TITLE 28.INSURANCE

Part 1. TEXAS DEPARTMENT OF INSURANCE

Chapter 1. GENERAL ADMINISTRATION

Subchapter F. SUMMARY PROCEDURES FOR ROUTINE MATTERS

28 TAC §§1.702 - 1.705

The Commissioner of Insurance adopts amendments to §§1.702 - 1.705 concerning activities related to summary procedures for routine matters. The amendments to §1.702 and §1.704 are adopted with changes to the proposed text as published in the December 6, 2002 issue of the Texas Register (27 TexReg 11451). The amendments to §1.703 and §1.705 are adopted without changes to the proposed text and will not be republished.

The amendments are necessary to update Subchapter F to reflect the restructuring of the department's divisions, statutory changes, and technological advancements regarding communication between the department and persons affected by these routine matters. Insurance Code §36.102 permits the commissioner by rule to create a summary procedure for certain routine matters. This subchapter sets forth those activities that have been designated by the commissioner as routine because they are voluminous, repetitive, believed to be noncontroversial, and of limited interest to persons other than those immediately involved or affected.

The amendments to §1.702 set forth the activities designated for summary procedure disposition. Among other things, these amendments add viatical and life settlement certificates of registration, utilization review and independent review organization certificates, and third-party administrator certificates of authority to the list of designated forms and filings and licenses, certificates, or registrations, as applicable. The amendments also eliminate outdated references to Insurance Code Chapter 5, Subchapter B, (a) rates; Chapter 5, Subchapter B, excess rate or umbrella; excess inland marine; and cessation of acceptance of workers' compensation of small premium policies. Due to statutory changes, (a) rates are no longer accepted, personal umbrella rates are subject to prior approval, and commercial umbrella rates are submitted as file and use. In House Bill 2 (72nd Legislative Session, 1991) the Texas Legislature deregulated commercial property and general liability insurance rates, and in Board Order No. 59970 (1992), the former State Board of Insurance re-designated the status of the rates to "standard" from "approved standard and uniform." The department no longer approves standard and uniform rates and Insurance Code Article 5.26 provides for rates in excess of the promulgated rate, making the language in §1.702 regarding "excess of" no longer applicable. Insurance Code Article 5.65-2, which among other things contained provisions regarding the workers' compensation small premium policy plan, was repealed effective December 31, 1993. Minor changes were also made to the section to correct punctuation.

The amendments to §1.703 delegate the various activities listed in §1.702 to the appropriate associate or deputy commissioner within the department responsible for summary procedure disposition of those activities. These amendments reflect a restructuring of various divisions within the department and assignment of responsibilities for certain functions, including the regulatory functions regarding health maintenance organizations, which is delegated in part to the Financial Program and in part to the HMO Division. Language was also added to recognize that, in the event of such a restructuring of the department in the future, the delegation of the administration over the activities will follow the appropriate associate or deputy commissioner assuming responsibility for the activities. The amendments to this section also delete language referencing the filings for which the deputy commissioner of property insurance was delegated responsibility because they were previously deleted pursuant to Board Order No. 59970 (1992). The amendments also change various references to the former state board of insurance to commissioner or department, as appropriate. Amendments to §1.704 add electronic transmission as another means of notifying a person of an action regarding a matter requiring final disposition by the department. The amendments to this section also establish the procedure to be used by the department in notifying a person of a departmental action affecting the person. Minor changes were also made to the section to correct punctuation. The amendments to §1.705 correct statutory references to the Insurance Code and clarify how to file a petition for review.

No comments were received.

The sections are adopted pursuant to Insurance Code §36.102 and §36.001. Insurance Code §36.102 provides that the commissioner of insurance may, by rule, create a summary procedure for routine matters and designate department activities that otherwise would be subject to Government Code Chapter 2001, as routine matters to be handled under summary procedure. Insurance Code §36.001 permits the commissioner to adopt rules for the conduct and execution of the powers and duties of the department as authorized by statute.

§1.702.Designated Activities.

The following statutorily prescribed activities are designated for summary procedure disposition:

(1) Filings of forms, rates, and related filings pursuant to Insurance Code Articles 3.42, 3.50-6A, 3.70-12, 3.53, 3.74, 5.13-1; Chapters 23 and 26; and §3.3325(f) and (g) of this title (relating to Medicare Select Policies, Certificates, and Plans of Operation), but not withdrawals of approval pursuant to Insurance Code Articles 3.42, 3.53, 5.13-1, and Chapter 23.

(2) Filings of forms, rates, and related filings by health maintenance organizations pursuant to §11.301(4)(A), (B), and (L), and (5)(C), (G), (K), (M), and (N) of this title (relating to Filing Requirements), but not withdrawals of approval pursuant to Insurance Code Chapter 20A.

(3) Filings of forms, rates, and related filings by health maintenance organizations pursuant to §11.301 of this title, except those listed in paragraph (2) of this section, but not withdrawals of approval pursuant to Insurance Code Chapter 20A.

(4) Filings of application or renewal for the following:

(A) agents and adjusters licenses pursuant to Insurance Code Articles 1.14-2, 3.75, 21.07, 21.07-1, 21.07-2, 21.07-3, 21.07-4, 21.09, 21.11, 21.14, and 23.23, insurance premium finance licenses pursuant to Insurance Code Article 24.03, and third party administrator certificates of authority pursuant to Insurance Code Article 21.07-6;

(B) viatical and life settlement certificates of registration pursuant to Insurance Code Article 3.50-6A;

(C) utilization review agent certificates pursuant to Insurance Code Article 21.58A and §§19.1704(g) and 19.2004 of this title (relating to Certification of Utilization Review Agents), and independent review organization certificates pursuant to Insurance Code Article 21.58C and §12.109 of this title (relating to Appeal of Denial of Application or Renewal); and

(D) licenses pursuant to Insurance Code Articles 9.35 - 9.38, 9.41 - 9.45, 9.56, and 9.58.

(5) Applications to change rates, forms, or deductibles for motor vehicle insurance on an individual risk basis pursuant to Rule 4 in the Texas Automobile Rules and Rating Manual adopted under Insurance Code Article 5.101.

(6) Applications to charge a rate or premium greater than the standard rate or premium approved by the commissioner for the types of insurance specified in Insurance Code Article 5.13, pursuant to Insurance Code Article 5.15(c).

(7) Filings of endorsements for negotiated deductible plans for workers' compensation insurance policies made pursuant to Insurance Code Article 5.55C.

§1.704.Summary Procedure; Notice.

(a) Actual notice for proposed negative action. In the case of proposed negative action with regard to any delegated activity designated under §1.702 of this subchapter (relating to Designated Activities), parties directly involved shall be given actual notice at least five days in advance of the action proposed. Actual notice means written or electronic notice. If the actual notice is a written notice, it will be sent by mail addressed to the last known address of the person, or, if the person is represented by an attorney, to the person's attorney of record, as submitted with the filing, application, form, or submission that is the subject of the proposed negative action. If the actual notice is electronic, it will be sent electronically to the email address or to the electronic destination, as applicable, from which the person submitted the filing, application, form, or submission which is the subject of the proposed negative action.

(b) Notice of decision. For §1.702(1) - (7) of this subchapter, the appropriate associate or deputy commissioner shall notify the person by mail or electronic transmission of a positive or negative decision and the date of the decision, shall record the decision in the department's electronic files, and shall retain a record of the notification with the filing, application, form, or submission or cause the appropriate license, certificate, or registration to be mailed to the person.

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 May 5, 2003.

TRD-200302774

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: June 1, 2003

Proposal publication date: December 6, 2002

For further information, please call: (512) 463-6327


Chapter 3. LIFE, ACCIDENT AND HEALTH INSURANCE AND ANNUITIES

Subchapter A. REQUIREMENTS FOR FILING OF POLICY FORMS, RIDERS, AMENDMENTS, AND ENDORSEMENTS FOR LIFE, ACCIDENT AND HEALTH INSURANCE AND ANNUITIES

28 TAC §§3.1 - 3.21

The Commissioner of Insurance adopts the repeal of Subchapter A, §§3.1 - 3.21, concerning requirements for filing of policy forms, riders, amendments, and endorsements for life, accident and health insurance and annuities. The repeal is adopted without changes to the proposed text as published in the December 6, 2002 issue of the Texas Register (27 TexReg 11454) and will not be republished.

The repeal of §§3.1 - 3.21 is necessary so that new Subchapter A can be adopted which will streamline and clarify the overall process by which policy forms, certificates, riders, amendments, and endorsements for life, accident and health insurance and annuities are filed with the department for statutory and regulatory review and approval. Simultaneous to the adoption of this repeal, adopted new Subchapter A, §§3.1 - 3.21, is published elsewhere in this issue of the Texas Register .

The adopted repeal will result in the elimination of sections that are obsolete and combine information from several sections into the same or similar sections. This elimination of sections streamlines Chapter 3 of the Texas Administrative Code, and clarifies and simplifies the filing process with the department.

No comments were received regarding the repeal.

The repeal of §§3.1 - 3.21 is adopted under Insurance Code Article 3.42 and §36.001. Insurance Code Article 3.42(p) provides that the commissioner is authorized to adopt such reasonable rules as are necessary to implement and accomplish the specific provisions of Article 3.42. Insurance Code §36.001 authorizes the commissioner of insurance 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 May 5, 2003.

TRD-200302777

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: June 1, 2003

Proposal publication date: December 6, 2002

For further information, please call: (512) 463-6327


Subchapter A. SUBMISSION REQUIREMENTS FOR FILINGS AND DEPARTMENTAL ACTIONS RELATED TO SUCH FILINGS

28 TAC §§3.1 - 3.8

The Commissioner of Insurance adopts new Subchapter A, §§3.1 - 3.8, concerning requirements for filing of policy forms, certificates, riders, amendments, and endorsements for life, accident, and health insurance and annuities. Sections 3.3, 3.4 and 3.8 are adopted with changes to the proposed text as published in the December 6, 2002, issue of the Texas Register (27 TexReg 11455). Sections 3.1. 3.2, 3.5 - 3.7 are adopted without changes and will not be republished.

Sections 3.1 - 3.8 are necessary to streamline and clarify the overall process by which forms and related documents concerning life insurance products, annuities, accident and health insurance products, credit life insurance, credit accident and health insurance, and prepaid legal forms are filed for statutory and regulatory review and approval. To further streamline the filing process, the sections allow companies to electronically file forms with the department using a form and format determined by the department, which currently is the National Association of Insurance Commissioners (NAIC) supported SERFF (System for Electronic Rate and Form Filing) system. The department will be able to receive SERFF filings after all necessary rules are adopted. The new sections further streamline the filing process by enabling the department to notify companies of the department's decisions by letter in lieu of stamping the duplicate copy, thus eliminating the need for filing of duplicate copies of forms.

The new sections will facilitate consistent and appropriate filing of forms and rates with the department and will improve communications and understanding of the filing requirements. The sections will further combine the existing filing requirements for the regular, general and expedited review processes into one filing process by consolidating the information into one transmittal checklist with a transmittal form for miscellaneous documents. This will eliminate the use of the previously promulgated certification transmittal checklists for the regular, general and expedited review processes.

In conjunction with the adoption of the new subchapter, the department is adopting the repeal of existing Subchapter A, §§3.1 - 3.21, which is published elsewhere in this issue of the Texas Register .

New §3.1 sets out the scope of the subchapter to identify the types of forms and miscellaneous documents that must be filed under Chapter 3, Subchapter A, Section 3.2 defines terms used in this subchapter. Section 3.3 establishes the information that must be included in a transmittal checklist and transmittal form which must accompany all filings. Section 3.4 specifies the general submission requirements, which include information concerning the contact person, form specifications, specimen language, variable material, matrix and insert page filings, limited/partial refilings, outlines of coverage, supplemental coverage, policy or contract forms, and rates/actuarial information. Section 3.4(q)(5) clarifies that if, during any 12-month period, the cumulative increase in premium rate is equal to or greater than 50%, actuarial information must be provided to support the rate increase. For example, for a particular 12-month period, the premium rate for the first 2 months is $100. The premium increases by 10% in month three, 10% in month five and 25% in month eleven. The cumulative increase for purposes of applying the 50% test under this paragraph is 51.25% (1.10 x 1.10 x 1.25). Section 3.4(r) specifies required filing fees. Section 3.4(r)(1)(D) increases the filing fee from $50 to $100 for rates filed separately from the policy or contract that are subject to review and approval by the department. The department currently assesses a fee of $100 for other rates filed for review. Section 3.4(r)(1)(J) and (2)(H) require a filing fee of $50 for each form with a maximum fee of $500 for each matrix filing as these filings can be used to create multiple contracts or policies through the combination of various matrix provisions.

