28 Tex. Admin. Code § 7.1613 - Written Agreements Between Administrators and Insurers
(a) An administrator may not provide
administrative services in Texas on behalf of an insurer unless the
administrator has entered into a written agreement with the insurer that meets
the requirements of the Insurance Code Chapter 4151 and this section.
(b) An administrator subcontractor may meet
the requirements of this section by entering into a written agreement with the
administrator contractor only, provided the written agreement meets the
requirements of the Insurance Code Chapter 4151 and this section, as
applicable.
(c) A written agreement
entered into under this section may not be construed to limit, in any way, an
insurer's ultimate accountability and responsibility for compliance with all
statutory and regulatory requirements under the Insurance Code, the Labor Code,
and rules adopted thereunder.
(d) A
written agreement entered into under this section shall include:
(1) a requirement that the administrator must
comply with all statutory, contractual, and regulatory requirements related to
a function assumed or carried out by the administrator and related to a plan
for which the administrator performs or offers to perform administrative
services;
(2) a description of the
administrative services the administrator is expected to provide and any
applicable instructions related to the performance of those services, including
references to an insurer's claims handling practices or procedures;
(3) a provision relating to the continuity of
services and addressing the obligations of the administrator and the insurer
under §
7.1615 of this subchapter
(relating to Transfer of Books and Records), including the method and manner in
which the insurer and administrator will meet those requirements; and
(4) a provision addressing an insurer's
obligation to review and audit the performance of its administrators under §
7.1611 of this subchapter
(relating to Operational Review and On-Site Audit), including the method and
manner in which the insurer will meet those requirements.
(e) A written agreement entered into under
this section shall also ensure that the books and records of the insurer:
(1) remain the property of the insurer at all
times; and
(2) are available to the
insurer or its designee at any time while in the custody of the
administrator.
(f)
Notwithstanding subsection (e) of this section, an administrator may retain a
proprietary interest in the books and records of an insurer pursuant to the
Insurance Code §
4151.113(c),
provided that the written agreement between the administrator and the insurer
specifically identifies the items that will be subject to the administrator's
proprietary interest. An administrator may not withhold, based upon a claim of
proprietary interest, any portion of an insurer's books and records that would
restrict the ability of the insurer to comply with statutory, regulatory, or
contractual obligations.
(g) A
master services agreement may be used to meet the requirements of this
section.
(h) If a particular
requirement under this section does not apply to an administrative service
offered or performed by an administrator on behalf of an insurer, that
particular requirement may be omitted from the written agreement between the
administrator and the insurer. However, the remainder of the written agreement
between the administrator and the insurer must comply with the Insurance Code
Chapter 4151 and this section.
(i)
A written agreement required under this section shall meet the requirements of
this section no later than September 1, 2009.
Notes
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