Texas Administrative Code

(a) An HCC must maintain working capital composed of current assets with a ratio of current assets to current liabilities of 1.25:1, based on the greater of the prior year's actual liabilities or the projected liabilities for the subsequent year, subject to the following requirem…

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise. (1) Affiliate--As defined in Insurance Code § 848.001(1) . (2) Clinical director--Health professional who is: (A) appropriately licensed in goo…

This subchapter implements Insurance Code Chapter 848 and other insurance laws of this state that apply to health care collaboratives to provide the framework to support the use of innovative health care collaborative payment and delivery systems in this state. (1) Severability. …

No company or association shall operate under a name that is misleading or confusing to the public. A burial association shall include the words "burial association" in its name. Notes 28 Tex. Admin. Code § 13.4 The provisions of this §13.4 adopted to be effective February 23, 19…

(a) Requirement for use of specific forms. Risk retention group or purchasing group filings and registrations under the Insurance Code, Chapter 2201, must be effected by using forms promulgated by the commissioner of insurance. (b) Adoption by reference of forms. The commissioner…

The regulated entities subject to the fees imposed by this section shall include all risk retention groups and purchasing groups defined in the Insurance Code, Article 21.54, §2(9) and (10), and doing business in this state. For filings and other actions on and after May 19, 1987…

The following are deceptive acts or practices under the Insurance Code, Article 21.21: (1) representing a group to be a purchasing group located in another state, when the group is actually located in Texas, according to the Insurance Code, Article 21.54, §2(14); (2) soliciting m…

(a) At the time of reinsurance of a Chapter 14 association or company: (1) Determine on a reasonable basis the amount of net assets of the mutual assessment company attributable to the various blocks of life and health and accident business. The various blocks of business to whic…

(a) No association or company shall merge with another association or company nor transfer any part or group of its membership to another association or company nor merge nor transfer members from one group to another within an association or company without first obtaining the c…

(a) The applicant must file the original and a duplicate copy of the vacancy application with the county clerk of each county in which all or part of the land alleged to be vacant is located. (b) The county clerk shall mark the exact date and hour of filing on the original and a …

(a) Trustees' fidelity coverage. The board of trustees must maintain a fidelity bond or a zero-deductible crime policy that complies with the requirements of § 13.568 of this title (relating to Standards for Fidelity Coverage). The fidelity bond or zero-deductible crime policy mu…

Benefit claims or other disputes arising under an approved PEO's plan are subject to the Insurance Code, including utilization review and independent review under Insurance Code Title 14, concerning Utilization Review and Independent Review, and to resolution under state law in t…

The financial statements filed by an approved PEO under § 13.570 of this title (relating to Financial Filing Requirements) must report the trust's reserves as described below: (1) the trust's year-end reserves must be calculated as the difference between the trust's total claim d…

The trust must invest its assets in compliance with Insurance Code Chapter 425, Subchapter C, concerning Authorized Investments and Transactions for Capital Stock, Life, Health, and Accident Insurers. Notes 28 Tex. Admin. Code § 13.561 Adopted by Texas Register, Volume 41, Number…

(a) The following are membership fee plans. (1) Plan 1. The first three monthly assessments may be stipulated as a membership fee and may be placed in the expense fund. All other premiums or assessments shall be known as regular premium assessments and shall be divided as follows…

(a) Following the investigation described in § 13.44 of this title (relating to Investigation of Vacancy Application) and a hearing, if one is required by § 13.52 of this title (relating to Findings that Require Hearing), the commissioner shall issue a final order with a finding …

(a) If all necessary parties that can be located enter into an agreement with the commissioner that a hearing required by § 13.52 of this title (relating to Findings that Require Hearing) may be waived, no hearing is required. (b) After the chief surveyor determines that a vacanc…

(a) A hearing must be held under § 51.187 of the Texas Natural Resources Code if both of the following conditions exist: (1) a necessary party has properly filed an exception to the survey or the application under § 13.43 or § 13.48 (b) of this title (relating to Necessary Party …

Unless a hearing is required under § 13.52 of this title (relating to Findings that Require Hearing), the commissioner may find that a vacancy exists by issuing a final order supported by findings of fact and conclusions of law at any time following the completion of the investig…

(a) Prior to the first anniversary of the application commencement date, the commissioner may issue an order finding that the alleged vacancy is "Not Vacant Land" at any time following the completion of the investigation of the vacancy under § 13.44 of this title (relating to Inv…

(a) An appointed surveyor may be removed upon motion of the commissioner or of any necessary party. (b) Petition for removal. (1) Any necessary party may petition the commissioner for the removal of an appointed surveyor because of bias, prejudice, or conflict of interest. (2) An…

(a) A necessary party may file an exception or exceptions to the survey or to the vacancy application within sixty (60) days of the date of the notice of vacancy application from the agency, or within thirty (30) days of the date of notice of an appointed surveyor's report under …

(a) If the agency sends a notice to a necessary party and the notice is returned, the agency shall make reasonable efforts to locate the necessary party. If the reasonable efforts do not locate the necessary party, the agency, in its sole discretion, may request that the attorney…