Section 3.5 sets forth the appropriate statutory and/or regulatory authorities to utilize when submitting filings to the department and the description of each filing such as: new, informational, substantially similar, exact copy, substitution, pending, and resubmission. Section 3.6 addresses information concerning certifications, attachments, and other additional information required for a complete and comprehensive review of the submitted forms. Section 3.7 contains the requirements for form acceptance and the final disposition of the form. Section 3.8 establishes an effective date for the adopted rules.

Section 3.3 was changed to correct two clerical errors and §3.4 was changed to clarify sentence structure. In §3.8, the date has been changed to June 1, 2003 in order to complete technical and administrative tasks necessary to implement the billing system.

General: A commenter expresses support of the proposed rules providing requirements for policy forms and related filings.

Agency Response: The department appreciates the commenter's support and believes the more efficient and effective policy form filing and review process will benefit all parties involved.

Matrix filings: A commenter asks for confirmation that following the approval of various matrix provisions, new form filings may reference previously approved provisions and thus only submit for review new provisions for a particular filing.

Agency Response: The commenter is correct that matrix filings submitted to the department should only include new provisions for review. Carriers should not include previously approved provisions with the new filing. Carriers must determine how they will file new product filings. A carrier may file forms for a specific policy, certificate, rider, endorsement form or for a matrix filing, however; it may not file a specific form as both.

Section 3.2(6)(D): A commenter asks for clarification regarding limited, partial refilings due to a change to the separate account for variable products when the separate account is bracketed as variable text on the initial filing. The commenter's specific concern is whether a change in funds in the separate account triggers this requirement.

Agency Response: The rule does not require limited or partial refilings for a change to the funds of the separate account if, when the form reflecting the funds was filed and approved, the fund names were bracketed as variable text.

Section 3.4(r)(1)(A) - (J): A commenter asks whether companies, when submitting a new filing, are required to pay for use of matrix filings in addition to new form filing fees.

Agency Response: Insurers are required to choose between either a matrix filing or single form filing (policy, certificate, rider, endorsement, etc.). An insurer may use a matrix filing only with other approved or exempted matrix filings, not in conjunction with single form filings. The department will charge the appropriate fee as provided by §3.4(r)(1)(A) - (J). Matrix filings are always $50 per form with a maximum of $500 (see §3.4(r)(1)(J) and (2)(H)), whether they are a new filing, an exempt filing, or a resubmission.

For with changes: New York Life Insurance Company. Against: None.

The new sections are adopted pursuant to Insurance Code Articles 3.42, 3.51-6, 3.53, 3.64, 3.70-1, 3.70-12, 3.74, 5.13-1, and 21.42, Chapters 23 and 26 and §36.001. Insurance Code Article 3.42(p) provides that the commissioner is authorized to adopt reasonable rules that are within the standards and purposes of Insurance Code Article 3.42 and necessary to implement and accomplish the specific provisions of Article 3.42. Insurance Code Article 3.51-6 §5 provides that the department is authorized to issue rules necessary to accomplish the specific provisions of Article 3.51-6. Insurance Code Article 3.53 §7(H) authorizes the department to charge a fee for forms or schedules filed under Article 3.53 in an amount to be determined by the department. Insurance Code Article 3.64(f) provides that the commissioner is authorized to adopt rules to implement and accomplish the specific provisions of Article 3.64. Insurance Code Articles 3.70-1 and 3.70-12 require the department to issue reasonable rules necessary to carry out the purposes of the articles. Insurance Code Article 3.74 provides that the department shall adopt rules in accordance with federal law applicable to the regulation of Medicare supplement insurance coverage that are necessary for the state to obtain or retain certification as a state with an approved regulatory program under 42 U.S.C. 1395ss. Insurance Code Article 5.13-1(d) authorizes the department to promulgate and enforce rules concerning legal service contracts that in the discretion of the department are deemed necessary to accomplish the purposes of the article. Insurance Code Article 21.42 provides that Texas laws govern any insurance contract that is payable to any citizen or inhabitant of Texas. Insurance Code Article 23.19 authorizes the commissioner to adopt rules concerning participation contracts and agreements related to non-profit legal services. Insurance Code Article 26.04 requires the commissioner to adopt rules as necessary to implement Chapter 26 and to meet the minimum requirements of federal law and regulations. Insurance Code §36.001 authorizes the commissioner of insurance to adopt rules for the conduct and execution of the powers and duties of the department as authorized by statute.

§3.3.Transmittal Information.

(a) All filings submitted pursuant to this subchapter shall be accompanied by the department's transmittal checklist except for the documents listed in §3.1(11)(B) of this subchapter (relating to Scope), which shall be accompanied by the department's transmittal form as described in this section. Copies of the transmittal checklist and transmittal form are available from the Filings Intake Division, Mail Code 106-1E, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104 or 333 Guadalupe, Austin, Texas, 78701, or by accessing the department's website at www.tdi.state.tx.us.

(b) The transmittal checklist shall:

(1) provide complete and accurate information about the filing;

(2) include, at a minimum, the following information:

(A) the name and address of the submitting company;

(B) the contact person information as required in §3.4(b) of this subchapter (relating to General Submission Requirements);

(C) the unique identifying form number of each form submitted;

(D) an explanation of the purpose and use of each form as defined in §3.2 of this subchapter (relating to Definitions);

(E) an indication of the product and type;

(F) an indication of whether the filing is prompted by a business change such as an assumption, a name change, or a demutualization/conversion;

(G) the applicable authority from the Insurance Code or the Administrative Code under which the form is being submitted as described in §3.5 of this subchapter (relating to Filing Authorities and Categories);

(H) an indication of whether the filing is a matrix filing;

(I) rate filing information, if applicable;

(J) a statement that the submission will be used:

(i) on a general use basis, only with the policy being filed, or with previously approved or exempted forms; and

(ii) if the submission will be used with previously approved or exempted forms, a listing of the following:

(I) the form numbers of the previously approved or exempted forms;

(II) the approval or exemption dates of the previously approved or exempted forms; and

(III) a brief description of when or how each submitted form will be used with the previously approved or exempted forms;

(K) if the filing is a group filing, it must contain:

(i) A statement specifying the specific group type as set forth in §3.6(c)(1) of this subchapter (relating to Certifications, Attachments, and Additional Information Requirements).

(ii) A separate policy and certificate for each type of group. A submission of a single policy and certificate for use with more than one type of group is prohibited.

(iii) The following as applicable:

(I) a statement specifying the size of the group if issued under Chapter 26 of this title (relating to Small Employer Health Insurance Regulations);

(II) a copy of the trust agreement if issued to a trust;

(III) a copy of the constitution, bylaws, and articles of incorporation if issued to an association; or

(IV) certification and evidence that the master policy for the group was lawfully issued and delivered in a state in which the company was authorized to do insurance business;

(L) any certifications and attachments, including summary of differences, if applicable, or any additional information required by §3.6 of this subchapter, or variable information in accordance with §3.4(e) of this subchapter.

(3) be completed, signed, and certified by an attorney licensed to practice law in this state, an actuary familiar with the requirements of the Insurance and Administrative Codes, the chief executive officer of the filing company, or a person with authority to bind the company.

(c) The transmittal form shall:

(1) provide complete and accurate information about the filing;

(2) include, at a minimum, the following information:

(A) the name and address of the submitting company;

(B) the contact person information as required by §3.4(b) of this subchapter;

(C) an identification of the type of miscellaneous document or information being submitted as described in §3.1(11)(B) of this subchapter; and

(D) for filings to be used with previously approved or exempted forms:

(i) the form numbers of the previously approved or exempted forms;

(ii) the approval or exemption dates of the previously approved or exempted forms;

(iii) a general statement of the types of previously approved or exempted forms (e.g., waiver of surrender charge rider); and

(iv) a brief description of when or how each submitted form will be used with the previously approved or exempted forms;

(d) Notwithstanding subsections (b)(2) and (c)(2) of this section, the commissioner may prescribe a transmittal document prescribed by the NAIC for purposes of standardization.

(e) Filings that are not accompanied by a completed transmittal checklist or transmittal form, or which do not include all required certifications or signatures will not be accepted by the department and will be returned to the company as incomplete.

§3.4.General Submission Requirements.

(a) Submission. Companies shall submit one copy of the filing to the Filings Intake Division at the address set forth in §3.3(a) of this subchapter (relating to Transmittal Information). A filing submitted electronically shall be submitted in such form and format as determined by the department.

(b) Contact Person. A company submitting a filing to the department shall:

(1) have one person designated as the contact person for that filing;

(2) provide the contact person's name, address, telephone number, and if available, fax number on the transmittal checklist or transmittal form;

(3) provide, for any filing submitted by anyone other than the company, a dated letter of specific authorization which shall:

(A) designate the consulting firm, actuary, legal counsel, or other person as the designated contact person for that filing; and

(B) be signed by an officer of the company or a person with authority to bind the company; and

(4) notify the department immediately of any change of information with regard to the contact person for a pending filing, regardless of whether the contact person is the company's employee or other authorized representative.

(c) Form Specifications. Any filing submitted pursuant to this subchapter shall comply with the following:

(1) Filings submitted in paper format shall:

(A) be submitted on 8 1/2 by 11 inch paper;

(B) not be submitted in bound booklets;

(C) be legible;

(D) be in typewritten, computer generated, or printer's proof format; and

(E) not contain any color highlighting.

(2) Any form submitted shall be designated by a form number that:

(A) is sufficient to distinguish it from all other forms used by the company;

(B) is located in the lower left-hand corner of the cover page or on the first page of the form if the form number is visible with the cover closed;

(C) has the additional identifying form number requirements set forth in Subchapter FF of this chapter (relating to Credit Life and Accident and Health Insurance), if the form is submitted for consideration pursuant to Insurance Code Article 3.53; and

(D) has the additional identifying form number requirements set forth in §26.14(g) of this title (relating to Coverage), if the form is submitted for consideration pursuant to Insurance Code Chapter 26.

(d) Specimen Language and Specimen Fill-in Material.

(1) For all forms, specimen language and fill-in material shall reflect the most restrictive option available under variability. Additional descriptions of variability options shall be provided upon request or as otherwise required.

(2) Life and annuity forms shall be completed with fill-in material for specimen age 35. If the form is not issued at age 35, the fill-in material shall be completed for the youngest age at which the form may be issued. If reduced death benefits are provided for any age at issue, the specimen form shall be filled in for the age at issue for which the greatest reduction in benefits is made. The fill-in material shall be for the longest premium paying period available under the form.

(e) Variable Material.

(1) For all forms, any variable material in a form shall be bracketed and shall contain a clear explanation of how the material will vary. It is acceptable for certain materials to vary due solely to the age, sex, classification of the insured, plan type such as 403(b) and IRA, telephone numbers, and addresses depending on the manner in which the company intends to use the variations. The unique form number on a form may not be bracketed as variable.

(2) For individual life forms, the text and specifications of non-forfeiture assumptions generally cannot be considered variable material.

(f) Matrix Filings. Policies, certificates, contracts, or applications may be submitted as a matrix filing. Any company submitting a matrix filing:

(1) shall identify each provision with a unique form number that:

(A) is sufficient to distinguish it from all other provisions used by the company; and

(B) is located at the lower left-hand corner of the provision;

(2) may use the same provision filed under one form number for all products, provided the language is applicable to each product; however, any changes in the language to comply with the requirements for each product will require a unique form number;

(3) shall list the form number for each provision on the transmittal checklist and provide a statement indicating how the provision will be used and the type of product for which the provision will be used; and

(4) shall provide the certifications required in §3.6(a)(8) of this subchapter (relating to Certifications, Attachments, and Additional Information Requirements).

