Texas Administrative Code

The purpose of this subchapter is to augment and implement the regulation of an employee health benefit plan that is not fully insured and is sponsored by a PEO as permitted by Texas Labor Code Chapter 91, concerning Professional Employer Organizations. Notes 28 Tex. Admin. Code …

(a) The governing body, which must comply with the requirements described in Insurance Code § 848.052 , must have ultimate responsibility for the development, approval, implementation, and enforcement of administrative, operational, personnel, and patient care policies and proced…

An HCC that delegates responsibility by contract with a delegated entity, delegated network, or delegated third party, as those terms are defined in Insurance Code § 1272.001 through reference to contracts with HMOs, must: (1) submit to the department a monitoring plan setting ou…

An HCC must notify all affected payors in writing of a material change in the payment arrangement for physicians, health care providers, or both within 30 days of any change in the type of payment arrangement for any type of service (for example, from capitation to fee-for-servic…

(a) The commissioner may require additional information from the HCC or any participant in the HCC as reasonably necessary to make any determination required by Insurance Code Chapter 848, this subchapter, and applicable insurance laws and regulations of this state. (b) The commi…

For any change in control of an authorized HCC that results in an increase to its market share in any PSA as provided in § 13.414 of this title (relating to Limited Exemption from Certain Information Filing Requirements), the department may require that the HCC file an applicatio…

(a) A proposed acquisition of control will be disapproved if, after notice and opportunity for hearing, the commissioner determines that: (1) immediately following the change of control, the certificate holder would not be able to satisfy the requirements for the issuance of a ce…

(a) Unless an individual or entity has filed with the department the items as set forth in subsection (b) of this section, the individual or entity is prohibited from: (1) acquiring an ownership interest in an entity that holds a certificate of authority as an HCC if the individu…

HCCs must comply with Insurance Code Chapters 541 and 542, and rules promulgated by the department pursuant to Insurance Code Chapters 541 and 542, as applicable, in the same manner as insurance companies or HMOs. Notes 28 Tex. Admin. Code § 13.429 The provisions of this §13.429 …

(a) An HCC must establish and administer procedures and internal controls to safeguard and ensure against the sharing of any confidential information with or among participants. (b) The requirements of this section include establishing and enforcing collection, custodial, retriev…

(a) An HCC must comply with Insurance Code § 848.053 , including requirements relating to committee membership, charges, fees, distributions, or other compensation assessed for services provided by HCC participants, and to the sharing of the data among nonparticipating physicians…

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…

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) 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…

The following terms, when used in this subchapter, mean the following unless the context clearly indicates otherwise. (1) "Applicant" means any person, including a good-faith claimant, who files a vacancy application. (2) "Application commencement date" means the date determined …

(a) An applicant seeking a vacancy determination should file a vacancy application on the form prescribed by the commissioner, which may be obtained as follows: (1) by request in a letter addressed to the Vacancy Administrator, Texas General Land Office, Legal Services Division, …

(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) 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…

The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) "Agency" means the Department of Public Safety, Employees Retirement System, Teacher Retirement System, and the Texas Workforce Commiss…

(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 …

The commissioner of the General Land Office may reduce or waive any fee set forth in this chapter, or accept non-cash consideration in lieu of all or part of such fee, or both, if such action would be in the public interest as determined by the commissioner. Notes 31 Tex. Admin. …

(a) The commissioner may grant easements or leases for commercial and non-commercial improvements constructed on, across, through or under non-tidally influenced state-owned riverbeds and beds of navigable streams in the public domain, for bridges and those structures and purpose…

(a) Permanent Improvements. (1) On permanent school fund land leased or improvements for any purposes, the commissioner of the General Land Office may: (A) grant money from a special account funded from surface damage fees to the lessee to make permanent improvements to the land …

(a) This subchapter applies to applications to lease public lands dedicated to the permanent school fund for the purpose of exploring for or developing groundwater resources located on or under such lands. (b) The provisions of this subchapter are intended to assure that the grou…

(a) Permanent school fund lands may be leased for the exploration or development of groundwater resources through either a sealed bid procedure or through direct negotiation, at the discretion of the commissioner. Municipalities and other providers of public water supplies may be…

(a) This subchapter applies to applications to purchase or lease vacant land filed on or after June 18, 2009. This subchapter implements Texas Natural Resources Code §§ 51.171 - 51.195 , Acts 2005, 79th Legislature, Chapter 974 (2005), as amended in Acts 2009, 81st Legislature, C…

(a) Property report(s) filed by a holder pursuant to Property Code, Chapters 72-75 and 77, shall be submitted to the comptroller in the NAUPA Standard Electronic File format prescribed in the Comptroller's Unclaimed Property Reporting Instructions. A property report filed under t…

(a) Nothing in §§ 13.16 , 13.17 , 13.18 and 13.19 of this title (relating to Applicability, Definitions, Provisions of Information to the Comptroller, and Limitations) requires a state agency to search for or transfer information held outside its normal course of business. (b) In…

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…