28 Tex. Admin. Code § 7.1614 - Prohibited Acts

(a) An administrator is prohibited from:

(1) misrepresenting the terms or nature of an agreement with an insurer, HMO, plan sponsor, or group;

(2) making false, misleading, or incomplete comparisons to the agreements of other administrators or persons in order to induce any person to enter into, continue, or discontinue an agreement;

(3) accepting or rejecting risk, other than under the authority of, and in accordance with, a written agreement with an insurer, HMO, plan sponsor, or group;

(4) publishing or circulating any advertising or informational material, benefit descriptions, certificates, booklets, or brochures pertaining to business underwritten by an insurer, HMO, plan sponsor, or group without advance written approval of the insurer, HMO, plan sponsor, or group;

(5) pursuant to the Labor Code § 415.0036, offering to pay, paying, soliciting, or receiving an improper inducement relating to the delivery of benefits to an injured employee, if the administrator performs administrative services on behalf of a person who is a participant in the workers' compensation system of this state; and

(6) pursuant to the Labor Code § 415.0036, improperly attempting to influence the delivery of benefits to an injured employee, including through the making of improper threats, if the administrator performs administrative services on behalf of a person who is a participant in the workers' compensation system of this state.

(b) An administrator may be subject to other prohibitions under the Insurance Code, the Labor Code, and rules adopted thereunder that are not specified in subsection (a) of this section.

Notes

28 Tex. Admin. Code § 7.1614

The provisions of this §7.1614 adopted to be effective June 25, 2009, 34 TexReg 4143