(g) Insert Page Filings. Policies, certificates, and contracts may be submitted with insert pages, or an insert page may be filed subsequent to the approval of a policy, certificate, or contract. Any company submitting an insert page filing:

(1) shall identify each insert page with a unique form number that:

(A) is sufficient to distinguish it from all other forms used by the company; and

(B) is located in the lower left-hand corner of the page;

(2) may use the same insert page filed under one form number for all products, provided the language is applicable to each product type; however, any changes in the language to comply with the requirements for each product type will require a unique form number;

(3) may use the same insert page to replace an existing page of a previously approved or exempted contract, if used in this manner, the replaced page, as originally filed, must reflect a unique form number that distinguishes it from the other pages of the form or contract;

(4) shall list the form number for each insert page on the transmittal checklist and provide a statement indicating how the insert page will be used and the type of product for which the insert page will be used; and

(5) shall provide the certifications required in §3.6(a)(8) of this subchapter.

(h) Limited, Partial Re-filings. Limited, partial refilings shall contain the change and any additional actuarial information necessary for a comprehensive review of the filing(s).

(i) Outline of Coverage. An outline of coverage shall be filed with each individual accident and health policy, group or individual Medicare supplement policy and/or certificate, or group or individual long-term care policy and/or certificate.

(j) Supplemental Coverages.

(1) Individual accident and health forms submitted pursuant to §3.3080 of this title (relating to Supplemental Coverage) shall be accompanied by the certification required in §3.6(a)(7) of this subchapter;

(2) Group life forms submitted pursuant to Insurance Code Article 3.50 §1(1) or (5) shall be accompanied by the certification required in §3.6(a)(7) of this subchapter.

(k) Complete Submission of Policy or Contract Forms. For a submission to be considered complete, the submission shall include the following:

(1) the toll-free notice unless the company is exempt under §1.601(c) of this title (relating to Notice of Toll-Free Telephone Numbers and Information and Complaint Procedures) or has on file a toll-free notice which is current with the requirements set forth in §1.601 of this title;

(2) the application, if applicable;

(3) in the case of group policies or contracts, the certificate;

(4) any rider which will or can be included in all issues of the form; and

(5) disclosures and other information, if applicable.

(l) Riders Included with Filing. For any rider included with the policy or contract filing, indicate whether the rider is to be used:

(1) only with the policy being filed; or

(2) with other clearly identified previously approved or exempted forms.

(m) Previously Approved or Exempted Forms. Any previously approved or exempted form (e.g., application or rider) to be used with the policy or contract filing need not be resubmitted; however, the filing shall indicate the type of form (e.g., rider, policy, application, etc.), form number, and the approval or exemption date of the previously approved or exempted form. If there is a change in the use of the previously approved or exempted form, the filing must state the form number of the form(s) with which the previously approved or exempted form was designed to be exclusively used, as well as the updated forms list.

(n) Appropriate Use of Previously Approved or Exempted Forms. The company is responsible for assuring the appropriate use of previously approved or exempted forms. This includes the appropriate use of any riders or other forms such as matrix and insert pages.

(o) Submission of a Certificate for Policies or Contracts Issued Outside of Texas. A copy of the master policy or contract issued outside of Texas must accompany any life, annuity, credit, or accident and health certificate filed for review or filed as exempt, along with certification and evidence that the master policy for the group was lawfully issued and delivered in a state in which the company was authorized to do insurance business.

(p) Rates. Initial and subsequent rate filings shall include all specific descriptions and required information as follows:

(1) policy forms for which the rate filing applies shall be specified on the transmittal checklist or the transmittal form, as applicable;

(2) credit life and credit accident and health filings submitted under Insurance Code Article 3.53 and Subchapter FF of this chapter shall include the rate information;

(3) group and individual Medicare supplement filings submitted under Insurance Code Article 3.74 §4, and Subchapter T of this chapter (relating to Minimum Standards for Medicare Supplement Policies) shall include the applicable rate schedule and experience by plan;

(4) group and individual long-term care forms submitted under Insurance Code Article 3.70-12 and Chapter 3, Subchapter Y of this chapter (relating to Standards for Long-Term Care Insurance Coverage Under Individual and Group Policies) shall include the rate schedule;

(5) all individual accident and health filings submitted under Insurance Code Article 3.42 shall include the rate schedule; and

(6) rate schedules submitted shall be accompanied by the actuarial information set forth in subsection (q) of this section.

(q) Actuarial Information.

(1) Each life filing, including riders, insert pages, or limited partial refilings, which changes the non-forfeiture values of a particular policy or certificate shall be accompanied by the information set forth in subparagraphs (A) - (C) of this paragraph:

(A) The mathematical formulas and sample calculations for the items set forth in clauses (i) - (iv) of this subparagraph.

(i) net premiums for the specimen age and plan of insurance;

(ii) specimen non-forfeiture calculations necessary to verify consistency between the non-forfeiture values and the text of the form for years one, 20, and 50;

(iii) terminal reserves for the specimen age and plan; and

(iv) any other calculations necessary to verify non-forfeiture values and reserves.

(B) An actuarial memorandum as specified in clauses (i) and (ii) of this subparagraph, as applicable:

(i) for universal life and interest sensitive forms:

(I) an actuarial memorandum shall provide the mortality table, guaranteed interest rates, maximum surrender charges, maximum expense charges, maximum risk rates (cost of insurance rates), maximum loads, and maximum fees at issue. Upon a change in basic coverage, bands and risk classes for all ages shall be provided.

(II) actuarial proof shall be provided that:

(-a-) cash surrender values meet the minimum requirements of Insurance Code Article 3.44a;

(-b-) cash surrender values will always equal or exceed the minimum values required by law; and

(-c-) provide a comparison table of all guaranteed cash surrender values, standard nonforfeiture law minimum cash surrender values, guaranteed death benefits, and reserves. Such comparison should be based on the fill-in issue age (usually age 35) as defined in subsection (d) of this section, a premium which will provide coverage to the latest available maturity date, the minimum issue amount, minimum guaranteed interest rates, maximum guaranteed cost of insurance rates (mortality rates), maximum guaranteed charges, and a month-by-month calculation of the values shown in the comparison for the first and fiftieth years.

(ii) for variable life forms, actuarial information shall be provided as required by §3.804 of this chapter (relating to Insurance Contract and Filing Requirements), and as required by this section.

(C) A statement shall be provided certifying that all policies or certificates, in addition to the specimen language and fill-in material, will have premiums, reserves, and non-forfeiture values calculated in a manner consistent with the information furnished with the specimen language and fill-in material. Any qualifications to such certification shall be specified, including any variation in formulas at different ages at issue or at time of a change.

(2) For each annuity filing, an actuarial memorandum shall be provided to meet the minimum requirements of Insurance Code Article 3.44b and specify the guaranteed interest rates, the maximum surrender charges, and any other maximum charges applicable in the determination of non-forfeiture values. If the company intends to change the guaranteed interest rates specified in the form, notification shall be submitted to the department prior to the change. The notification shall specify the new guaranteed interest rate and the date when the new guaranteed interest rate will be effective for new issues of a specified policy form, as required by §3.1004 of this chapter (relating to Policy Form Review).

(A) For variable annuities, the actuarial information shall provide the information required in this paragraph and the information required by §3.705 of this chapter (relating to Contract Requirements), to the extent such material is applicable.

(B) For policies or contracts that contain a market-value adjustment, the actuarial memorandum shall:

(i) identify the name of the separate account;

(ii) indicate the basis for the market-value adjustment formula and that the formula provides reasonable equity to both the contract holder and the company;

(iii) detail that the reserve liabilities are established in accordance with actuarial procedures that recognize that assets of the separate account are based on market values, the variable nature of the benefits provided, and any mortality guarantees;

(iv) include a table of minimum guaranteed policy values and cash surrender values which:

(I) are based on the longest guaranteed investment period,

(II) reflect both upward and downward market-value adjustments; and

(III) show that the minimum guaranteed values prior to the adjustment are not less than the minimum non-forfeiture values required by law; and

(v) provide a numerical illustration reproducing the values shown in the table for the first, second, and third years of investment, and at the end of the guaranteed investment period.

(3) Group and individual Medicare supplement (including Medicare SELECT) rate filings shall be accompanied by supporting actuarial information as required by Subchapter T of this chapter.

(4) Group and individual long-term care:

(A) rate filings shall be accompanied by supporting actuarial information as required by Subchapter Y of this chapter; and

(B) annual reports shall include the rates, rating schedule, and supporting documentation as required by Insurance Code Article 3.70-12, §4(b).

(5) Individual accident and health premium rate increases which result in any policyholder experiencing an increase in premium rate greater than or equal to 50% in any 12-month period must be accompanied by actuarial information which includes, at a minimum, the items of information specified in subparagraphs (A) - (E) of this paragraph. For the purpose of this paragraph, an increase in premium rate greater than or equal to 50% in any 12-month period shall mean the cumulative increase with respect to such premium considered over a 12-month period.

(A) The form number or numbers to which the submitted rate increase applies.

(B) The planned effective date of the increased rate.

(C) The schedule or schedules of rates to be used.

(D) A concise explanation of the rating process, including assumptions, claims data, methodology, and formulas used in development of gross premium rates.

(E) A statement of actual and projected experience as a basis for the rate adjustments.

(6) Discretionary group filings shall be accompanied by supporting actuarial information as required by Insurance Code Articles 3.50 §1(6) and 3.51-6 §1(a)(6).

(r) Filing Fee.

(1) The appropriate filing fee for filings for approval (excluding prepaid legal filings) are set forth in subparagraphs (A) - (J) of this paragraph.

(A) For each contract or policy, including Certification Form for Prototype Forms Figure Number 45, its certificate, approved or exempted application, and all approved or exempted riders filed as part of the entire policy or contract, a fee of $100 is required.

(B) For a filing of applications filed separately from the policy or contract to which it will be attached, a fee of $100 is required.

(C) For a filing of riders filed separately from the policy or contract to which it will be attached, a fee of $100 is required.

(D) For a filing of rates filed separately from the policy(ies) or contract(s) to which it is applicable, that require approval by the department as specified in §3.1(9) of this subchapter (relating to Scope), a fee of $100 is required.

(E) For a filing of alternate face pages with constitution and bylaws, articles of incorporation, or trust agreements, a fee of $100 is required.

(F) For a filing of insert pages filed subsequent to the original approval of a policy, a fee of $100 is required.

(G) For filings which normally would be considered exempt, but which, due to certain reasons specified in Subchapter Z of this chapter (relating to Exemption from Review and Approval of Certain Life, Accident, Health and Annuity Forms and Expedition of Review) are required to be submitted to the department for approval, a fee of $100 is required.

(H) For filing a resubmission of a previously disapproved form, a fee of $50 is required.

(I) For each refiling of a previously withdrawn form, a fee of $50 is required.

(J) For a filing of matrix provisions, due to the ability to create multiple contracts or policies from matrix provisions, a fee of $50 per form with a maximum fee of $500 is required.

(2) The appropriate filing fee for a filing exempt under Subchapter Z of this chapter is set forth in subparagraphs (A) - (H), as follows:

(A) For each exempt policy or contract filed simultaneously with its certificate, application, and exempt riders which are filed as part of the entire policy or contract, a fee of $50 is required.

(B) For a filing of exempt applications filed separately from the exempt policy or contract to which it will be attached, a fee of $50 is required.

(C) For a filing of exempt riders filed separately from the exempt policy or contract to which it will be attached, a fee of $50 is required.

(D) For a filing of rates filed separately from the exempt policy or contract to which it is applicable, and which is not subject to approval by the department as specified in §3.1(11)(A) of this subchapter, a fee of $50 is required.

(E) For a filing of outlines of coverage filed separately from the exempt policy or contract to which it is applicable, and which is not subject to approval by the department as specified in §3.1(11)(A) of this subchapter, a fee of $50 is required.

