28 Tex. Admin. Code § 11.2607 - Examinations of Delegated Entities

(a) On receipt of complaints, a notice under § 11.2606 of this title (relating to Reporting Requirements), or as otherwise permitted under the Insurance Code or related rules, the department may examine any matter relating to the financial solvency of the delegated entity or delegated third party or the delegated entity's ability to meet its responsibilities under the delegation agreement.

(b) The department may request documents, perform on-site examinations, and require any other action of the delegated entity and any delegated third party that the department determines necessary to perform an examination under this section.

(c) A delegated entity's failure to comply with a request under subsection (b) of this section may result in either or both:

(1) notification to the HMO that the delegated entity is subject to penalties under the delegation agreement; or

(2) entry of an order by the commissioner to resume or redelegate any functions delegated to the delegated entity or terminate the agreement in its entirety.

(d) The department will issue a report to the delegated entity and HMO on completion of the department's examination. The report will detail the results of the examination and any corrective actions necessary by the delegated entity or HMO.

(e) The delegated entity and the HMO must respond to the department's report and submit a corrective action plan to the department not later than the 30th day after the date of receipt of the department's report.

Notes

28 Tex. Admin. Code § 11.2607

The provisions of this §11.2607 adopted to be effective October 13, 2002, 27 TexReg 9585; Adopted by Texas Register, Volume 42, Number 16, April 21, 2017, TexReg 2266, eff. 8/1/2017