TAX ADMINISTRATION

(a) Disclosure of complaint system. An EPP policy or certificate must contain the Complaints and Appeals Process found in this subchapter. This information must include a clear and understandable description of the issuer's methods for resolving complaints. An issuer must provide…

(a) An issuer shall notify, by publication or in writing, all health care providers in the service area of its intent to offer an EPP and of the opportunity to participate. The issuer shall provide such notice prior to issuance of the initial EPP and yearly thereafter. (b) An iss…

An issuer that uses subcontractors to perform one or more function(s) remains responsible for ensuring compliance with all applicable regulatory compliance requirements. A limited provider network shall comply with all statutory and regulatory requirements. Notes 28 Tex. Admin. C…

(a) An issuer must establish and maintain procedures to assure that the health care services provided to insureds are rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. These procedures must i…

An issuer is subject to the same credentialing criteria as outlined in § 11.1902 (4) of this title (relating to Quality Improvement Program). Notes 28 Tex. Admin. Code § 3.9207 The provisions of this §3.9207 adopted to be effective September 17, 2003, 28 TexReg 7993

(a) An issuer must write all policies, health benefit plan certificates, endorsements, amendments, applications, and riders in plain language, in a readable and understandable format, and in compliance with all applicable requirements relating to minimum readability requirements …

(a) Complaints System. Issuers must comply with this section; any requirements under a Medicaid contract, subject to Government Code, Chapter 533; and any other applicable law. The complaint system must provide reasonable procedures for the resolution of oral and written complain…

Any person, including a person who has attempted to resolve complaints through an issuer complaint system process and who is dissatisfied with the resolution, may report an alleged violation of this subchapter to the Texas Department of Insurance at www.tdi.texas.gov or 1-800-252…

An issuer must perform utilization review in compliance with Insurance Code Chapter 4201 and must maintain procedures for notification, review, and appeal of an adverse determination, as defined by this section. An issuer must implement and maintain an internal appeal system for …

This subchapter establishes procedures for the acceptance of donations by the Texas Department of Insurance to assist with the funding of the Health Coverage Awareness and Education Program and to establish procedures to govern the relationships between employees of the departmen…

For purposes of this subchapter, the following words and terms shall have the following meanings, unless the context clearly indicates otherwise. (1) Bid response--A response to a departmental request for goods or services, including a formal bid response, a formal bid proposal, …

(a) The commissioner or the commissioner's designee may accept a donation only for the purposes authorized in the Insurance Code Chapter 524 in the manner authorized in this subchapter. The commissioner or the commissioner's designee must accept all donations on behalf of the dep…

(a) Prior to executing the donation agreement described by § 3.9306 of this subchapter (relating to Procedures for Acceptance of Donations), an offeree seeking to contract with the department shall: (1) notify the department, in a form acceptable to the department, that the offer…

(a) Prior to executing the donation agreement described by § 3.9306 of this subchapter (relating to Procedures for Acceptance of Donations), an offeree subject to department regulation pursuant to the Insurance Code, the Labor Code, or federal law, must notify the department, on …

(a) Donation agreement. Prior to accepting any donation, the offeree and the commissioner or the commissioner's designee shall execute a donation agreement that includes the following information: (1) the name of the offeree; (2) a description of the donation, including a determi…

The purpose of this subchapter is to recognize and permit the use of mortality tables that reflect differences in mortality between preferred and standard lives in determining minimum reserve liabilities in accordance with Insurance Code § 425.058(c)(3) and § 3.4505 of this title…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) 2001 CSO Mortality Table--Mortality tables, consisting of separate rates of mortality for male and female lives, developed by the Am…

(a) Policies issued on or after January 1, 2007, and before January 1, 2017. At the election of the insurer, for each calendar year of issue, for any one or more specified plans of insurance and subject to satisfying the conditions stated in this subchapter, the 2001 CSO Preferre…

(a) For each plan of insurance with separate rates for preferred and standard nonsmoker lives, an insurer may use the super preferred nonsmoker, preferred nonsmoker, and residual standard nonsmoker tables to substitute for the nonsmoker mortality table found in the 2001 CSO Morta…

The purpose of this subchapter is to specify the content and procedural requirements for consumer notices for life insurance policy and annuity contract replacements as required by the Insurance Code § 1114.006 . Notes 28 Tex. Admin. Code § 3.9501 The provisions of this §3.9501 a…

When used in this subchapter, the words "agent" and "producer" shall mean, unless the context clearly indicates otherwise, an individual who holds a license under Insurance Code Chapter 4054 and who sells, solicits, or negotiates life insurance or annuities in this state. Notes 2…

(a) The text contained in Figure: 28 TAC § 3.9504 (b) , Figure: 28 TAC § 3.9505 (1) and Figure: 28 TAC § 3.9505 (2) must be in at least 10-point type and presented in the same order as indicated in each figure and without any change to the specified text, including bolding effect…

(a) An agent who initiates an application for a life insurance policy or annuity contract shall submit to the insurer, with or as part of the application, a statement signed by both the applicant and the agent as to whether the applicant has existing life insurance policies or an…

In the case of a life insurance or annuity application initiated as a result of a direct response solicitation, the insurer shall inquire whether the applicant, by applying for the proposed policy or contract, intends to replace, discontinue, or change an existing life insurance …

(a) Beginning with the effective date of this subchapter and ending January 31, 2008, an insurer subject to Insurance Code Chapter 1114 may use a consumer notice that is substantially similar to the text promulgated in Figure: 28 TAC § 3.9504 (b) orFigure: 28 TAC § 3.9505 (1) imm…