(F) For a filing of alternate face pages filed subsequent to the original approval of a policy for use with multiple employer trusteed arrangements as defined in Insurance Code Articles 3.50, §1(5) and 3.51-6, §1(a)(3), a fee of $50 is required.

(G) For a filing of exempt insert pages filed separately from the exempt policy or contract to which it is applicable, a fee of $50 is required.

(H) For a filing of exempt matrix provisions to be used with only exempt products, a fee of $50 per form with a maximum fee of $500 is required.

(3) The appropriate filing fees for filings other than those specified in paragraphs (1) and (2) of this subsection are set forth in subparagraphs (A) - (C) of this paragraph, as follows:

(A) For a filing of outlines of coverage filed separately from the policy or contract to which it is applicable, and which is subject to review by the department, a fee of $50 is required.

(B) For a filing of PPO disclosures filed separately from the policy or contract to which it is applicable, and which is subject to review by the department, a fee of $50 is required.

(C) For a filing of Accident and Health or Life rates filed separately from the policy or contract to which it is applicable, and which is subject to review by the department, a fee of $50 is required.

(4) Filings as described in §3.1(11)(B) of this subchapter shall require no filing fee.

§3.8.Effective Date.

The provisions of these sections shall apply to any form received by the department on or after June 1, 2003. Forms received by this department prior to June 1, 2003 shall be governed by the laws in effect at the time of the submission.

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 May 5, 2003.

TRD-200302776

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: June 1, 2003

Proposal publication date: December 6, 2002

For further information, please call: (512) 463-6327


Chapter 7. CORPORATE AND FINANCIAL REGULATION

Subchapter A. EXAMINATION AND FINANCIAL ANALYSIS

28 TAC §7.28

The Commissioner of Insurance adopts the repeal of §7.28 concerning the regulation of accounting of reinsurance agreements by insurers. The repeal of the section is adopted without changes to the proposal as published in the November 8, 2002 of the Texas Register (27 TexReg 10558) and will not be republished.

The repeal of the section is necessary to eliminate a redundancy between the repealed section and §7.18, and the potential for conflicting interpretations. The substantive provisions of the repealed section are contained in §7.18 which is the adoption of the National Association of Insurance Commissioners’ Accounting Practices and Procedures Manual, and includes Appendix A-791. The repeal of §7.28 furthers the objective of §7.18 to codify statutory accounting guidance into a single source in order to improve consistency in the regulations applicable to the accounting standards, treatments, and practices of insurers dong business in Texas. The substantive portions of the reinsurance requirements contained in the repealed section are contained in §7.18.

The repeal of the section provides consistency in the regulations applicable to the accounting standards, treatments and practices of insurers doing business in Texas. As a result of the repeal of the section there will be more efficient and standardized accounting by insurers licensed to do business in Texas.

Comment: Commenters raised concerns that the exemptions for assumption reinsurance and for certain 100% coinsurance transaction provided in §7.28(b)(3)(A) and (B) would no longer be available if the section is repealed and contend that the provisions are not carried forward in §7.18.

Agency Response: The department disagrees. The department notes that the rule applied to ceding insurers and not assuming insurers, and exemptions are continued through §7.18 and the accompanying appendixes.

For: Texas Association of Life and Health Insurers and Central United Life Insurance Company.

The repeal of the section is adopted under the Insurance Code Articles 1.11, 1.32, 3.10, 3.28, 5.75-1, 21.39-B, and 21.49-1 and §36.001. These articles authorize the Commissioner of Insurance to adopt rules to establish or set standards for the evaluation of the financial condition of insurers and health maintenance organizations, including reinsurance transactions, reserves and insurance holding company system transactions. Section 36.001 authorizes the Commissioner of Insurance to adopt rules for the conduct and execution of the duties and functions of the department as authorized by statute. Subchapter A. Examination and Financial Analysis.

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 May 5, 2003.

TRD-200302779

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: May 25, 2003

Proposal publication date: November 8, 2002

For further information, please call: (512) 463-6327


Subchapter M. REGULATORY FEES

28 TAC §7.1301, §7.1302

The Commissioner of Insurance adopts amendments to §7.1301 and new §7.1302 concerning the establishment of a billing system for certain filings. Section 7.1301 is adopted with changes to the proposed text as published in the December 6, 2002 issue of the Texas Register (27 TexReg 11476). Section 7.1302 is adopted without changes to the proposed text and will not be republished.

The amendments and new section are necessary to permit the establishment and implementation of a new billing system for certain filings submitted under Chapters 3 and 11. Upon adoption of new §7.1302 and implementation of a billing system, the fee(s) will no longer be required to be submitted with the filing; instead, the regulated entity submitting the filing will be billed by itemized invoice from the department.

New §7.1302 is necessary to streamline the collection and receipt of filing fees. The billing system will reduce the process of refunding fee amounts received in excess of the actual fee amount and eliminate the need to reject filings due to insufficient fee amounts.

To permit the establishment of a billing system, new §7.1302 addresses the mailing of invoices on a periodic basis for filings received and amounts billed, and billing addresses and billing contact persons for regulated entities submitting filings, including requirements for notifying the department of a change of billing address or billing contact person information. The new section also addresses departmental handling of filing fee account balances, including filing fee accounts with invoice amounts past due and the placement of a hold on a filing fee account for any invoice amount past due 120 days or more.

Upon completion of the development and design of the billing system, the department will issue a commissioner's bulletin to notify regulated entities affected by the billing system of the official implementation date and of the specific date when they should cease submitting filing fee(s) along with certain filings to the department. Because of the implementation of the billing system adopted in §7.1302, amendments were made to §7.1301. Express fee amounts for certain filings are no longer specified in §7.1301; rather, they are addressed in amendments adopted under Chapter 3, Subchapter A. Therefore, express references to those filings have been deleted from this subchapter. The amendments to Chapter 3, Subchapter A are adopted elsewhere in this issue of the Texas Register. In §7.1301, the date has been changed to June 1, 2003 in order to complete technical and administrative tasks necessary to implement the billing system. Minor changes were also made throughout this section to correct punctuation.

No comments were received.

The sections are adopted pursuant to Insurance Code Articles 3.42, 3.53, 20A.22, 20A.32, and §36.001. Insurance Code Article 3.42(p) provides that the commissioner is authorized to adopt such reasonable rules that are within the standards and purposes of Article 3.42, and necessary to implement and accomplish the specific provisions of Article 3.42. Insurance Code Article 3.53, §7(H) authorizes the department to charge a fee for forms or schedules filed under the article in an amount to be determined by the department. Insurance Code Article 20A.22 provides that the commissioner may promulgate such reasonable rules as are necessary and proper to carry out the provisions of the HMO Act. Insurance Code Article 20A.32 requires that the expenses for filing fees for every organization subject to Insurance Code Chapter 20A shall be paid in accordance with rules adopted by the commissioner. Insurance Code §36.001 authorizes the commissioner of insurance to adopt rules for the conduct and execution of the powers and duties of the department as authorized by statute.

§7.1301.Regulatory Fees.

(a) Regulated entities subject to fees. The regulated entities subject to the fees imposed by this section shall include all authorized insurers writing any class of insurance in this state which are regulated by the Insurance Code, Chapters 1-3, 6-20, 20A, 22, and 23. For filings and other actions received by the department on and after June 1, 2003, the Texas Department of Insurance shall charge these entities fees in amounts in accordance with the provisions of this section. Filings or other actions received by the department on or before June 1, 2003, shall be governed by this subchapter as it existed immediately prior to June 1, 2003.

(b) Fees for insurers with annual gross premium receipts less than $450,000. As provided in the Insurance Code, Article 4.07, any insurer to which the article applies and whose gross premium receipts are less than $450,000 according to its annual statement for the preceding year ending December 31, shall be required to pay only one-half the amount of the fees required to be paid under subsection (d) or subsection (e) of this section. The fees will be collected at the higher rate unless the applicant can provide the Texas Department of Insurance with satisfactory documentation that gross premium receipts were less than $450,000.

(c) Fees for specified filings pursuant to the Insurance Code, Article 3.42. Fees for specified filings pursuant to the Insurance Code, Article 3.42 are set forth in Chapter 3, Subchapter A of this title (relating to Submission Requirements for Filings and Departmental Actions Related to Such Filings) and shall be governed thereby.

(d) Fees for authorized insurers writing classes of insurance in this state which are regulated by the Insurance Code, Chapters 1-3, 6-20, 20A, 22, and 23. For the following filings and actions, the fees shall be as follows.

(1) For classes of insurance for which statutory authority exists for collecting annual statement fees, the fee for filing annual statements shall be $250 unless otherwise specified.

(2) For filing amendments to certificate of authority if charter is not amended, the fee shall be $50.

(3) For reservation of name, the fee shall be $100.

(4) For renewal of reservation of name, the fee shall be $25.

(5) For filing application for admission of a foreign or alien insurance company, including issuance of certificate of authority, the fee shall be $2,000.

(6) For filing original charter, including issuance of certificate of authority, the fee shall be $1,500.

(7) For filing amendment to charter, including issuance of certificate of authority, if a hearing is held, the fee shall be $250.

(8) For filing amendment to charter, including issuance of certificate of authority, if a hearing is not held, the fee shall be $125.

(9) For filing designation of attorney for service of process or amendment thereto, the fee shall be $25.

(10) For filing a total reinsurance agreement, the fee shall be $750.

(11) For filing a partial reinsurance agreement, the fee shall be $150.

(12) For filing a direct reinsurance agreement pursuant to the Insurance Code, Article 22.19, the fee shall be $150.

(13) For filing for approval of reinsurance agreement pursuant to the Insurance Code, Article 21.26, the fee shall be $750.

(14) For filing for approval of merger pursuant to the Insurance Code, Article 21.25, the fee shall be $750.

(15) For accepting a security deposit, excluding deposits made pursuant to the Insurance Code, Article 3.16, the fee shall be $100.

(16) For substitution/amendment of a security deposit, excluding deposits made pursuant to the Insurance Code, Article 3.16, the fee shall be $50.

(17) For certification of statutory deposit, the fee shall be $10.

(18) For filing notice of intent to relocate the books/records pursuant to the Insurance Code, Article 1.28, the fee shall be $150.

(19) For filing restated articles of incorporation for domestic/foreign companies, the fee shall be $250.

(20) For filing a statement pursuant to the Insurance Code, Article 21.49-1, §5, for the first $9,900,000 of the purchase price or consideration, the fee shall be $500.

(21) For filing a statement pursuant to the Insurance Code, Article 21.49-1, §5, if the purchase price or consideration exceeds $9,900,000, an additional $250 for each $10 million exceeding $9,900,000 but not more than a $5,000 total fee.

(22) For filing registration statement pursuant to the Insurance Code, Article 21.49-1, §3, the fee shall be $150.

(23) For filing for review pursuant to the Insurance Code, Article 21.49-1, §4 or Article 22.15, the fee shall be $250.

(24) For filing for an exemption pursuant to the Insurance Code, Article 21.49-1, §5(e), the fee shall be $250.

(e) Other fees established by the Insurance Code, Article 4.07. For the following filings, the fee shall be as follows.

(1) For filing joint control agreement, the fee shall be $50.

(2) For filing substitution/amendment to the joint control agreement, the fee shall be $20.

(3) For filing a change in attorney in fact, the fee shall be $500.

(f) Administrative procedures.

(1) When a reinsurance agreement or merger agreement is filed with the Texas Department of Insurance, as enumerated in subsection (d)(11)-(15) of this section, the ceding or merged company will be the company upon which the determination of the appropriate fee to be assessed will be based.

(2) The fee relating to reinsurance transactions entered into pursuant to the Insurance Code, Article 21.49-1, §4, and subsection (d)(24) of this section shall be determined using the ceding company as a basis for such fee.

(3) When an amendment to a reinsurance agreement between affiliated insurers is filed with the Texas Department of Insurance, as mentioned in paragraph (1) of this subsection, the ceding company will be the insurer upon which the determination of the appropriate fee to be charged will be based.

