28 Tex. Admin. Code § 13.523 - Applicable Insurance Code Provisions
(a)
The following provisions of the Insurance Code are applicable to an approved
PEO to the same extent as the provisions apply to any entity TDI regulates
under those provisions:
(1) Insurance Code
Chapter 36, Subchapter C, concerning General Subpoena Powers; Witnesses and
Production of Records;
(2)
Insurance Code Chapter 36, Subchapter D, concerning Judicial Review;
(3) Insurance Code §
38.001, concerning
Inquiries;
(4) Insurance Code
Chapter 38, Subchapter F, concerning Data Collecting and Reporting Relating to
Mandated Health Benefits and Mandated Offers of Coverage;
(5) Insurance Code Chapter 38, Subchapter H,
concerning Health Care Reimbursement Rate Information;
(6) Insurance Code Chapter 40, concerning
Duties of State Office of Administrative Hearings and Commissioner in Certain
Proceedings; Rate Setting Proceedings;
(7) Insurance Code Chapters 82, concerning
Sanctions;
(8) Insurance Code
Chapter 83, concerning Emergency Cease and Desist Orders;
(9) Insurance Code Chapter 84, concerning
Administrative Penalties;
(10)
Insurance Code Chapter 101, concerning Unauthorized Insurance;
(11) Insurance Code Chapter 461, concerning
General Provisions;
(12) Insurance
Code §
521.005, concerning
Notice to Accompany Policy;
(13)
Insurance Code Chapter 541, Subchapter A, concerning General
Provisions;
(14) Insurance Code
Chapter 541, Subchapter B, concerning Unfair Methods of Competition and Unfair
or Deceptive Acts or Practices Defined;
(15) Insurance Code Chapter 541, Subchapter
B-1, concerning Advertising Requirements;
(16) Insurance Code Chapter 542, concerning
Processing and Settlement of Claims;
(17) Insurance Code Chapter 543, concerning
Prohibited Practices Related to Policy or Certificate of Membership;
(18) Insurance Code Chapter 544, Subchapter
A, concerning General Prohibitions Against Discrimination by an Insurer or
Health Maintenance Organization;
(19) Insurance Code Chapter 544, Subchapter
B, concerning Other General Prohibitions Against Discrimination by
Insurers;
(20) Insurance Code
Chapter 544, Subchapter C, concerning English Fluency;
(21) Insurance Code Chapter 544, Subchapter
D, concerning Family Violence;
(22)
Insurance Code Chapter 544, Subchapter E, concerning Fibrocystic Breast
Condition;
(23) Insurance Code
Chapter 545, concerning HIV Testing;
(24) Insurance Code Chapter 546, concerning
Use of Genetic Testing Information;
(25) Insurance Code §
550.002, concerning
Increase in Certain Premium Payments;
(26) Insurance Code Chapter 558, concerning
Refund of Unearned Premium;
(27)
Insurance Code Chapter 560, concerning Prohibited Rates;
(28) Insurance Code Chapter 601, concerning
Privacy;
(29) Insurance Code
Chapter 602, concerning Privacy of Health Information;
(30) Insurance Code Chapter 701, concerning
Insurance Fraud Investigations;
(31) Insurance Code Chapter 705, concerning
Misrepresentations by Policyholders;
(32) Insurance Code Chapter 801, concerning
Certificate of Authority;
(33)
Insurance Code Chapter 803, concerning Location of Books, Records, Accounts,
and Offices Outside of this State;
(34) Insurance Code Chapter 804, concerning
Service of Process;
(35) Insurance
Code Chapter 823, Subchapter B, concerning Registration;
(36) Insurance Code Chapter 823, Subchapter
C, concerning Transactions of Registered Insurer;
(37) Insurance Code Chapter 823, Subchapter
D, concerning Control of Domestic Insurer; Acquisition or Merger;
(38) Insurance Code §
1201.013, concerning
Programs Promoting Disease Prevention, Wellness, and Health;
(39) Insurance Code §
1201.059, concerning
Termination of Coverage Based on Age of Child in Individual, Blanket, or Group
Policy;
(40) Insurance Code §
1201.062, concerning
Coverage for Certain Children in Individual or Group Policy or in Plan or
Program;
(41) Insurance Code §
1201.063, concerning
Prohibition of Certain Criteria Relating to a Child's Coverage in Individual or
Group Policy;
(42) Insurance Code §
1201.064, concerning
Coverage for Child of Spouse in Individual or Group Policy;
(43) Insurance Code Chapter 1203, concerning
Coordination of Benefits Provisions;
