28 Tex. Admin. Code § 3.23 - Acceptance, Rejection, and Disposition of Filings
(a) Acceptance, approval, and exemption of
filings. Upon submission, a filing will be accepted for preliminary review of
compliance with the filing requirements in this subchapter. If the filing
requirements in this subchapter have not been satisfied, the department will
consider the filing incomplete and may reject the filing or request that the
issuer make corrections. After a filing has been accepted by the department, an
issuer is not permitted to expand the scope of a filing, such as by submitting
additional forms for review, unless the department has instructed the issuer to
do so.
(1) Review period for filings subject
to approval. Filings subject to approval, whether filed in a
review-and-approval mode or a file-and-use mode, will be reviewed for
compliance with the Insurance Code, this title, and any other applicable law of
this state or the United States. Filings are considered filed as of the date
the filing is submitted, unless the filing is rejected as provided in
subsection (b) of this section. The filings, after review, will be
affirmatively approved or disapproved within the statutory deemer period if
applicable, under Insurance Code §
1271.102, concerning
Procedures for Approval of Form of Evidence of Coverage or Group Contract;
Withdrawal of Approval; §1701.054, concerning Approval of Form; or §1701.058,
concerning Reconsideration of Form, unless the department initiates a request
for correction as set forth in subsection (c) of this section.
(2) Date for exempt filings. As permitted
under Subchapter Z of this chapter (relating to Exemption from Review and
Approval of Certain Life, Accident, Health, and Annuity Forms and Expedition of
Review), an issuer may submit a filing in an exempt mode. A filing closed with
an exempt disposition is considered exempt as of the disposition date, unless
the filing is rejected as provided in subsection (b) of this section. Exempt
filings are subject to audit as specified in §
3.4008 of this title (relating to
Procedures for Corrections to Non-Compliant Exempt Forms).
(3) Date for informational filings. A filing
submitted in an informational mode will be closed with an informational
disposition, unless the department determines that the filing is subject to
review. Informational filings are considered filed as of the date the filing is
submitted, unless the filing is rejected as provided in subsection (b) of this
section.
(b) Rejection of
filings.
(1) If the department determines that
a filing does not meet the requirements of this subchapter, the department will
reject the filing as incomplete and notify the issuer of the reason for
rejection or request that the issuer make corrections to the filing. If the
issuer does not make corrections within two business days of the department's
request for corrections, the department may reject the filing. A filing that is
closed with a rejected disposition will not be considered to have been filed or
accepted with the department for purposes of Insurance Code §§
1153.106, concerning
Rate Outside Certain Percentages of Presumptive Rate; 1271.102; or 1701.054, or
this subchapter.
(2) The department
may reject a filing for failure to comply with any requirement in this
subchapter, for example if a filing:
(A) is
marked confidential in its entirety;
(B) contains an individual consumer's
personally identifiable information in violation of §3.15 of this title
(relating to Confidential Information in Filings);
(C) contains changes from the previous form
that are not clearly identified; or
(D) contains a certification that is
materially inaccurate.
(3) The department will not reopen a rejected
filing to allow the issuer to make corrections. The issuer must submit a new
filing for the department to consider any corrections.
(c) Request for correction.
(1) Rather than disapproving a filing, the
department may request that the issuer make corrections to a form that contains
compliance deficiencies if:
(A) for an
insurance filing, the issuer, as necessary and at least seven days before the
date the filing is deemed approved (unless otherwise permitted by the
department):
(i) requests a 45-day extension
of the review period; or
(ii)
provides a waiver of the issuer's right to deem the filing approved, if
applicable; or
(B) for an
HMO filing, consistent with §
11.301 of this title (relating to
Filing Requirements):
(i) the department
notifies the issuer that the review period has been postponed; or
(ii) the issuer, as necessary and no less
than seven days before the date the filing is deemed approved (unless otherwise
permitted by the department), provides a waiver of the issuer's right to deem
the filing approved.
(2) An issuer submitting a form as a
correction to a pending form must provide:
(A) a summary of the differences between the
previously reviewed form and the corrected form, including a description of any
deleted text, and a clear identification of all changes, with new or modified
text redlined; and
(B) a statement
that no changes were made to the form other than those
identified.
(3) If an
issuer fails to submit corrections to the department within 10 business days
after the department provides a notice of any deficiencies and request for
corrections, the department may consider the filing withdrawn from review by
the issuer. The department will not give any withdrawn filing consideration
unless the issuer resubmits it as a new filing. Upon request from an issuer,
TDI may agree to extend the 10-day period under this
paragraph.
(d)
Disposition. The department will send written or electronic notice of any
actions taken by the department when it has completed the processing of the
filing. The notice will state the disposition and its effective date.
(e) Withdrawal of approval. Before
withdrawing approval, the department will provide notice and opportunity for
hearing. The notice will specify each applicable form number and the compliance
deficiencies.
(f) Retention of
filings and dispositions. Companies must retain the written notification or a
copy of the electronic notification as documentation of the department's action
on a form and maintain copies of approved, reviewed, and exempted forms. This
requirement no longer applies if there are no lives insured under the form and
the issuer has submitted a written or electronic request that the department
withdraw approval of the form.
Notes
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