(4) An amendment to the charter would constitute any change in the original charter, including, but not limited to, name change, home office change, increase in capital, conversion, and increase in lines.

(5) The fee relating to affixing the official seal and certifying to the seal shall be applied to all requests for certification, irrespective of requesting party.

(6) The fees for filing an acquisition statement pursuant to the Insurance Code, Article 21.49-1, §5 and subsection (d)(21) and (22) of this section shall apply to and be collected from the applicant whenever:

(A) the applicant is a regulated entity subject to this section; or

(B) the company being acquired is a regulated entity subject to this section.

(g) Fees pursuant to the Texas Health Maintenance Organization Act, §32. For the following filings and actions, the fees shall be as follows.

(1) For filing original application for certificate of authority, the fee shall be $7,500.

(2) For filing annual report, the fee shall be $250.

(3) For all examinations made on behalf of the State of Texas by the Texas Department of Insurance or under its authority, the fee shall be in such amounts as the commissioner shall certify to be just and reasonable.

(4) For filing evidence of coverage which requires approval, the fee shall be $100.

(5) For filing required by rule but which do not require approval, the fee shall be $50.

(h) Fees under the Insurance Code, Article 23.08. For the following filings and actions, the fees shall be as follows.

(1) For filing annual statement, the fee shall be $200.

(2) For application for certificate of authority, the fee shall be $1,500.

(3) For issuance of additional certificate of authority and amendment to same, the fee shall be $50.

(i) Fees for filings pursuant to the Insurance Code, Article 3.53. Fees for filings pursuant to the Insurance Code, Article 3.53 are set forth in Chapter 3, Subchapter A of this title and shall be governed thereby.

(j) Fees under the Insurance Code, Chapter 3. For the following filings and actions, the fees shall be as follows.

(1) For valuing policies of life insurance, and for each $1 million of insurance or fraction thereof, $10.

(2) For filing the annual statement, $250.

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 May 5, 2003.

TRD-200302778

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: June 1, 2003

Proposal publication date: December 6, 2002

For further information, please call: (512) 463-6327


Chapter 11. HEALTH MAINTENANCE ORGANIZATION

Subchapter D. REGULATORY REQUIREMENTS FOR AN HMO SUBSEQUENT TO ISSUANCE OF CERTIFICATE OF AUTHORITY

28 TAC §11.301

The Commissioner of Insurance adopts amendments to §11.301 concerning certain health maintenance organization (HMO) filings. The amendments are adopted with changes to the proposed text as published in the December 6, 2002 issue of the Texas Register (27 TexReg 11478).

The amendments to §11.301 are necessary to provide uniformity in the establishment of a billing system for filing fees which is added by new §7.1302 published elsewhere in this issue of the Texas Register. Under new §7.1302, filing fees for certain filings made pursuant to Chapters 3 and 11 will be subject to the billing system. The new billing system will reduce the labor intensive process of refunding fee amounts received in excess of the actual fee amount and eliminate the need to reject filings due to insufficient fee amounts.

Upon completion of the development and design of the billing system, the department will issue a commissioner’s bulletin to notify regulated entities affected by the billing system of the official implementation date and of the specific date when they should cease submitting filing fee(s) along with certain filings to the department. An HMO submitting a filing will be billed by itemized invoice from the department. The amendments to §11.301 are necessary to ensure uniformity with and the effective and efficient use of the new billing system created by §7.1302. Section 11.301 was changed to correct a misspelled word in (5)(E) and to replace language which was inadvertently omitted in a prior amendment to (7)(B).

No comments were received.

The amendments are adopted pursuant to Insurance Code Articles 20A.22, 20A.32, and §36.001. Insurance Code Article 20A.22 provides that the commissioner may promulgate such reasonable rules as are necessary and proper to carry out the provisions of the HMO Act. Insurance Code Article 20A.32 requires that the expenses for filing fees for every organization subject to Insurance Code Chapter 20A shall be paid in accordance with rules adopted by the commissioner. Insurance Code §36.001 authorizes the commissioner of insurance to adopt rules for the conduct and execution of the powers and duties of the department as authorized by statute.

§11.301.Filing Requirements.

Subsequent to the issuance of a certificate of authority, each HMO is required to file certain information with the commissioner, either for approval prior to effectuation or for information only, as outlined in paragraphs (4) and (5) of this section and in §11.302 of this title (relating to Service Area Expansion Requests). These requirements include filing changes necessitated by federal or state law or regulations.

(1) Completeness of filings. The department shall not accept a filing for review until the filing is complete. An application to modify the approved application for a certificate of authority which requires the commissioner's approval in accordance with the Insurance Code, Articles 20A.04(b) and 20A.09(l) is considered complete when all information required by this section, §11.302 of this title, and §§11.1901-11.1903 of this title (relating to Quality of Care) that is applicable and reasonably necessary for a final determination by the department, has been filed with the department.

(2) Identifying form numbers required. Each item required to be filed pursuant to paragraphs (4) and (5) of this section must be identified by a unique form number, adequate to distinguish it from other items. Such identifying form numbers shall be composed of a total of no more than 40 letters, numbers, symbols, and spaces.

(A) The identifying form number must appear in the lower left-hand corner of the page. In the case of a multiple page document, the identifying form number must appear on the lower left-hand corner of the first page. Page numbers should appear on subsequent pages.

(B) If an item is to be replaced or revised subsequent to issuance of a certificate of authority, a new identifying form number must be assigned. A change in address or phone number on a form will not require a new identifying form number. A new edition date added to the original identifying form number is an acceptable way of revising the number so that it is identifiable from any previously approved item; e.g., if G-100 was the originally approved number, the revision may be numbered G-100 12/79. Changing the case of the suffix is not considered to be a change in the number, e.g., "ED" and "ed" or "REV" and "rev" are the same for form numbering purposes.

(3) Attachments for filings. The filings required in paragraphs (4) and (5) of this section must be accompanied by the following:

(A) an original and four copies of the HMO certification and transmittal form for each new, revised, or replaced item;

(B) an original and four copies of such supporting documentation as considered necessary by the commissioner for review of the filing; and

(C) except for the filings outlined in paragraphs (4)(A), (B), and (L), and (5)(C), (G), (K), (M), and (N) of this section, the applicable filing fee for other filings as required by Insurance Code Article 20A.32, as determined by §7.1301 of this title (relating to Regulatory Fees). The fee(s) for filings outlined in paragraphs (4)(A), (B), and (L), and (5)(C), (G), (K), (M), and (N) of this section are subject to the fee amounts described in §7.1301(g) of this title, but shall not be attached with the filing. Instead, the submission of such fee(s) is subject to the billing provisions of §7.1302 of this title (relating to Billing System).

(4) Filings requiring approval. Subsequent to the issuance of a certificate of authority, each HMO shall file for approval with the commissioner information required by any amendment to items specified in §11.204 of this title if such information has not previously been filed and approved by the commissioner. In addition, an HMO shall file with the commissioner a written request to implement or modify the following operations or documents and receive the commissioner's approval prior to effectuating such modifications:

(A) the evidence of coverage and related forms, as described in §11.501 of this title (relating to Forms Which Must Be Approved Prior to Use);

(B) a description and a map of the service area, with key and scale, which shall identify the county or counties or portions thereof to be served;

(C) the form of all contracts described in §11.204(13)(A) and (C) of this title, including any amendments to contracts described in §11.204(13)(A) and (C) of this title and prior notification of the cancellation of any management contracts in §11.204(13)(D) of this title;

(D) any change in more than 10% of control of the HMO, as specified in the definition of "control" in §11.2(b)(11) of this title (relating to Definitions);

(E) transactions with affiliates related to the purchase, construction, or renovation of hospitals, medical facilities, administrative offices, or any other property which represent more than one-half of 1.0% of admitted assets of the HMO, as well as transactions involving the lease, operation, or maintenance of hospitals, medical facilities, administrative offices, or any other property from or by an affiliate if the monthly cost for such transaction exceeds one-half of 1.0% of all the monthly expenses of the HMO or such agreement places a lien on any property owned by the HMO;

(F) dividends which do not meet the requirements specified in §11.807 of this title (relating to Dividends);

(G) any new or revised loan agreements, or amendments thereto, evidencing loans made by the HMO to any affiliated person or to any medical or other health care provider, whether providing services currently, previously, or potentially in the future; and any guarantees of any affiliated person's or health care provider's obligations to any third;

(H) a copy of any proposed amendment to basic organizational documents. If the approved amendment must be filed with the secretary of state, an original, or a certified copy of such document with the original file mark of the secretary of state, shall be filed with the commissioner;

(I) a copy of any amendments to bylaws of the HMO, with a notarized certification bearing the original signature of the corporate secretary of the HMO that it is a true, accurate, and complete copy of the original;

(J) any name, or assumed name, on a form, as specified in §11.105 of this title (relating to Use of the Term "HMO," Service Mark, Trademarks, d/b/a);

(K) any agreement by which an affiliate agrees to handle an HMO's investments pursuant to §11.804 of this title (relating to Investment Management by Affiliate Companies);

(L) any material change in the HMO's emergency care procedures; and

(M) any original guarantees, modifications to existing guarantees specified in §11.808 of this title (relating to Guarantee from a Sponsoring Organization) and guarantees relating to Medicaid business as specified in §§11.1801-11.1806 of this title (relating to Solvency Standards for Managed Care Organizations Participating in Medicaid).

(5) Filings for information. Material filed under this paragraph is not to be considered approved, but may be subject to review for compliance with Texas law and consistency with other HMO documents. Each item filed under this paragraph must be accompanied by a completed HMO certification and transmittal form in addition to those attachments required under paragraph (3) of this section. Within 30 days of the effective date, an HMO must file with the commissioner, for information only, deletions and modifications to the following previously approved or filed operations and documents:

(A) the list of officers and directors and a biographical data sheet for each person listed under the Insurance Code, Article 20A.04(a)(3), on the officers and directors page and biographical affidavit forms in §11.204(5)(A) and (B) of this title;

(B) a copy of any notice of cancellation of fidelity bonds, new fidelity bonds, or amendments thereto, for officers and employees, including notarized certification by the corporate secretary or corporate president that the material is true, accurate, and complete, as described in §11.204(7) and (13)(D) of this title;

(C) the formula or method for calculating the schedule of charges, as defined in §11.2(b) of this title;

(D) any change in the physical address of the books and records described in §11.205 of this title (relating to Documents To Be Available During Examinations);

(E) any change of the certificate of authority for a domestic or foreign HMO. If the HMO is a foreign HMO, a certified copy of the certificate of authority and power of attorney must be submitted;

(F) any new trademark or service mark, or any changes to an existing trademark or service mark;

(G) a copy of the form of any new contract or subcontracts or any substantive changes to previously filed copies of forms of all contracts between the HMO and any physicians or other providers described in §11.204(13)(B) of this title, and copies of forms of all contracts between the HMO and an insurer or group hospital service corporation to offer indemnity benefits, whether utilized with all contracts or on an individual basis. If such contracts are amended, each copy of such agreement must be marked to indicate revisions. In addition, questions listed on the HMO certification and transmittal form, must be answered;

(H) any insurance contracts or amendments thereto, guarantees, or other protection against insolvency, including the stop-loss or reinsurance agreements, if changing the carrier or description of coverage, as described in §11.204(15) of this title;

(I) changes to any of the requirements mandated for guarantees pursuant to §11.808 of this title (relating to Guarantee from a Sponsoring Organization);

(J) any change in the affiliate chart as described in §11.204(6)(A) of this title;

(K) the written description of health care plan terms and conditions made available to any current or prospective group contract holder and current or prospective enrollee of the HMO, including the enrollee handbook, pursuant to the requirements of the Insurance Code, Article 20A.04(13) and §11.1600 of this title (relating to Information to Prospective and Current Group Contract Holders and Enrollees);

(L) modifications to any types of compensation arrangements, such as compensation based on fee-for-service arrangements, risk-sharing arrangements, or capitated risk arrangements, made to physicians and providers in exchange for the provision of, or the arrangement to provide health care services to enrollees, including any financial incentives for physicians and providers;

(M) any material change in network configuration; and

(N) a description of the quality assurance program, including a peer review program, as required by the Insurance Code, Article 20A.05(a)(1). Descriptions of arrangements for sharing pertinent medical records between physicians and/or providers contracting or subcontracting pursuant to paragraph (13)(B) of §11.204 of this title with the HMO and assuring the records' confidentiality must also be provided.