(44) Insurance Code Chapter 1204, Subchapter
A, concerning Payments to Certain Public Hospitals;
(45) Insurance Code Chapter 1204, Subchapter
B, concerning Assignment of Benefit Payments;
(46) Insurance Code Chapter 1204, Subchapter
D, concerning Payments for Certain Publicly Provided Services;
(47) Insurance Code Chapter 1204, Subchapter
E, concerning Exclusionary Clauses;
(48) Insurance Code Chapter 1204, Subchapter
F, concerning Payment of Benefits to Conservator of Minor;
(49) Insurance Code Chapter 1205, concerning
Certificate of Creditable Coverage;
(50) Insurance Code Chapter 1206, concerning
Denial of Health Benefit Plan Enrollment Based on Existing Coverage
Prohibited;
(51) Insurance Code
Chapter 1207, concerning Enrollment of Medical Assistance Recipients and
Children Eligible for State Child Health Plan;
(52) Insurance Code Chapter 1208, concerning
Identity of Available Employee of Health Benefit Plan Issuer;
(53) Insurance Code Chapter 1210, concerning
Notice of Certain Policy Provisions;
(54) Insurance Code Chapter 1213, concerning
Electronic Health Care Transactions;
(55) Insurance Code Chapter 1214, concerning
Advertising for Certain Health Benefits;
(56) Insurance Code Chapter 1215, concerning
Reporting of Claims Information;
(57) Insurance Code Chapter 1216, concerning
Out-of-Country Coverage Prohibited;
(58) Insurance Code Chapter 1251, Subchapter
C, concerning Group Accident and Health Insurance: Required
Provisions;
(59) Insurance Code
Chapter 1251, Subchapter D, concerning Group Accident and Health Insurance:
Coverage for Dependents;
(60)
Insurance Code Chapter 1251, Subchapter E, concerning Group Accident and Health
Insurance: General Provisions;
(61)
Insurance Code Chapter 1251, Subchapter F, concerning Continuation or
Conversion Privilege on Termination of Coverage under Group Policy, except that
an approved PEO may not offer a conversion policy under Insurance Code §
1251.256, concerning
Conversion of Group Policy;
(62)
Insurance Code Chapter 1251, Subchapter G, concerning Continuation of Group
Coverage for Certain Family Members and Dependents;
(63) Insurance Code Chapter 1252, concerning
Discontinuation and Replacement of Group and Group-Type Health Benefit Plan
Coverage;
(64) Insurance Code
Chapter 1274, concerning Electronic Transmission of Eligibility and Payment
Status;
(65) Insurance Code Chapter
1301, concerning Preferred Provider Benefit Plans, except that a small PEO plan
is not subject to §1301.009, concerning Annual Report;
(66) Insurance Code Chapter 1351, concerning
Home Health Services;
(67)
Insurance Code Chapter 1352, concerning Brain Injury;
(68) Insurance Code Chapter 1355, concerning
Benefits for Certain Mental Disorders;
(69) Insurance Code Chapter 1356, concerning
Low-Dose Mammography;
(70)
Insurance Code Chapter 1357, concerning Mastectomy;
(71) Insurance Code Chapter 1358, concerning
Diabetes;
(72) Insurance Code
Chapter 1359, concerning Formulas for Individuals with Phenylketonuria or Other
Heritable Diseases;
(73) Insurance
Code Chapter 1360, concerning Diagnosis and Treatment Affecting
Temporomandibular Joint;
(74)
Insurance Code Chapter 1361, concerning Detection and Prevention of
Osteoporosis;
(75) Insurance Code
Chapter 1362, concerning Certain Tests for Detection of Prostate
Cancer;
(76) Insurance Code Chapter
1363, concerning Certain Tests for Detection of Colorectal Cancer;
(77) Insurance Code Chapter 1364, concerning
Coverage Provisions Relating to HIV, Aids, or HIV-Related Illnesses;
(78) Insurance Code Chapter 1365, concerning
Loss or Impairment of Speech or Hearing;
(79) Insurance Code Chapter 1366, concerning
Benefits Related to Fertility and Childbirth;
(80) Insurance Code Chapter 1367, concerning
Coverage of Children;
(81)
Insurance Code Chapter 1368, concerning Availability of Chemical Dependency
Coverage;
(82) Insurance Code
Chapter 1369, concerning Benefits Related to Prescription Drugs and Devices and
Related Services;
(83) Insurance
Code Chapter 1370, concerning Certain Tests for Detection of Human
Papillomavirus, Ovarian Cancer, and Cervical Cancer;
(84) Insurance Code Chapter 1371, concerning
Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related
Services;
(85) Insurance Code
Chapter 1376, concerning Certain Tests for Early Detection of Cardiovascular
Disease;
(86) Insurance Code
Chapter 1377, concerning Coverage for Certain Amino Acid-Based Elemental
Formulas;
(87) Insurance Code
Chapter 1379, concerning Coverage for Routine Patient Care Costs for Enrollees
Participating in Certain Medical Trials;
(88) Insurance Code Chapter 1451, concerning
Access to Certain Practitioners and Facilities;
(89) Insurance Code Chapter 1453, concerning
Disclosure of Reimbursement Guidelines under Managed Care Plan;
(90) Insurance Code Chapter 1454, concerning
Equal Health Care for Women;
(91)
Insurance Code Chapter 1455, concerning Telemedicine and Telehealth;
(92) Insurance Code Chapter 1456, concerning
Disclosure of Provider Status;
(93)
Insurance Code Chapter 1460, concerning Standards Required Regarding Certain
Physician Rankings by Health Benefit Plans;
(94) Insurance Code Chapter 1467, concerning
Out-of-Network Claim Dispute Resolution;
(95) Insurance Code Chapter 1501, Subchapter
A, concerning General Provisions;
(96) Insurance Code Chapter 1501, Subchapter
C, concerning Provision of Coverage;
(97) Insurance Code Chapter 1501, Subchapter
M, concerning Large Employer Health Benefit Plans;
(98) Insurance Code Chapter 1502, concerning
Health Benefit Plans for Children;
(99) Insurance Code Chapter 1503, concerning
Coverage of Certain Students;
(100)
Insurance Code Chapter 1504, concerning Medical Child Support;
(101) Insurance Code Chapter 1507, Subchapter
A, concerning Consumer Choice of Benefits Health Insurance Plans;
(102) Insurance Code Chapter 1653, concerning
High Deductible Health Plan;
(103)
Insurance Code Chapter 1661, concerning Information Technology;
(104) Insurance Code Chapter 1701, concerning
Policy Forms;
(105) Insurance Code
Chapter 4201, concerning Utilization Review Agents; and
(106) Insurance Code Chapter 4202, concerning
Independent Review Organizations.
(b) Approved PEO as insurer; client as
policyholder. For purposes of applying provisions addressing refunds of
unearned premiums in Insurance Code Chapter 558, an approved PEO is the
equivalent of an insurer, and the approved PEO's client is the equivalent of a
policyholder.
(c) Client as plan
sponsor. For purposes of applying Insurance Code Chapter 1215, a client is the
equivalent of a plan sponsor as defined by Insurance Code §
1215.001, concerning
Definitions.
(d) Approved PEO as
insurer and employer. For purposes of applying Insurance Code Chapter 1251,
Subchapters E, F, and G, an approved PEO is the equivalent of both an insurer
and an employer.
(e) Approved PEO
as insurer; client as group policyholder. For purposes of applying Insurance
Code §
1301.0061, an approved
PEO is the equivalent of an insurer, and the approved PEO's client is the
equivalent of a group policyholder.
(f) Approved PEO as employer. For purposes of
applying provisions addressing required offers of coverage in Insurance Code
Title 8, Subtitle E, concerning Benefits Payable under Health Coverages, an
approved PEO is the equivalent of an employer entitled to elect or decline an
offer of coverage required by the Insurance Code.
(g) Approved PEO as carrier; client as
policyholder. For purposes of applying Insurance Code Chapter 1501, Subchapter
A, an approved PEO is the equivalent of a health insurance carrier, and the
approved PEO's client is the equivalent of a policyholder.
(h) Approved PEO as large employer issuer;
client as employer. For purposes of applying Insurance Code Chapter 1501,
Subchapter C, an approved PEO is the equivalent of a large employer health
benefit plan issuer, and the approved PEO's client is the equivalent of an
employer.
(i) Approved PEO as
issuer; client as group contract holder. For purposes of applying provisions in
Insurance Code Chapter 1365 addressing required offers of coverage, an approved
PEO is the equivalent of a group health benefit plan issuer, and the approved
PEO's client is the equivalent of a group contract holder.
Notes
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