Tex. Ins. Code Section 4151.1042
Responsibilities of Insurer; Semiannual Audit

(a)

If an insurer uses the services of an administrator, the insurer is responsible for determining the benefits, premium rates, reimbursement procedures, and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The insurer shall provide a copy of the written requirements relating to those matters to the administrator. The responsibilities of the administrator as to any of those matters must be set forth in the written agreement between the administrator and the insurer.

(b)

An insurer shall ensure competent administration of its programs.

(c)

If an administrator administers benefits for more than 100 certificate holders, injured employees, plan participants, or policyholders on behalf of an insurer, the insurer shall, at least semiannually, conduct a review of the operations of the administrator. At least biennially, the insurer shall conduct an on-site audit of the operations of the administrator.
Added by Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.12, eff. September 1, 2007.

Source: Section 4151.1042 — Responsibilities of Insurer; Semiannual Audit, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­4151.­htm#4151.­1042 (accessed May 11, 2024).

4151.001
Definitions 4151.002
Exemptions 4151.003
Applicability of Other Provisions of Code 4151.004
Applicability to Certain Insurers and Health Maintenance Organizations 4151.005
Administrator Not Insurance Agent 4151.006
Rules 4151.0021
Applicability to Certain Processing Agents 4151.0022
Nonapplicability 4151.0031
Market Analysis 4151.0051
Referral to Adjuster by Administrator 4151.051
Certificate of Authority Required 4151.052
Application 4151.053
Approval of Application 4151.054
Denial of Application 4151.055
Fidelity Bond Required 4151.056
Duration of Certificate of Authority 4151.101
Written Agreement with Insurer or Plan Sponsor Required 4151.102
Contents of Written Agreement 4151.103
Retention of Written Agreement 4151.104
Notice of Use of Administrator’s Services 4151.105
Payments to Administrator 4151.106
Certain Funds Collected or Received by Administrator 4151.107
Delivery or Deposit of Certain Funds Received by Administrator 4151.108
Withdrawals from Fiduciary Account 4151.109
Payment of Claims from Fiduciary Account Prohibited 4151.110
Underwriting Standards 4151.111
Adjudication of Claims 4151.112
Maintenance of Books and Records 4151.113
Access to Books and Records 4151.114
Disposition of Books and Records on Termination of Written Agreement 4151.115
Confidentiality of Personal Information 4151.116
Advertising 4151.117
Compensation of Administrator 4151.151
Definition 4151.152
Identification Cards 4151.153
Disclosure of Certain Patient Information Prohibited 4151.154
Discount Health Care Programs 4151.201
Examination of Administrator 4151.202
Contents of Examination 4151.203
Cost of Examination 4151.204
Examination Under Oath 4151.205
Annual Report 4151.206
Fees 4151.210
Effect of Revocation of Other Certificates 4151.211
Restrictions on Acquisition of Ownership Interest 4151.212
Maintenance of Qualifications Required 4151.251
Definition 4151.252
Application 4151.253
Agreements Between Administrators and Carriers 4151.254
Agreements Between Administrators and Employers 4151.255
Administrator Compensation 4151.256
Large Deductible Policies 4151.257
Rules 4151.301
Grounds for Denial, Suspension, or Revocation of Certificate of Authority 4151.302
Remedies for Violation of Insurance Laws or Commissioner Rules 4151.303
Probated Suspension 4151.304
Hearing 4151.305
Application for Certificate of Authority After Denial or Revocation 4151.306
Disciplinary Proceeding for Conduct Committed Before Surrender or Forfeiture of Certificate 4151.307
Emergency Certificate Suspension 4151.308
General Administrative Sanctions 4151.309
Criminal Penalty 4151.1041
Referral by Insurer 4151.1042
Responsibilities of Insurer
Green check means up to date. Up to date

Accessed:
May 11, 2024

§ 4151.1042’s source at texas​.gov