(6) Approval time period. Any modification for which commissioner's approval is required is considered approved unless disapproved within 30 days from the date the filing is determined by the department to be complete. The commissioner may postpone the action for a period not to exceed 30 days, as necessary for proper consideration. The HMO will be notified by letter of any postponement.

(7) Filing Review Procedure. Within 20 days from the department's receipt of an initial filing for commissioner's approval under this section, the department shall determine whether the filing is complete or incomplete for purposes of acceptance for review and, if found to be incomplete, the department shall issue a written or electronic notice to the HMO of its incomplete filing. A filing under this subchapter that is subject to the billing provisions of §7.1302 of this title and which, upon receipt by the department, fails to comply with the requirements of that section, will be deemed to be incomplete for purposes of this subchapter.

(A) Incomplete filing. The written notice of an incomplete filing shall state that the filing is not complete and has not been accepted for review. In addition, the notice shall specify the information, documentation and corrections necessary to make the filing complete, as provided in paragraph (1) of this section. If a filing is resubmitted, in whole or in part, and is still incomplete, an additional written notice shall be issued. Such notice shall specify the corrections or information necessary for completeness, and state that the 30 day deemer will not begin until the date the department determines the filing to be complete. If a filing is not resubmitted within 30 days of the date of the written notice of incompleteness, then the filing shall be considered withdrawn by the department and closed.

(B) Processing of complete filing. The department shall in writing approve or disapprove a complete filing within the period of time set forth in paragraph (6) of this section, beginning on the date the filing is determined to be complete. The HMO may waive in writing the statutory deemer.

(C) Pending status. Complete filings will be approved or disapproved in writing within the statutory deemer period set forth in paragraph (6) of this section unless, prior to the department's issuance of notice of proposed negative action pursuant to §1.704(a) of this title (relating to Summary Procedure; Notice), the HMO has been contacted by the department regarding corrections or additional information necessary for commissioner's approval, and files with the department a written consent to waive the statutory deemer. The deemer shall be waived upon the department's receipt of the HMO's written consent. The filing shall be held in a pending status for 45 days from the date of the applicable statutory deemer, either on the 30th or 60th day from the date the filing is complete. If the necessary corrections or additional information have not been filed by the end of 45 days the filing shall be considered withdrawn.

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 may 5, 2003.

TRD-200302780

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: June 1, 2003

Proposal publication date: December 6, 2002

For further information, please call: (512) 463-6327


Chapter 19. AGENTS' LICENSING

Subchapter U. UTILIZATION REVIEWS FOR HEALTH CARE PROVIDED UNDER WORKERS' COMPENSATION INSURANCE COVERAGE

28 TAC §§19.2001, 19.2003 - 19.2006, 19.2010, 19.2012, 19.2015, 19.2017, 19.2019, 19.2020

The Commissioner of Insurance adopts amendments to §§19.2001, 19.2003 - 19.2006, 19.2010, 19.2012, 19.2015, 19.2017, 19.2019 and 19.2020, concerning utilization review for medical benefits provided pursuant to workers’ compensation insurance coverage. Sections 19.2003 - 19.2006, 19.2010, 19.2012, 19.2015, and 19.2020 are adopted with changes to the proposed text as published in the December 20, 2002, issue of the Texas Register (27 TexReg 11895). Sections 19.2001, 19.2017, and 19.2019 are adopted without changes and will not be republished.

The amendments are necessary to implement changes enacted by the 77th Texas Legislature in House Bill (HB) 2600, which among other things amended the workers’ compensation statute (Title 5, Labor ) with regard to utilization review in the provision of workers’ compensation benefits. The amendments are necessary to conform these sections to HB 2600 and to rules adopted by the Texas Workers’ Compensation Commission (TWCC). The amendments are adopted to regulate persons who perform utilization review of medical benefits provided under the workers’ compensation statute. Changes have been made to the proposed sections as follows. In response to comments, language was added to §§19.2005, 19.2006 and 19.2020 to clarify that out of state doctors who perform utilization review or specialty utilization review must either be on TWCC's approved doctors list (ADL), or be licensed in their own state and perform utilization review under the direction of a Texas-licensed doctor who is on the ADL. HB 2600 changed the workers’ compensation statute to provide that doctors and other health care providers, including those performing utilization review, must be on the ADL. However, it also provided that a utilization review agent may use doctors licensed in another state so long as reviews are performed under the direction of a doctor licensed in Texas. While the rule as proposed contained all these provisions, commenters pointed out that parts of the rule, if read in isolation, could be understood incorrectly. Accordingly, language was added to present a clearer and more complete picture of the requirements of HB 2600 regarding out of state doctors. In addition, changes were made to the titles of TWCC rules referenced in §§19.2003-19.2006, 19.2010, 19.2015, and 19.2020 to reflect the accurate and/or most recent citations, and to §§19.2004 and 19.2020 to remove redundant and unnecessary language. Finally, minor grammatical changes were made to the sections to correct punctuation.

The adopted amendment to §19.2001 removes as unnecessary references to legislation that has amended Insurance Code Article 21.58A. The adopted amendment to §19.2003 makes the definition of utilization review consistent with HB 2600, which added the concept of concurrent review to preauthorization and subjected requests for spinal surgery to preauthorization. It also revises the definition of preauthorization to make it consistent with TWCC's definition. The adopted amendment to §19.2005 adds the requirement that a utilization review plan must include written procedures for ensuring that doctors who perform utilization review for the utilization review agent are on the ADL. Similarly, adopted amendments to §19.2006(a) and §19.2020(f) include this requirement for doctors who perform utilization review and for doctors performing utilization review for specialty utilization review agents. The adopted amendment to §19.2006(d) provides that a utilization review agent may use doctors licensed in another state to perform reviews, but that the reviews must be performed under the direction of a doctor licensed in Texas and must comply with TWCC regulatory requirements. The adopted amendment to §19.2010 adds the requirement that a utilization review agent's notification of an adverse determination must include a plain-language notification informing the employee of the right to timely request reconsideration pursuant to TWCC rules. Adopted amendments to §19.2017 update references to the Insurance Code regarding administrative violations. In addition, adopted amendments to §§19.2003(5), 19.2004(2), 19.2012, 19.2015(2), 19.2019(a), and 19.2020(i) revise references to TWCC rules to reflect current titles. The adoption also updates references in this subchapter to names of various divisions and mail codes, as appropriate.

Section 19.2003: One commenter recommends amending the definition of "screening criteria" to include "if adopted, nationally recognized, scientifically valid, and outcome-based" treatment guidelines, in the event the Texas Workers’ Compensation Commission (TWCC) elects to adopt treatment guidelines to replace those repealed effective January 1, 2001.

Agency Response: Because TWCC repealed former treatment guidelines in accordance with HB 2600 and has not adopted new treatment guidelines, the department believes it would be premature to make the requested change at this time. The commenter is correct that any such adopted guidelines would come within the definition of "screening criteria" in this rule; however, the department believes that the phrase "treatment guidelines" in the current rule would encompass any guidelines TWCC may adopt in the future.

Comment: One commenter suggests adding a definition of "voluntary certification" because TWCC rules include the processes for requesting utilization review under the definitions of preauthorization, concurrent review, and voluntary certification. Because the department's rule includes new definitions for preauthorization and concurrent review, the commenter says, it is appropriate to include "voluntary certification" for consistency between the two rules.

Agency Response: The department disagrees. HB 2600 says TWCC may not prohibit an insurance carrier and health care provider from voluntarily discussing health care treatment and treatment plans, either prospectively or concurrently, and may not prohibit a carrier from certifying or agreeing to pay for health care consistent with those agreements. TWCC's implementing rules provide that an insurance carrier is liable for all reasonable and necessary medical costs relating to the health care required to treat a compensable injury when voluntary certification was requested and payment agreed upon prior to providing the health care for any care for which preauthorization or concurrent review is not required. The rules further provide that denials of voluntary certification are not subject to prospective necessity dispute resolution, although health care for which voluntary certification was denied is subject to retrospective necessity dispute resolution. Thus, voluntary certification is not utilization review within the meaning of Title 5 of the Labor Code, Art. 21.58A of the Insurance Code, and this rule. In addition, it would not be useful to define a term for which there is no reference in the rule.

Sections 19.2005, 19.2006 and 19.2020: Two commenters recommend changing these sections to clarify that HB 2600 specifically authorizes doctors licensed out of state to perform utilization review so long as they perform under the direction of a Texas-licensed doctor. The commenters expressed concern that, as proposed, these sections could lead to the erroneous conclusion that out of state doctors performing utilization review must also be on TWCC's approved doctor list (ADL).

Agency Response: The department agrees that the ADL requirements in other parts of the rule, if read in isolation, could appear to pose a conflict with the out of state doctor provisions. Therefore, the department has added language to these sections to ensure consistency and clarity consistent with the provisions of HB 2600, stating that the utilization review plan must ensure that doctors performing utilization review are either on the ADL or are licensed in another state and will perform utilization review under the direction of a doctor licensed in Texas who is on the ADL. To further ensure consistency with HB 2600, the added language makes reference to TWCC's rules concerning out of state doctors.

Section 19.2020: One commenter says that there is no definition within Chapter 19, Subchapter U, to clarify what type of provider qualifies as a specialty utilization review agent and what sections of the rule such agents are subject to. The commenter recommends that the rule clarify the difference between "specialty utilization review" and "utilization review," possibly by adding definitions for the former and for specialty review agent.

Agency Response: The department disagrees, as it believes §19.2020 and the statute are sufficiently self-explanatory concerning requirements of the rule and statute to which specialty utilization review agents are subject.

For with changes: Insurance Council of Texas, American Insurance Association, Texas Mutual Insurance Company.

The amendments are adopted under the Insurance Code, Art. 21.58A and §36.001. Art. 21.58A, Health Care Utilization Review Agents, gives the commissioner the authority to adopt rules to implement the provisions of that article. Section 36.001 provides that the commissioner may adopt rules for the conduct and execution of the powers and duties of the department only as authorized by statute.

§19.2003.Definitions.

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise.

(1) Act--Insurance Code Article 21.58A, entitled "Health Care Utilization Review Agents."

(2) Active practice--A minimum of 20 hours per week in the examination, diagnosis and/or treatment of patients.

(3) Administrative Procedure Act--Government Code Chapter 2001.

(4) Adverse determination--A determination by a utilization review agent that the health care furnished or proposed to be furnished to an injured employee is not reasonable and necessary.

(5) Appeal process--The processes outlined in the Texas Workers' Compensation Act, including but not limited to Texas Labor Code §413.031, Chapter 134, Subchapter G of this title (relating Prospective and Concurrent Review of Health Care), and Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers).

(6) Certificate--A certificate of registration granted by the commissioner to a utilization review agent.

(7) Commissioner--The Commissioner of Insurance.

(8) Compensable injury--An injury that arises out of and in the course and scope of employment for which compensation is payable under the Texas Workers' Compensation Act.

(9) Complaint--An oral or written expression of dissatisfaction with a utilization review agent concerning the utilization review agent's process. A complaint is not an expression of dissatisfaction with a specific adverse determination, a misunderstanding or misinformation that is resolved promptly by supplying the appropriate information or clearing up the misunderstanding to the satisfaction of the complaining party.

(10) Department--Texas Department of Insurance.

(11) Dentist--A licensed doctor of dentistry, holding either a D.D.S. or a D.M.D. degree.

(12) Doctor--A doctor of medicine, osteopathic medicine, optometry, dentistry, podiatry, or chiropractic who is licensed and authorized to practice.