(a) If, based on all the documents submitted, the applicant's list of necessary parties appears to be incomplete, the agency will conduct an investigation of the ownership interests in the alleged vacant land and in the land surrounding the alleged vacant land to ensure that all …

(a) Not later than thirty days following the application commencement date, the agency shall send a written notice of vacancy application to all necessary parties by regular mail and by certified mail, return receipt requested. The notice shall include the following documents: (1…

(a) A cost deposit from the applicant is required for the agency to evaluate and investigate the vacancy application. Any required deposit shall be used only for the agency's administrative costs, the expenses of a survey (if the commissioner appoints a surveyor), and other inves…

(a) The properly filed vacancy application will be deemed administratively complete when the agency determines that the applicant has submitted all the necessary documents in the proper form to support a claim of vacancy. (b) Within forty-five (45) days after the date that the ap…

(a) When a vacancy application is received by the agency, the chief surveyor will determine whether the application was properly filed under § 13.34 of this title (relating to Vacancy Application: Requirements). (b) The date of the chief surveyor's determination that the applicat…

(a) The applicant shall submit to the commissioner two duplicate copies of the marked copy that has been file-stamped by the county clerk not later than the 30th day after the date the vacancy application is filed with the county clerk. The commissioner shall mark the date on whi…

(a) Each company or association shall hereafter maintain no less than the following records, which shall be the property of such company or association. (1) A daily collection sheet (or other acceptable records) on which the following shall be recorded: date, policy number, name …

(a) The board finds and declares that mutual assessment companies, local mutual aid associations and burial associations shall operate in the following manner and under the following conditions. (1) The operation of such companies shall be mutual in character. (2) The operation o…

The purpose of this subchapter is to regulate, to the extent permitted by law and dictated by sound public policy, groups doing business in Texas as risk retention groups or purchasing groups. Notes 28 Tex. Admin. Code § 13.301 The provisions of this §13.301 adopted to be effecti…

(a) Documents must be submitted for approval. (1) Forms must be submitted in duplicate, completed as John Doe Specimen. Typewritten forms may be submitted for preliminary review, but only printed forms will be accepted for approval and filing. (2) The following forms are required…

(a) At the time of determination (effective December 31, 1965): (1) determine on a reasonable basis the amount of net assets of the mortuary fund of the mutual assessment company attributable to the various blocks of life and health and accident business. The various blocks of bu…

The association may take an asset in the mortuary fund for uncollected net premiums on policies for which the reserve has been included in the reserve valuation. No credit will be allowed for deferred premiums if a method adopted by the company or association for computing its re…

(a) General. The life insurance reserves required to be maintained by all mutual assessment associations shall be computed in accordance with recognized actuarial principles based upon the liability of the association as set out in its various life insurance contracts. In general…

In computing any period of time for the mailing of notices of a meeting of the membership or board of directors of a mutual assessment company or association, the day of mailing and the day of meeting shall not be counted. Notes 28 Tex. Admin. Code § 13.26 The provisions of this …

(a) The name of a new association must be submitted and reserved before making any definite arrangements for conversion. To convert a burial association or change the name of a burial association or local mutual aid association, the constitution and bylaws and articles of associa…

(If articles of association are changed, the same procedure should be followed as for amending constitution and bylaws.) (1) The constitution and bylaws must be amended in accordance with the Insurance Code, Article 14.05, which reads substantially as follows: "Bylaws of any asso…

(a) Ownership of assets. (1) No company or association funds may be disbursed for the purpose of purchasing or investing in any asset unless such asset thereby becomes the property of the fund from which the disbursement is made, but this requirement shall not prohibit an unequiv…

There is no present rule on this subject. Licensees should refer to statutory law. Notes 28 Tex. Admin. Code § 13.13 The provisions of this §13.13 adopted to be effective January 1, 1976.

(a) All rate schedules to be used by a company or association shall be first adopted in accordance with the bylaws or articles of association of such company or association and shall be submitted in duplicate to the State Board of Insurance prior to the use of such rates. (b) All…

There is no present rule on this subject. Licensees should refer to statutory law. Notes 28 Tex. Admin. Code § 13.11 The provisions of this §13.11 adopted to be effective January 1, 1976.

(a) The reserve basis adopted by the company shall be shown on the rate schedule and may be shown in the policy. (b) Family group policies, upon which the rate is calculated on an individual insured basis, shall contain a provision with reference to a reduction of premium in the …

(a) Responsible for operations and assets. Members of the board of trustees are responsible for all operations of the trust and must take all necessary precautions to safeguard plan assets. (b) Contract for plan administration. Within 12 months of the establishment of the initial…

(a) Appointment. An approved PEO may appoint members of the board of trustees. (b) Number of members. The board of trustees must have no fewer than three members. (c) Ineligible individuals. An owner, officer, or employee of a third party administrator or contracted regulated ent…

(a) Commissioner's review. The commissioner will review the applicant's submission and other pertinent information, including information from TDLR, to ensure the applicant's compliance with applicable statutes and regulations, and: (1) conduct any investigation that the commissi…