28 TAC §11.204
The Commissioner of Insurance adopts the amendment to §11.204(15)(A),
concerning the notice that an insurer is required to give the commissioner
and a health maintenance organization (HMO) prior to the termination or reduction
of coverage by the insurer of any reinsurance agreement and any other agreement
covering excess of loss, stop-loss, and/or catastrophes as prescribed in Insurance
Code Article 20A.05(a)(4)(C). The section is adopted without change to the
proposed text as published in the February 8, 2002, issue of the
Texas Register
(27 TexReg 868) and will not be republished.
The amendment to §11.204 is necessary to correct an incorrect cite
to the Insurance Code contained in §11.204(15)(A). Section 11.204(15)(A)
currently refers to any reinsurance agreement and any other agreement described
in Insurance Code Article 20A.05(b)(2)(C)(iii). No such provision exists in
the Insurance Code. Section 11.204(15)(A) should cite to Insurance Code Article
20A.05(a)(4)(C), which states that the commissioner consider any agreement
that an HMO enters into with an insurer, group hospital service corporation,
a political subdivision of government, or any other organization for insuring
the payment of the cost of health care services or the provision for automatic
applicability of alternative coverage in the event of discontinuance of the
plan.
The amendment to §11.204(15)(A) correctly references Insurance Code
Article 20A.05(a)(4)(C), and thereby provides that the contents of an application
for an HMO certificate of authority must include any reinsurance agreement
and any other agreement described in Insurance Code Article 20A.05(a)(4)(C),
covering excess of loss, stop-loss, and/or catastrophes. Section 11.204(15)(A)
requires that an agreement entered into between an HMO and an insurer provide
that the commissioner and the HMO will be notified no less that 60 days prior
to termination or reduction of coverage by the insurer.
No comments were received.
The amendment is adopted under Insurance Code Article 20A.22
and §36.001. Article 20A.22 authorizes the commissioner to adopt rules
as necessary to carry out the provisions of Insurance Code, Chapter 20A. Section
36.001 provides the Commissioner of Insurance with the authority to adopt
rules for the conduct and execution of the powers and duties of the department
as authorized by statute.
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of
the Secretary of State on March 28, 2002.
TRD-200201957
Lynda Nesenholtz
General Counsel and Chief Clerk
Texas Department of Insurance
Effective date: April 17, 2002
Proposal publication date: February 8, 2002
For further information, please call: (512) 463-6327