(13) Health care--Includes all reasonable and necessary medical aid, medical examinations, medical treatments, medical diagnoses, medical evaluations, and medical services. The term does not include vocational rehabilitation. The term includes:

(A) medical, surgical, chiropractic, podiatric, optometric, dental, nursing, and physical therapy services provided by or at the direction of a doctor;

(B) physical rehabilitation services performed by a licensed occupational therapist provided by or at the direction of a doctor;

(C) psychological services prescribed by a doctor;

(D) the services of a hospital or other health care facility;

(E) a prescription drug, medicine, or other remedy; and

(F) a medical or surgical supply, appliance, brace, artificial member, or prosthesis, including training in the use of the appliance, brace, member, or prosthesis.

(14) Health care facility--A hospital, emergency clinic, outpatient clinic, or other facility providing health care.

(15) Health care provider--Any person, corporation, facility, or institution licensed by a state to provide or otherwise lawfully providing health care that is eligible for independent reimbursement for those services.

(16) Injured employee--An employee with a compensable injury under the Texas Workers' Compensation Act.

(17) Inquiry--A request for information or assistance from a utilization review agent.

(18) Insurance carrier---

(A) an insurance company;

(B) a certified self-insurer for workers' compensation insurance; or

(C) a governmental entity that self-insures, either individually or collectively.

(19) Insurance company--A person authorized and admitted by the Texas Department of Insurance to do insurance business in this state under a certificate of authority that includes authorization to write workers' compensation insurance.

(20) Life-threatening--A disease or condition resulting from a compensable injury, for which the likelihood of death is probable unless the course of the disease or condition is interrupted.

(21) Medical benefit--Payment for health care reasonably required by the nature of a compensable injury and intended to:

(A) cure or relieve the effects naturally resulting from the compensable injury, including reasonable expenses incurred by the injured employee for necessary treatment to cure and relieve the injured employee from the effects of an occupational disease before and after the injured employee knew or should have known the nature of the disability and its relationship to the employment;

(B) promote recovery; or

(C) enhance the ability of the injured employee to return to or retain employment.

(22) Medical records--The entire history of diagnosis and treatment for a compensable injury, including but not limited to medical, dental, and other health care records from all disciplines rendering care to an injured employee.

(23) Nurse--A professional or registered nurse, a licensed vocational nurse, or a licensed practical nurse.

(24) Open records law--Government Code Chapter 552.

(25) Person--An individual, a corporation, a partnership, an association, a joint stock company, a trust, an unincorporated organization, any similar entity or any combination of the foregoing acting in concert.

(26) Physician--A licensed doctor of medicine or a doctor of osteopathy.

(27) Preauthorization--The process requesting approval to provide a specific treatment or service prior to rendering the treatment or service as defined and delineated in Chapter 134, Subchapter G of this title (relating to Prospective and Concurrent Review of Health Care).

(28) Retrospective review--The process of reviewing health care which has been provided to injured employees under the Texas Workers' Compensation Act to determine if the health care was medically reasonable and necessary.

(29) Screening criteria--The written policies, decision rules, medical protocols, TWCC fee and treatment guidelines, and TWCC rules and advisories used by the utilization review agent as part of the utilization review process (e.g., appropriateness evaluation protocol (AEP), and intensity of service, severity of illness, discharge, and appropriateness screens (ISD-A)). The TWCC Treatment Guidelines are tools that identify recommended treatment parameters and typical courses of intervention, whose purpose is to clarify those services that are reasonable and medically necessary. The guidelines are not to be used as fixed treatment protocols by either the health care provider or insurance carrier and shall not be viewed as prescriptive or the sole basis for approval or denial of proposed services. There may be injured employees who will require more or less treatment than is recommended in the guidelines. Treatment falling outside the parameters of the guidelines will be subject to more careful scrutiny and may require additional documentation of special circumstances to justify the need for treatment. Each guideline includes specific ground rules which establish the use of the guideline.

(30) Texas Workers' Compensation Act--Texas Labor Code Title 5.

(31) Treating doctor--The doctor primarily responsible for treating the injured employee's compensable injury as defined in the Texas Labor Code, §401.011(42).

(32) TWCC--Texas Workers' Compensation Commission.

(33) Utilization review--A system for preauthorization and concurrent review, or both preauthorization and retrospective review or both concurrent and retrospective review, to determine if health care proposed to be provided, being provided, or which has been provided to an injured employee is medically reasonable and necessary. Utilization review shall not include elective requests for clarification of coverage or prepayment guarantee.

(34) Utilization review agent--An insurance carrier, the carriers' agent(s), and/or any entity contracted or subcontracted to provide utilization review.

(35) Utilization review plan--The screening criteria and utilization review procedures of a utilization review agent.

(36) Working day--A weekday, excluding a legal holiday.

(37) Workers' compensation insurance coverage:

(A) an approved insurance policy, pursuant to Article 5.56 of the Insurance Code, to secure the payment of compensation under the Texas Workers' Compensation Act;

(B) coverage to secure the payment of compensation through self-insurance as provided by the Texas Workers' Compensation Act; or

(C) coverage provided by a governmental entity to secure the payment of compensation under the Texas Workers' Compensation Act.

(38) Concurrent review--A review of on-going health care for an extension of treatment beyond previously approved health care in accordance with §134.600 of this title (relating to Preauthorization, Concurrent Review, and Voluntary Certification of Health Care).

§19.2004.Certification of Utilization Review Agents.

(a) An application for certification of a utilization review agent must be filed with the Texas Department of Insurance at the following address: HMO Compliance/URA/IRO Section, Mail Code 103-6A, Texas Department of Insurance, P.O. Box 149104, Austin, TX 78714-9104.

(b) The application must be submitted on a form which can be obtained from the HMO Compliance/URA/IRO Section, Mail Code 103-6A, Texas Department of Insurance, P.O. Box 149104, Austin, TX 78714-9104.

(c) The attachments to the application form require the following information:

(1) a summary description of the utilization review plan which must include the matters listed in subparagraphs (A) and (B) of this paragraph. The utilization review plan must meet the requirements of §19.2005 of this title (relating to General Standards of Utilization Review);

(A) an adequate summary description of screening criteria and review procedures to be used to determine health care is medically reasonable and necessary; and

(B) a certification, signed by an authorized representative of the company, that screening criteria and review procedures to be applied in review determination are established with input from appropriate health care providers and approved by physicians;

(2) copies of procedures established for informing appropriate parties of the process for appeal of an adverse determination to TWCC. These procedures must comply with the provisions of Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers);

(3) copies of procedures established for handling oral or written complaints by injured employees, their representatives or health care providers. These procedures must comply with §19.2016 of this title (relating to Complaints and Information);

(4) copies of policies and procedures which ensure that all applicable state and federal laws to protect the confidentiality of medical records are followed. These procedures must comply with §19.2014 of this title (relating to Confidentiality);

(5) a certification signed by an authorized representative of the company that the utilization review agent will comply with the provisions of the Act, the Texas Workers' Compensation Act and TWCC Rules;

(6) a description of the categories of persons and names of the personnel employed or under contract to perform utilization review;

(7) a description of the hours of operation within the State of Texas and how the utilization review agent may be contacted during weekends and holidays. This description must be in compliance with §19.2013 of this title (relating to Utilization Review Agent's Telephone Access);

(8) representative samples of all materials provided by the utilization review agent/applicant to inform its clients, injured employees, their representatives or providers of the requirements of the utilization review plan. Samples shall include language for notification of an adverse determination made in a utilization review;

(9) a description of the basis by which the utilization review agent compensates its employees or agents to ensure compliance with paragraph (10) of this subsection;

(10) a certification signed by an authorized representative of the company that the utilization review agent shall not permit or provide compensation or anything of value to its employees or agents, condition employment or its employee or agent evaluations, or set its employee or agent performance standards based on: the amount or volume of adverse determinations; reductions or limitations on lengths of stay, duration of treatment, medical benefits, services, or charges; or on the number or frequency of telephone calls or other contacts with health care providers or injured employees, which are inconsistent with the provisions of this subchapter;

(11) the organizational information, documents and all amendments, including:

(A) the bylaws, rules, or any similar document regulating the conduct of the internal affairs of the applicant with a notarized certification bearing the original signature of an officer or authorized representative of the applicant that they are true, accurate, and complete copies of the originals;

(B) for an applicant that is publicly held, the name of each stockholder or owner of more than five percent of any stock or options;

(C) a chart showing the internal organizational structure of the applicant's management and administrative staff; and

(D) a chart showing contractual arrangements of the utilization review agent related to utilization review;

(12) the name and biographical information for each director, officer and executive of the applicant.

(d) The utilization review agent shall report any material changes in the information in the application or renewal form referred to in this section, not later than the 30th day after the date on which the change takes effect. Material changes include but are not limited to new personnel hired as directors, officers, or executives, changes in the organizational structure, changes in contractual relationships, changes in the utilization review plan and changes in methods of compensation to utilization review agents or their employees.

(e) The application process is described in paragraphs (1) - (4) of this subsection.

(1) The department shall have 60 days after receipt of an application to process the application and to certify or deny it. The department shall give the applicant written notice of any omissions or deficiencies noted as a result of the review conducted pursuant to this paragraph.

(2) The applicant must correct the omissions or deficiencies in the application within 30 days of the date of the department's latest notice of such omissions or deficiencies. If the applicant fails to do so, the application file will be closed as an incomplete application. The application fee will not be refundable.

(3) The applicant may waive any of the time limits described in this subsection, except in paragraph (2). The applicant may waive the time limit in paragraph (2) of this subsection only with the consent of the department.

(4) The department shall maintain an application file which shall contain the application, notices of omissions or deficiencies, responses and any written materials generated by any person that was considered by the department in evaluating the application.

(f) An applicant for a certificate of registration as a utilization review agent must provide evidence that the applicant:

(1) has available the services of doctors, nurses, physician's assistants, or other health care providers qualified to provide the service requested by the provider to carry out its utilization review activities in a timely manner;

(2) meets any applicable provisions of this subchapter and regulations relating to the qualifications of the utilization review agents or the performance of utilization review;

(3) has policies and procedures which protect the confidentiality of medical records in accordance with applicable state and federal laws;

(4) makes itself accessible to injured employees, their representatives and health care providers 40 working hours a week during normal business hours in this state in each time zone in which it operates.

(g) A utilization review agent must apply for renewal of the certificate of registration every two years from the date of certification. A renewal form must be used for this purpose. The renewal fee must be submitted with the renewal form. The renewal form can be obtained from the address listed in subsection (b) of this section. The completed renewal form, a summary of the current screening criteria, a statement signed by an authorized representative of the company certifying that all information previously submitted is true and correct and all changes have been previously filed to the application certified by the department, and the renewal fee must be submitted to the department at the address listed in subsection (a) of this section. A utilization review agent may continue to operate under its certificate of registration, if the information and the fee have been filed for renewal and timely received by the department, until the renewal is finally denied or issued by the department. If the required information and fee are not received prior to the deadline for renewal of the certificate of registration, the certificate of registration will automatically expire and the utilization review agent must complete and submit a new application form and a new fee with all required information.

(h) If an application or renewal is initially denied under this section, the applicant or registrant may appeal such denial under the terms of the provisions of Chapter 1, Subchapter A of this title (relating to Rules of Practice and Procedure) and Government Code Chapter 2001. A hearing of such appeal shall be conducted within 45 days of the date the petition for such hearing is filed with the commissioner. A decision by the commissioner shall be rendered within 60 days of the date of the hearing.

(i) A utilization review agent providing utilization review on the effective date of this subchapter must abide by the provisions of this subchapter effective upon its adoption, and must file with the department its original application within 180 days of the effective date of this subchapter. Utilization review agents that have received their certificate of registration prior to the adoption of these rules, and are performing workers' compensation utilization review as defined in §19.2003 of this title (relating to Definitions), must file with the department all changes to their original application as set forth in subsections (c) and (d) of this section within 180 days of the effective date of this subchapter.

(j) A utilization review agent will be required to make a single application and fee payment for one certification to cover all lines of utilization review business.

§19.2005.General Standards of Utilization Review.

