State Codes and Statutes

Statutes > Texas > Insurance-code > Title-21-discount-health-care-programs > Chapter-7001-registration-of-discount-health-care-program-operators

INSURANCE CODE

TITLE 21. DISCOUNT HEALTH CARE PROGRAMS

CHAPTER 7001. REGISTRATION OF DISCOUNT HEALTH CARE

PROGRAM OPERATORS

Sec. 7001.001. DEFINITIONS. In this chapter:

(1) "Discount health care program" means a business arrangement

or contract in which an entity, in exchange for fees, dues,

charges, or other consideration, offers its members access to

discounts on health care services provided by health care

providers. The term does not include an insurance policy,

certificate of coverage, or other product otherwise regulated by

the department or a self-funded or self-insured employee benefit

plan.

(2) "Discount health care program operator" means a person who,

in exchange for fees, dues, charges, or other consideration,

operates a discount health care program and contracts with

providers, provider networks, or other discount health care

program operators to offer access to health care services at a

discount and determines the charge to members.

(3) "Health care services" includes physician care, inpatient

care, hospital surgical services, emergency services, ambulance

services, laboratory services, audiology services, dental

services, vision services, mental health services, substance

abuse services, chiropractic services, and podiatry services, and

the provision of medical equipment and supplies, including

prescription drugs.

(4) "Marketer" means a person who sells or distributes, or

offers to sell or distribute, a discount health care program,

including a private label entity that places its name on and

markets or distributes a discount health care program, but does

not operate a discount health care program.

(5) "Member" means a person who pays fees, dues, charges, or

other consideration for the right to participate in a discount

health care program.

(6) "Program operator" means a discount health plan program

operator.

(7) "Provider" means a person who is licensed or otherwise

authorized to provide health care services in this state.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.002. EXEMPTION. This chapter does not apply to a

program operator who is an insurer and who holds a certificate of

authority under Title 6.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.003. RULES. The commissioner shall adopt rules in the

manner prescribed by Subchapter A, Chapter 36, as necessary to

implement this chapter.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.004. REGISTRATION REQUIRED. A discount health care

program operator may not offer a discount health care program in

this state unless the program operator is registered with the

department.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.005. APPLICATION FOR REGISTRATION AND RENEWAL OF

REGISTRATION. (a) An applicant for registration under this

chapter or an applicant for renewal of registration under this

chapter whose information has changed shall submit:

(1) a completed registration application on the form prescribed

by the department indicating the program operator's name,

physical address, and mailing address and its agent for service

of process;

(2) a list of names, addresses, official positions, and

biographical information of:

(A) the individuals responsible for conducting the program

operator's affairs, including:

(i) each member of the board of directors, board of trustees,

executive committee, or other governing board or committee;

(ii) the officers of the program operator; and

(iii) any contracted management company personnel; and

(B) any person owning or having the right to acquire 10 percent

or more of the voting securities of the program operator;

(3) a statement generally describing the applicant, its

facilities and personnel, and the health care services or

products for which a discount will be made available under its

discount health care programs;

(4) a list of the marketers authorized to sell or distribute the

program operator's programs under the program operator's name, a

list of the marketing entities authorized to private label the

program operator's programs, and other information about the

marketers and marketing entities considered necessary by the

commissioner; and

(5) a copy of the form of all contracts made or to be made

between the program operator and any providers or provider

networks regarding the provision of health care services or

products to members.

(b) After the initial registration, if the form of a contract

described by Subsection (a)(5) changes, the program operator must

file the modified contract form with the department before it may

be used.

(c) As part of the registration required under Subsection (a),

and annually thereafter, the program operator shall certify in

writing to the department that its programs comply with the

requirements of this chapter and Chapter 562.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.006. FEES. A discount health care program operator

shall pay the department an initial registration fee of $1,000

and an annual renewal fee in the amount set by the commissioner

not to exceed $500.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.007. DEPOSIT IN OPERATING ACCOUNT. All fees collected

by the department under this chapter shall be deposited to the

credit of the Texas Department of Insurance operating account.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.008. CRIMINAL BACKGROUND CHECK. The department may

conduct a criminal background check on:

(1) the individuals responsible for conducting the program

operator's affairs;

(2) each member of the board of directors, board of trustees,

executive committee, or other governing board or committee;

(3) the officers of the program operator;

(4) any contracted management company personnel; and

(5) any person owning or having the right to acquire 10 percent

or more of the voting securities of the program operator.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.009. ENFORCEMENT. (a) The department may deny a

registration application or take any action authorized under

Chapters 82, 83, and 84 if the department determines that the

applicant or registered discount health care program operator,

individually or through an officer, director, or shareholder:

(1) has wilfully violated a provision of this code or an order

or rule of the commissioner;

(2) has intentionally made a material misstatement in the

registration application;

(3) has obtained or attempted to obtain a registration by fraud

or misrepresentation;

(4) has misappropriated, converted to the applicant's or

registration holder's own use, or illegally withheld money

belonging to a member of a discount health care program;

(5) has engaged in fraudulent or dishonest acts or practices; or

(6) has been convicted of a felony.

