Sec. 91.0411. SELF-FUNDED HEALTH BENEFIT PLAN. (a) In this section, "commissioner" means the commissioner of insurance.
(b) A license holder may sponsor a benefit plan that is not fully insured if the license holder meets the requirements of this section and is approved to sponsor the plan by the commissioner.
(c) The commissioner may, on notice and opportunity for all interested persons to be heard, adopt rules and issue orders reasonably necessary to augment and implement the regulation of benefit plans sponsored by a license holder that are not fully insured. The commissioner may not adopt a rule that requires clients or covered employees to be members of an association or group in the same trade or industry in order to be covered by a license holder-sponsored benefit plan that is not fully insured. The rules must include all requirements that must be met by the license holder and the plan, including:
(1) initial and final approval requirements;
(2) authority to prescribe forms and items to be submitted to the commissioner by the license holder;
(3) a fidelity bond;
(4) use of an independent actuary;
(5) use of a third-party administrator;
(6) authority for the commissioner to examine an application or a plan;
(7) the minimum number of clients and covered employees covered by the plan;
(8) standards for those natural persons managing the plan;
(9) the minimum amount of gross contributions;
(10) the minimum amount of written commitment, binder, or policy for stop-loss insurance;
(11) the minimum amount of reserves; and
(12) a fee in an amount reasonable and necessary to defray the costs of administering this section to be deposited to the credit of the operating fund of the Texas Department of Insurance.
(d) Information submitted under this section is confidential and not subject to disclosure under Chapter 552, Government Code.
(e) Each license holder under this section shall appoint the commissioner as its resident agent for purposes of service of process. The fee for that service is $50, payable at the time of appointment.
(f) The commissioner may examine the affairs of any plan and shall have access to the records of the plan. The commissioner may examine under oath a manager or employee of the license holder in connection with the plan.
(g) In addition to any requirement or remedy under a law, the commissioner may suspend, revoke, or limit the authorization of a plan if the commissioner determines, after notice and hearing, that the plan does not comply with this section. The commissioner may notify the attorney general of a violation of this section, and the attorney general may apply to a district court in Travis County for leave to file suit in the nature of quo warranto or for injunctive relief or both.
(h) A plan under this section is subject to Chapters 401, 404, 441, and 443, Insurance Code.
Added by Acts 2013, 83rd Leg., R.S., Ch. 117 (S.B. 1286), Sec. 16, eff. September 1, 2013.
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