
| § 19.1710. Requirements Prior to Issuing an Adverse Determination |
| § 19.1711. Written Procedures for Appeal of Adverse Determinations |
| § 19.1712. URA's Telephone Access |
| § 19.1713. Confidentiality |
| § 19.1714. Regulatory Requirements Subsequent to Certification or Registration |
| § 19.1715. Administrative Violations |
| § 19.1716. Specialty URA |
| § 19.1717. Independent Review of Adverse Determinations |
| § 19.1718. Preauthorization for Health Maintenance Organizations and Preferred Provider Benefit Plans |
| § 19.1719. Verification for Health Maintenance Organizations and Preferred Provider Benefit Plans |
| DIVISION 2. PREAUTHORIZATION EXEMPTIONS |
| § 19.1730. Definitions |
| § 19.1731. Preauthorization Exemption |
| § 19.1732. Notice of Preauthorization Exemption Grants, Denials, or Rescissions |
| § 19.1733. Retrospective Reviews and Appeals of Preauthorization Exemption Rescissions |
| SUBCHAPTER S. FORMS TO REQUEST PRIOR AUTHORIZATION |
| DIVISION 1. TEXAS STANDARD PRIOR AUTHORIZATION REQUEST FORMS |
| § 19.1801. Applicability |
| § 19.1802. Exception |
| § 19.1803. Definitions |
| § 19.1804. Severability |
| DIVISION 2. TEXAS STANDARDIZED PRIOR AUTHORIZATION REQUEST FORM FOR HEALTH CARE SERVICES |
| § 19.1810. Prior Authorization Request Form for Health Care Services, Required Acceptance, and Use |
| DIVISION 3. TEXAS STANDARD PRIOR AUTHORIZATION REQUEST FORM FOR PRESCRIPTION DRUG BENEFITS |
| § 19.1820. Prior Authorization Request Form for Prescription Drug Benefits, Required Acceptance, and Use |
| SUBCHAPTER T. SPECIALTY INSURANCE LICENSE |
| § 19.1901. Purpose |
| § 19.1902. Definitions |
| § 19.1903. Qualifications |
| § 19.1904. Application |
| § 19.1906. Expiration and Renewal of Licenses |
| § 19.1907. Non-Residents |
| § 19.1908. Notice to Department |
| § 19.1909. Employee Training |
| § 19.1910. Denial Or Refusal Of Specialty License Application; Suspension Or Revocation Of Specialty Licenses; Discipline Of Specialty License Holders |
| SUBCHAPTER U. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE |
| § 19.2001. General Provisions |
| § 19.2002. Applicability |
| § 19.2003. Definitions |
| § 19.2004. Certificate or Registration of URAs |
| § 19.2005. General Standards of Utilization Review |
| § 19.2006. Requirements and Prohibitions Relating to Personnel |
| § 19.2007. URA Contact with and Receipt of Information from Health Care Providers |
| § 19.2008. On-Site Review by a URA |
| § 19.2009. Notice of Determinations Made in Utilization Review |
| § 19.2010. Requirements Prior to Issuing Adverse Determination |
| § 19.2011. Written Procedures for Appeal of Adverse Determinations |
| § 19.2012. URA's Telephone Access and Procedures for Certain Drug Requests and Post-Stabilization Care |
| § 19.2013. Confidentiality |
| § 19.2014. Regulatory Requirements Subsequent to Certification or Registration |
| § 19.2015. Administrative Violations |
| § 19.2016. Specialty URA |
| § 19.2017. Independent Review of Adverse Determinations |