(b) Chapter 2001, Government Code, applies to an action taken

under this section.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-21-discount-health-care-programs > Chapter-7001-registration-of-discount-health-care-program-operators

INSURANCE CODE

TITLE 21. DISCOUNT HEALTH CARE PROGRAMS

CHAPTER 7001. REGISTRATION OF DISCOUNT HEALTH CARE

PROGRAM OPERATORS

Sec. 7001.001. DEFINITIONS. In this chapter:

(1) "Discount health care program" means a business arrangement

or contract in which an entity, in exchange for fees, dues,

charges, or other consideration, offers its members access to

discounts on health care services provided by health care

providers. The term does not include an insurance policy,

certificate of coverage, or other product otherwise regulated by

the department or a self-funded or self-insured employee benefit

plan.

(2) "Discount health care program operator" means a person who,

in exchange for fees, dues, charges, or other consideration,

operates a discount health care program and contracts with

providers, provider networks, or other discount health care

program operators to offer access to health care services at a

discount and determines the charge to members.

(3) "Health care services" includes physician care, inpatient

care, hospital surgical services, emergency services, ambulance

services, laboratory services, audiology services, dental

services, vision services, mental health services, substance

abuse services, chiropractic services, and podiatry services, and

the provision of medical equipment and supplies, including

prescription drugs.

(4) "Marketer" means a person who sells or distributes, or

offers to sell or distribute, a discount health care program,

including a private label entity that places its name on and

markets or distributes a discount health care program, but does

not operate a discount health care program.

(5) "Member" means a person who pays fees, dues, charges, or

other consideration for the right to participate in a discount

health care program.

(6) "Program operator" means a discount health plan program

operator.

(7) "Provider" means a person who is licensed or otherwise

authorized to provide health care services in this state.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.002. EXEMPTION. This chapter does not apply to a

program operator who is an insurer and who holds a certificate of

authority under Title 6.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.003. RULES. The commissioner shall adopt rules in the

manner prescribed by Subchapter A, Chapter 36, as necessary to

implement this chapter.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.004. REGISTRATION REQUIRED. A discount health care

program operator may not offer a discount health care program in

this state unless the program operator is registered with the

department.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.005. APPLICATION FOR REGISTRATION AND RENEWAL OF

REGISTRATION. (a) An applicant for registration under this

chapter or an applicant for renewal of registration under this

chapter whose information has changed shall submit:

(1) a completed registration application on the form prescribed

by the department indicating the program operator's name,

physical address, and mailing address and its agent for service

of process;

(2) a list of names, addresses, official positions, and

biographical information of:

(A) the individuals responsible for conducting the program

operator's affairs, including:

(i) each member of the board of directors, board of trustees,

executive committee, or other governing board or committee;

(ii) the officers of the program operator; and

(iii) any contracted management company personnel; and

(B) any person owning or having the right to acquire 10 percent

or more of the voting securities of the program operator;

(3) a statement generally describing the applicant, its

facilities and personnel, and the health care services or

products for which a discount will be made available under its

discount health care programs;

(4) a list of the marketers authorized to sell or distribute the

program operator's programs under the program operator's name, a

list of the marketing entities authorized to private label the

program operator's programs, and other information about the

marketers and marketing entities considered necessary by the

commissioner; and

(5) a copy of the form of all contracts made or to be made

between the program operator and any providers or provider

networks regarding the provision of health care services or

products to members.

(b) After the initial registration, if the form of a contract

described by Subsection (a)(5) changes, the program operator must

file the modified contract form with the department before it may

be used.

(c) As part of the registration required under Subsection (a),

and annually thereafter, the program operator shall certify in

writing to the department that its programs comply with the

requirements of this chapter and Chapter 562.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.006. FEES. A discount health care program operator

shall pay the department an initial registration fee of $1,000

and an annual renewal fee in the amount set by the commissioner

not to exceed $500.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.007. DEPOSIT IN OPERATING ACCOUNT. All fees collected

by the department under this chapter shall be deposited to the

credit of the Texas Department of Insurance operating account.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.008. CRIMINAL BACKGROUND CHECK. The department may

conduct a criminal background check on:

(1) the individuals responsible for conducting the program

operator's affairs;

(2) each member of the board of directors, board of trustees,

executive committee, or other governing board or committee;

(3) the officers of the program operator;

(4) any contracted management company personnel; and

(5) any person owning or having the right to acquire 10 percent

or more of the voting securities of the program operator.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.009. ENFORCEMENT. (a) The department may deny a

registration application or take any action authorized under

Chapters 82, 83, and 84 if the department determines that the

applicant or registered discount health care program operator,

individually or through an officer, director, or shareholder:

(1) has wilfully violated a provision of this code or an order

or rule of the commissioner;

(2) has intentionally made a material misstatement in the

registration application;

(3) has obtained or attempted to obtain a registration by fraud

or misrepresentation;

(4) has misappropriated, converted to the applicant's or

registration holder's own use, or illegally withheld money

belonging to a member of a discount health care program;

(5) has engaged in fraudulent or dishonest acts or practices; or

(6) has been convicted of a felony.