(a) The purpose of this subchapter is to establish the minimum mortality standards for reserves and nonforfeiture values for preneed life insurance policies or certificates, and to recognize, permit, and prescribe the use of the Ultimate 1980 CSO in determining the minimum standa…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) 2001 CSO Mortality Table--Mortality tables, consisting of separate rates of mortality for male and female lives, developed by the Am…

Except as provided by § 3.9606 of this subchapter (relating to Transitional Use of the 2001 CSO Mortality Table), the Ultimate 1980 CSO shall be the minimum mortality standard for determining reserve liabilities and nonforfeiture values for both male and female insureds for prene…

(a) The interest rates used in determining the minimum standard for valuation of preneed life insurance shall be the calendar year statutory valuation rates as defined in the Insurance Code Chapter 425 Subchapter B (Standard Valuation Law). (b) The interest rates used in determin…

(a) The method used in determining the standard for the minimum valuation of reserves for preneed life insurance shall be the method defined in the Insurance Code Chapter 425 Subchapter B (Standard Valuation Law). (b) The method used in determining the standard for the minimum no…

(a) For preneed life insurance policies or certificates issued on or after January 1, 2009, and before January 1, 2012, the 2001 CSO Mortality Table may be used as the minimum standard for reserves and minimum standard for nonforfeiture benefits for both male and female insureds …

The purpose of this subchapter is to: (1) provide standards for the disclosure of certain minimum information about annuity contracts; and (2) assist purchasers of annuity contracts to understand certain basic features of annuity contracts. Notes 28 Tex. Admin. Code § 3.9701 The …

(a) This subchapter applies to all group and individual annuity contracts and certificates except as provided by subsection (b) of this section. (b) This subchapter does not apply to the following annuity products except as provided in subsection (c) of this section: (1) immediat…

This subchapter shall apply only to annuity transactions subject to regulation under this subchapter that occur on or after the date that is six months after the effective date of this subchapter. Notes 28 Tex. Admin. Code § 3.9703 The provisions of this §3.9703 adopted to be eff…

(a) Words and terms defined in the Insurance Code Chapter 102 shall have the same meaning when used in this subchapter. (b) The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. (1) Agent--An…

(a) For the purposes of this subchapter, "determinable elements" means elements derived from processes or methods that are guaranteed at issue and are not subject to company discretion, but for which the values or amounts cannot be determined until some point after issue. The ter…

(a) For the purposes of this subchapter, "guaranteed element" means an element listed in § 3.9705 (a)(1) - (7) of this subchapter (relating to Determinable Elements) that is guaranteed and determined at issue. An element is considered guaranteed if all of the underlying elements …

Compliance with this subchapter is not a defense in any action brought by or for the department alleging a violation of the Insurance Code, or, except for this subchapter, any rule adopted pursuant to the Insurance Code. Notes 28 Tex. Admin. Code § 3.9707 The provisions of this §…

(a) If an application for an annuity contract or certificate is taken in a face-to-face meeting, the applicant shall be given at or before the time of application both a disclosure document and the appropriate buyer's guide specified in § 3.9710 of this subchapter (relating to Bu…

(a) At a minimum, the following information, if applicable, must be included in the disclosure document required to be provided under this subchapter: (1) the generic name of the contract; the insurer product name, if different from the generic name; the product's form number; an…

For the purposes of this subchapter, an appropriate buyer's guide is the latest version of the buyer's guide adopted by the NAIC that applies to the particular type of annuity (such as fixed deferred annuity, equity-indexed annuity, or variable annuity) that is the subject of the…

(a) If the buyer's guide and the disclosure document required by this subchapter are not provided at or before the time of application, a free look period of at least 15 calendar days must be provided during which the applicant may return the contract without penalty. (b) Notice …

(a) For annuities in the payout period with changes in non-guaranteed elements and for the accumulation period of a deferred annuity, the insurer shall provide each contract owner with a report, at least annually, on the status of the contract. (b) The report must contain at leas…

The purpose of this division is to provide standards for the disclosure of certain minimum information about annuity suitability and to adopt related forms to meet the requirements of Insurance Code Chapter 1115, concerning Suitability of Certain Annuity Transactions. Notes 28 Te…

(a) Before the recommendation or sale of an annuity, an agent must provide to the consumer a form that meets the requirements of Insurance Code § 1115.0514(b) , concerning Disclosure Obligation. The agent must use: (1) form FIN194 (07/21), which is adopted by reference and is ava…

(a) Terms in this subchapter have the same meaning as defined and used in Insurance Code Chapter 1458. (b) The following words and terms when used in this subchapter have the following meanings unless the context clearly indicates otherwise: (1) Affiliate--Includes each person th…

(a) TDI adopts the Provider Network Contracting Entity Registration Form by reference. (b) Except as provided in subsection (c) of this section, each person operating as a contracting entity must submit to TDI a fully completed Provider Network Contracting Entity Registration For…

(a) TDI adopts the Provider Network Contracting Entity Exemption of Affiliates Form by reference. (b) Unless the commissioner has granted an affiliate exemption to the contracting entity under this section, each contracting entity that is a health maintenance organization or othe…

(a) A Provider Network Contracting Entity Registration Form under § 3.9802 of this title or a Provider Network Contracting Entity Exemption of Affiliates Form under § 3.9803 of this title must be accompanied by the required fee of $1,000. (b) No fee is required for submitting a c…

(a) Except as provided in subsection (c) of this section, the grant of express authority of a provider for access to their fee schedules cannot be presumed for any line of business for the purposes of compliance with Insurance Code § 1458.101 . (b) The contracting entity must not…