The utilization review plan shall be reviewed by a physician and conducted in accordance with standards developed with input from appropriate health care providers, including doctors engaged in an active practice that are both primary and specialty doctors, and approved by a physician. The utilization review plan shall include the following components:

(1) a description of the elements of review which the utilization review agent provides, including:

(A) prospective and concurrent review in accordance with Chapter 134, Subchapter G of this title (relating to Prospective and Concurrent Review of Health Care);

(B) the elements of review in the TWCC guidelines contained in Chapter 134, Subchapter G of this title (relating to Prospective and Concurrent Review of Health Care);

(C) The elements of review contained in Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers).

(2) written procedures for:

(A) identification of individuals with special circumstances who may require flexibility in the application of screening criteria through utilization review decisions. Special circumstances include, but are not limited to, a person who has a disability, an acute condition or life-threatening illness. Disability shall not be construed to mean an injured employee who is off work or receiving income benefits;

(B) notification of the utilization review agent's determinations provided in accordance with Chapter 134, Subchapter G of this title and as addressed in §19.2010(b) of this title (relating to Notice of Determinations Made by Utilization Review Agents, Excluding Retrospective Review);

(C) informing appropriate parties of the process for appeal of an adverse determination to TWCC, as required by §19.2011 and §19.2012 of this title (relating to Requirements Prior to Adverse Determination and Appeal of Adverse Determinations of Utilization Review Agents);

(D) receiving or redirecting a toll-free normal business hour and after-hour calls, either in person or by recording, and assurance that a toll-free number will be maintained 40 hours per week during normal business hours as addressed in §19.2013 of this title (relating to Utilization Review Agent's Telephone Access);

(E) review including:

(i) any form used during the review process;

(ii) time frames that shall be met during the review;

(F) handling of oral or written complaints by injured employees, their representatives or health care providers as addressed in §19.2016(a) of this title (relating to Complaints and Reporting Requirements);

(G) determining if doctors or other health care providers utilized by the utilization review agent are licensed, qualified and appropriately trained, including written procedures for ensuring that doctors that perform utilization review for the utilization review agent are either on TWCC's list of approved doctors or, if licensed in another state, will perform utilization review under the direction of a doctor licensed in Texas who is on TWCC's list of approved doctors, in accordance with Chapter 180 of this title (relating to Monitoring and Enforcement);

(H) assuring that injured employee-specific information obtained during the process of utilization review, as addressed in §19.2014 of this title (relating to Confidentiality), will be:

(i) kept confidential in accordance with applicable federal and state laws;

(ii) used solely for the purposes of utilization review, quality assurance and case management;

(iii) shared with only those agencies who have authority to receive such information; and

(iv) in the case of summary data, not considered confidential if it does not provide sufficient information to allow identification of individual injured employees;

(I) providing prior written notice to a doctor or health care provider when publishing data, including quality review studies or performance tracking data which identifies a particular doctor, or health care provider;

(3) screening criteria. Each utilization review agent shall utilize written medically acceptable screening criteria as defined in §19.2003 of this title (relating to Definitions) and review procedures which are established and periodically evaluated and updated, at a minimum, upon certification renewal with appropriate involvement from the doctors, including doctors engaged in an active practice, and other health care providers. Utilization review decisions shall be made in accordance with currently accepted medical or health care practices, taking into account special circumstances of each case that may require deviation from the norm stated in the screening criteria. Screening criteria must be objective, clinically valid, compatible with established principles of health care, and flexible enough to allow deviations from the norm when justified on a case-by-case basis. Screening criteria must be used to determine only whether to approve the requested treatment. Denials must be referred to an appropriate doctor or other health care provider to determine whether health care is medically reasonable and necessary. Such written screening criteria and review procedures shall be available for review and inspection to determine appropriateness and compliance as deemed necessary by the commissioner, his or her designated representative, or TWCC and copying as necessary for the commissioner and/or TWCC to carry out the lawful duties under the Insurance Code, and the Texas Labor Code, provided, however, that any information obtained or acquired under the authority of this subchapter and the Act, is confidential and privileged and not subject to the open records law or subpoena except to the extent necessary for the commissioner to enforce this subchapter and the Act, and for TWCC to enforce the Texas Workers' Compensation Act.

(4) delegation of review. Provide circumstances, if any, under which the utilization review agent may delegate the review to qualified personnel in the hospital or health care facility where the health care is to be provided. Such delegation shall not relieve the utilization review agent of full responsibility for compliance with this subchapter, the Act, and the Texas Workers' Compensation Act, including the conduct of those to whom utilization review has been delegated.

§19.2006.Personnel.

(a) Personnel employed by or under contract with the utilization review agent to perform utilization review shall be appropriately trained and qualified and, if applicable, currently licensed. Doctors that perform utilization review for the utilization review agent must be on TWCC's list of approved doctors in accordance with Chapter 180 of this title (relating to Monitoring and Enforcement), or comply with subsection (d) of this section. Personnel who obtain information regarding an injured employee's specific medical condition, diagnosis and treatment options or protocols directly from the doctor or other health care provider, either orally or in writing, and who are not doctors shall be nurses, physicians assistants, or health care providers qualified to provide the service requested by the provider. This provision shall not be interpreted to require such qualifications for personnel who perform clerical or administrative tasks.

(b) A utilization review agent may not permit or provide compensation or any thing of value to its employees or agents, condition employment or its employee or agent evaluations, or set its employee or agent performance standards, based on: the amount or volume of adverse determinations; reductions or limitations on lengths of stay, duration of treatment, medical benefits, services, or charges; or the number or frequency of telephone calls or other contacts with health care providers or injured employees, which are inconsistent with the provisions of this subchapter.

(c) The utilization review agent is required to provide the name, number, type, and minimum qualification or qualifications of the personnel either employed or under contract to perform the utilization review to the commissioner. Utilization review agents shall be required to adopt written procedures used to determine if doctors or other health care providers utilized by the utilization review agent are licensed, qualified, and appropriately trained, and must maintain records on such.

(d) A utilization review agent that uses doctors to perform reviews of health care services provided under a workers’ compensation policy may use doctors licensed by another state to perform the reviews, but the reviews must be performed under the direction of a doctor licensed to practice in this state who is on TWCC's approved doctor list, in accordance with Chapter 180 of this title. Such doctor may be employed by or under contract to the utilization review agent.

(e) Utilization review of dental health care shall be reviewed by a dentist currently licensed by a state licensing agency in the United States prior to issuance of an adverse determination.

§19.2010.Notice of Determinations Made by Utilization Review Agents, Excluding Retrospective Review.

(a) A utilization review agent shall notify the injured employee, their representative and the treating doctor or the treating doctor's designated representative (e.g., referred health care providers or health care facilities) of a determination made in a utilization review.

(b) The notification and time frames for notification required by this section must be made in accordance with TWCC rules contained in Chapter 134, Subchapter G of this title (relating Prospective and Concurrent Review of Health Care).

(c) Notification of adverse determination by the utilization review agent must include:

(1) the principal reasons for the adverse determination;

(2) the clinical basis for the adverse determination;

(3) a description or the source of the screening criteria that were utilized as guidelines in making the determination;

(4) a description of the procedure for the complaint process to the Department and appeal process to TWCC, and

(5) plain language notifying the employee of the right to timely request reconsideration of the health care denied in accordance with Chapter 134, Subchapter G of this title (relating to Prospective and Concurrent Review of Health Care).

§19.2012.Appeal of Adverse Determination of Utilization Review Agents.

Appeals from an adverse determination by a utilization review agent shall be governed by the Texas Workers' Compensation Act and the applicable rules and procedures of the TWCC including but not limited to Chapter 134, Subchapter G of this title (relating to Prospective and Concurrent Review of Health Care) and Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers).

§19.2015.Retrospective Review of Medical Necessity.

(a) When a retrospective review is performed:

(1) such retrospective review shall be based on written screening criteria as defined in §19.2003 of this title (relating to Definitions) established and periodically updated, at a minimum, upon certification renewal with appropriate involvement from doctors, including doctors engaged in an active practice, and other health care providers; and

(2) such retrospective review shall be under the direction of a physician and performed in accordance with Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers).

(b) When retrospective review results in an adverse determination or denial of payment, the utilization review agent shall notify the health care providers of the opportunity to appeal the determination through the appeal process as outlined in Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers).

§19.2020.Specialty Utilization Review Agent.

(a) A utilization review agent that solely performs specialty review under the Insurance Code, Article 21.58A, §14(j) is not subject to the Insurance Code, Article 21.58A, §4(b), (c), (h) or (k) or §6(b)(3) of the Act. A utilization review agent that does not solely perform specialty review, is not subject to the provisions of this section or the Insurance Code, Article 21.58A, §14(j).

(b) A utilization review agent that performs specialty review under the Insurance Code, Article, 21.58A, §14(j) is subject to this subchapter, except §19.2004(c)(1)(B) and (c)(6) of this title (relating to Certification of Utilization Review Agents); the first sentence of §19.2005 of this title (relating to General Standards of Utilization Review); §19.2006(a), (d), (e) of this title (relating to Personnel); §19.2011 of this title (relating to Requirements Prior to Adverse Determination) and §19.2012 of this title (relating to Appeal of Adverse Determination of Utilization Review Agents).

(c) A specialty utilization review agent must submit, by attachment to the application, assurance that the utilization review plan shall be reviewed by a health care provider of the appropriate specialty and conducted in accordance with standards developed with input from a health care provider of the appropriate specialty.

(d) A specialty utilization review agent must submit by attachment to the application a description of the categories of personnel who perform utilization review, such as doctors, nurses, physicians assistants, or other health care providers of the same specialty as the utilization review agent and who are licensed or otherwise authorized to provide the specialty health care by a state licensing agency in the United States, except that this provision does not require those qualifications from personnel who perform solely clerical or administrative tasks.

(e) An applicant for a certificate of registration as a specialty utilization review agent must provide evidence that the applicant has available the services of doctors, nurses, physician's assistants, or other health care providers of the same specialty as the utilization review agent and who are licensed or otherwise authorized to provide the specialty health care by a state licensing agency in the United States to carry out its utilization review activities in a timely manner.

(f) Personnel employed by or under contract with the specialty utilization review agent to perform utilization review shall be appropriately trained and qualified and, if applicable, currently licensed. Doctors that perform utilization review for the specialty utilization review agent must be on TWCC's list of approved doctors in accordance with Chapter 180 of this title (relating to Monitoring and Enforcement). Personnel who obtain information regarding an injured employee's specific medical condition, diagnosis, and treatment options or protocols directly from the doctor or health care provider, either orally or in writing, and who are not doctors, shall be nurses, physician's assistants, or other health care providers of the same specialty as the utilization review agent and who are licensed or otherwise authorized to provide the specialty health care by a state licensing agency in the United States. This provision shall not be interpreted to require such qualifications for personnel who perform clerical or administrative tasks.

(g) Utilization review conducted by a specialty utilization review agent shall be conducted under the direction of a health care provider of the same specialty and shall be licensed or otherwise authorized to provide the specialty health care by a state licensing agency in the United States.

(h) Subject to the notice requirements of §19.2012 of this title, in any instance where the specialty utilization review agent questions whether the health care is medically reasonable and necessary, the health care provider who ordered the services shall, prior to the issuance of an adverse determination, be afforded a reasonable opportunity to discuss the plan of treatment for the patient and the clinical basis for the decision of the utilization review agent with a health care provider of the same specialty as the utilization review agent.

(i) Appeals from an adverse determination by a specialty utilization review agent shall be governed by the Texas Workers' Compensation Act and the applicable rules and procedures of the TWCC including but not limited to Chapter 134, Subchapter G of this title (relating to Prospective and Concurrent Review of Health Care) and Chapter 133, Subchapter D of this title (relating to Dispute and Audit of Bills by Insurance Carriers).

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 May 5, 2003.

TRD-200302775

Gene C. Jarmon

General Counsel and Chief Clerk

Texas Department of Insurance

Effective date: June 1, 2003

Proposal publication date: December 20, 2002

For further information, please call: (512) 463-6327