Texas Administrative Code

(a) The banking commissioner may not be compelled to hold a hearing before granting or denying the charter application. He may grant a hearing at the request of an applicant or a protesting party. He may order a hearing without any party having requested one. (b) A party requesti…

(a) A protest of a charter application must be received by the department before the 15th day after the date the organizers publish notice and must be accompanied by any fee required by § 21.5 (b) of this title (relating to Public Notice). If the protest is untimely, the departme…

Words and terms used in this chapter that are defined in the Trust Company Act, have the same meanings as defined therein. The following words and terms, when used in this chapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Accepted fil…

Unless otherwise noted, this chapter only applies to single family Programs. Program rules may impose additional requirements related to any provision of this chapter. Elements of local residential building codes that require a greater degree of energy efficiency than this chapte…

(a) Tex. Gov't Code, § 2306.187 requires that the Department develop and adopt rules relating to Minimum Energy Efficiency requirements for new construction, reconstruction, and rehabilitation activities in Single Family Programs. (b) This chapter describes the Minimum Energy Eff…

(a) An advertisement in respect of the time within which claims are paid, the dollar amounts of claims paid, the number of claims paid, the number of persons insured under a particular policy or policies, or similar statistical information relating to an insurer or policy may not…

(a) An advertisement may not state or imply anything offering or tending to offer a good, service, or other guarantee or contractual right of pecuniary value outside of the express terms of the policy offered by the advertisement. (1) This subsection does not prohibit, in connect…

(a) An advertisement may not directly or indirectly unfairly disparage competitors, their policies, services, or business methods, and may not unfairly disparage or minimize competing methods of marketing insurance. (b) An advertisement may not contain statements that are untrue …

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. (1) Affiliation period--A period of time that under the terms of the coverage offered by an HMO, must expire before the coverage becomes effec…

Each issuer of a health benefit plan shall provide a certification of coverage in accordance with § 21.1103 of this title (relating to Timing of Issuance of Written Certificate of Creditable Coverage to an Individual) through § 21.1108 of this title (relating to Notification of C…

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. (1) Health status-related factor--Health status; medical condition, including both physical and mental illnesses; claims experience; receipt o…

(a) Each issuer of a health benefit plan shall comply with the following: (1) For an individual who is a qualified beneficiary entitled to elect COBRA continuation coverage, a certificate of creditable coverage shall be provided at the time the individual would lose coverage unde…

(a) Except as otherwise provided in § 21.1107 of this title (relating to Creditable Coverage Established Through Means Other Than Written Certificate), a certificate of creditable coverage must be provided in writing. (b) The written certificate of creditable coverage shall inclu…

(a) A certificate shall be provided to an individual as provided in § 21.1103 (a) of this title (relating to Timing of Issuance of a Written Certificate of Creditable Coverage to an Individual) or an entity requesting the certificate on behalf of the individual by first-class mai…

(a) An issuer of a health benefit plan is required to use reasonable efforts to determine the information needed for a certificate of creditable coverage relating to dependent coverage. (b) An issuer of a health benefit plan that cannot provide the names or addresses of dependent…

(a) An individual may establish creditable coverage through means other than a written certificate of creditable coverage as provided in § 21.1103 of this title (relating to Timing of Issuance of a Written Certificate of Creditable Coverage) if the accuracy of a written certifica…

(a) After receipt of a written certification of creditable coverage as provided under § 21.1103 of this title (relating to Timing of Issuance of a Written Certificate of Creditable Coverage to an Individual) or other means as provided under § 21.1107 of this title (relating to Cr…

If any provision of this subchapter or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of this subchapter and the application of its provisions to any persons under other circumstances shall not be affected thereby. Notes…

(a) An advertisement may not directly or indirectly make an unfair or incomplete comparison of policies, benefits, dividends, or rates, or compare noncomparable policies. (b) An advertisement containing a comparison of policies of different insurers shall prominently state the fo…

(a) Form CCC relating to Insurance Code § 1205.002 and § 1357.056 for certification and disclosure of coverage under a health benefit plan is included in subsection (b) of this section in its entirety and has been filed with the Office of the Secretary of State. (b) Form CCC refe…

Failure to abide by §§21.101 - 21.122 of this division (relating to Insurance Advertising) is prohibited. An omission of information, false implication, or impression which is misleading or deceptive or has the tendency or capacity to be misleading or deceptive is prohibited. The…

(a) Coverage details. An invitation to inquire that specifies either the dollar amount of benefit payable or the period of time during which the benefit is payable must contain a provision in effect as follows: "For specific costs and further details of the coverage, including ex…

As can be made applicable and as necessary the same or similar test or standard as is stated hereafter within paragraph (1)(B) of this section is to be used as the standard in the interpretation of the provisions of this section. (1) Identification of policy. (A) The form number …

(a) No advertisement may use the word "dividends" or similar words or illustrations in such a manner as to state or to imply that future dividends are guaranteed or certain to occur. (b) The word "dividends" includes every return of premium and payment to policyholders on a parti…

