Sec. 4201.058. INSURERS. (a) This chapter applies to an insurer subject to this code that delivers or issues for delivery a health insurance policy in this state except as expressly provided by this section. As a condition of holding a certificate of authority to engage in the business of insurance, an insurer that performs utilization review shall comply with this chapter, except Subchapter C. The insurer is subject to assessment of a maintenance tax under Chapter 257 to cover the costs of administering compliance with this subsection.
(b) The commissioner shall adopt rules for appropriate verification and enforcement of compliance with Subsection (a).
(c) Notwithstanding Subsection (a), an insurer subject to this code that performs utilization review for a person or entity subject to this chapter, other than a person or entity for which the insurer is the payor, must obtain a certificate of registration under Subchapter C and shall comply with all of the provisions of this chapter.
Added by Acts 2005, 79th Leg., Ch. 727 (H.B. 2017), Sec. 4, eff. April 1, 2007.
Structure Texas Statutes
Title 14 - Utilization Review and Independent Review
Chapter 4201 - Utilization Review Agents
Subchapter B. Applicability of Chapter
Section 4201.051. Persons Providing Information About Scope of Coverage or Benefits
Section 4201.052. Certain Contracts With Federal Government
Section 4201.053. Medicaid and Other State Health or Mental Health Programs
Section 4201.054. Workers' Compensation Benefits
Section 4201.055. Health Care Service Provided Under Automobile Insurance Policy
Section 4201.056. Employee Welfare Benefit Plans