(a) Advertising file. Each insurer, domestic and foreign, doing an insurance business in Texas shall maintain at its home office or principal (executive) office, a complete file containing a specimen of every institutional advertisement, invitation to inquire advertisement, or in…

This division is not intended to conflict with or supersede and are to be interpreted when possible as not to conflict with any sections except as stated in this section currently in force or subsequently adopted in this state and including without intending any limitation those …

If any provision of this division or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect the other provisions or any other application of this division which can be given effect without the invalid provisions or ap…

Each cause of action, pending litigation, matter in process before the Texas Department of Insurance or commissioner of insurance, or matter hereafter arising from an event occurring prior to the time this division becomes effective shall be determined in accordance with and gove…

(a) Any advertisement required to be submitted or submitted voluntarily by an insurer licensed to do business in Texas must be accompanied by a transmittal letter addressed to the Texas Department of Insurance, Life and Health Lines, MC-LH-LHL, P.O. Box 12030, Austin, Texas 78711…

(a) No advertisement may state a premium for a policy that does not apply to the exact coverage advertised. (b) If a premium is quoted in an advertisement that does not apply to all classes of risk solicited, the class or classes to which it applies must be identified. (c) Advert…

If any provision of this subchapter or the application thereof to any person or circumstances is for any reason held invalid, the invalidity shall not affect the other provisions or any application of this subchapter that can be given effect without the invalid provisions or appl…

(a) The purpose of this section is to implement Insurance Code Chapter 1213. This section applies to a contract between an issuer of a health benefit plan and a health care professional or health care facility (hereinafter referred to as "physicians or providers"). (b) Consistent…

This subchapter applies to a health benefit plan issuer that enters into or renews a contract with a participating provider on or after January 31, 2006. The provisions of Insurance Code § 1274.002 and this subchapter are not applicable to Medicaid and Children's Health Insurance…

The following words and terms, when used in this subchapter, have the following meanings unless the context clearly indicates otherwise. (1) Enrollee--An individual who is eligible for coverage under a health benefit plan, including a covered dependent. (2) Health benefit plan--A…

(a) Beginning January 31, 2006, a health benefit plan issuer shall, in writing, communicate to each participating provider that enters into or renews a contract with the health benefit plan issuer, the method or methods by which the provider may request an eligibility statement. …

(a) A participating provider may, prior to providing services to an enrollee, request an eligibility statement using a method designated by the health benefit plan issuer. (b) A request under subsection (a) of this section must include: (1) the enrollee's full name; (2) the enrol…

(a) A health benefit plan issuer shall maintain a system to enable it to provide eligibility statements to participating providers using the information provided under § 21.3804 (b) and (c) of this subchapter (relating to Requests for Eligibility Statements). On receipt of a requ…

(a) No provision of the Insurance Code may be construed to prevent a health carrier or other entity issuing a health benefit plan from applying deductible or copayment requirements to benefits and services, including state-mandated health benefits and services, in order to qualif…

This subchapter applies to coverage under a health benefit plan issued, amended to be effective, renewed, or issued for delivery on or after January 1, 2006. Notes 28 Tex. Admin. Code § 21.3905 The provisions of this §21.3905 adopted to be effective May 31, 2006, 31 TexReg 4439

The term misrepresentation, or the prohibited conduct, act, or practice that constitutes misrepresentation by a person subject to the provisions of these sections, is defined as any one of the following acts or omissions: (1) any untrue statement of a material fact; (2) any omiss…

This subchapter applies to group preferred provider benefit plans and evidences of coverage issued pursuant to Insurance Code Chapters 843 and 1301. The subchapter outlines a group policyholder's or group contract holder's liability for premium payment, and a health carrier's obl…

(a) Notwithstanding the provisions of Insurance Code Chapter 1501, §541.056(a) and §544.052, and the provisions of Chapter 26, Subchapter A of this title, an individual or group health benefit plan issuer, an accident and health insurance issuer, or a health maintenance organizat…

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise. (1) Evidence of coverage--Any certificate, agreement, or contract, including a blended contract, that: (A) is issued to an enrollee; and …

(a) Liability for Premiums for Individuals Who Are No Longer Part of the Covered Group. (1) A contract between a health carrier and a group policyholder or group contract holder under a health benefit plan contract must provide that: (A) the group policyholder or group contract h…

The purpose of these sections is to eliminate unfair discrimination based upon sex or marital status in the terms and conditions of insurance policies, in the underwriting criteria of insurers, and in the rates, rating plans, and rating classifications of insurers. Notes 28 Tex. …

In individual policies, if a person loses coverage due to a change in marital status, that person shall be issued a policy which the insurer is then issuing which most nearly approximates the coverage of the policy which was in effect prior to the change in marital status. The ne…

The subject matters covered by this subchapter treat only a portion of the subject matters contemplated by Insurance Code Chapter 541 and are not exhaustive on this subject; therefore, these sections remain open for corrections and future additions as the needs may arise or proce…