(b) Chapter 2001, Government Code, applies to an action taken

under this section.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.


State Codes and Statutes


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State Codes and Statutes

Statutes > Texas > Insurance-code > Title-21-discount-health-care-programs > Chapter-7001-registration-of-discount-health-care-program-operators

INSURANCE CODE

TITLE 21. DISCOUNT HEALTH CARE PROGRAMS

CHAPTER 7001. REGISTRATION OF DISCOUNT HEALTH CARE

PROGRAM OPERATORS

Sec. 7001.001. DEFINITIONS. In this chapter:

(1) "Discount health care program" means a business arrangement

or contract in which an entity, in exchange for fees, dues,

charges, or other consideration, offers its members access to

discounts on health care services provided by health care

providers. The term does not include an insurance policy,

certificate of coverage, or other product otherwise regulated by

the department or a self-funded or self-insured employee benefit

plan.

(2) "Discount health care program operator" means a person who,

in exchange for fees, dues, charges, or other consideration,

operates a discount health care program and contracts with

providers, provider networks, or other discount health care

program operators to offer access to health care services at a

discount and determines the charge to members.

(3) "Health care services" includes physician care, inpatient

care, hospital surgical services, emergency services, ambulance

services, laboratory services, audiology services, dental

services, vision services, mental health services, substance

abuse services, chiropractic services, and podiatry services, and

the provision of medical equipment and supplies, including

prescription drugs.

(4) "Marketer" means a person who sells or distributes, or

offers to sell or distribute, a discount health care program,

including a private label entity that places its name on and

markets or distributes a discount health care program, but does

not operate a discount health care program.

(5) "Member" means a person who pays fees, dues, charges, or

other consideration for the right to participate in a discount

health care program.

(6) "Program operator" means a discount health plan program

operator.

(7) "Provider" means a person who is licensed or otherwise

authorized to provide health care services in this state.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.002. EXEMPTION. This chapter does not apply to a

program operator who is an insurer and who holds a certificate of

authority under Title 6.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.003. RULES. The commissioner shall adopt rules in the

manner prescribed by Subchapter A, Chapter 36, as necessary to

implement this chapter.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.004. REGISTRATION REQUIRED. A discount health care

program operator may not offer a discount health care program in

this state unless the program operator is registered with the

department.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.005. APPLICATION FOR REGISTRATION AND RENEWAL OF

REGISTRATION. (a) An applicant for registration under this

chapter or an applicant for renewal of registration under this

chapter whose information has changed shall submit:

(1) a completed registration application on the form prescribed

by the department indicating the program operator's name,

physical address, and mailing address and its agent for service

of process;

(2) a list of names, addresses, official positions, and

biographical information of:

(A) the individuals responsible for conducting the program

operator's affairs, including:

(i) each member of the board of directors, board of trustees,

executive committee, or other governing board or committee;

(ii) the officers of the program operator; and

(iii) any contracted management company personnel; and

(B) any person owning or having the right to acquire 10 percent

or more of the voting securities of the program operator;

(3) a statement generally describing the applicant, its

facilities and personnel, and the health care services or

products for which a discount will be made available under its

discount health care programs;

(4) a list of the marketers authorized to sell or distribute the

program operator's programs under the program operator's name, a

list of the marketing entities authorized to private label the

program operator's programs, and other information about the

marketers and marketing entities considered necessary by the

commissioner; and

(5) a copy of the form of all contracts made or to be made

between the program operator and any providers or provider

networks regarding the provision of health care services or

products to members.

(b) After the initial registration, if the form of a contract

described by Subsection (a)(5) changes, the program operator must

file the modified contract form with the department before it may

be used.

(c) As part of the registration required under Subsection (a),

and annually thereafter, the program operator shall certify in

writing to the department that its programs comply with the

requirements of this chapter and Chapter 562.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.006. FEES. A discount health care program operator

shall pay the department an initial registration fee of $1,000

and an annual renewal fee in the amount set by the commissioner

not to exceed $500.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.007. DEPOSIT IN OPERATING ACCOUNT. All fees collected

by the department under this chapter shall be deposited to the

credit of the Texas Department of Insurance operating account.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.008. CRIMINAL BACKGROUND CHECK. The department may

conduct a criminal background check on:

(1) the individuals responsible for conducting the program

operator's affairs;

(2) each member of the board of directors, board of trustees,

executive committee, or other governing board or committee;

(3) the officers of the program operator;

(4) any contracted management company personnel; and

(5) any person owning or having the right to acquire 10 percent

or more of the voting securities of the program operator.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.

Sec. 7001.009. ENFORCEMENT. (a) The department may deny a

registration application or take any action authorized under

Chapters 82, 83, and 84 if the department determines that the

applicant or registered discount health care program operator,

individually or through an officer, director, or shareholder:

(1) has wilfully violated a provision of this code or an order

or rule of the commissioner;

(2) has intentionally made a material misstatement in the

registration application;

(3) has obtained or attempted to obtain a registration by fraud

or misrepresentation;

(4) has misappropriated, converted to the applicant's or

registration holder's own use, or illegally withheld money

belonging to a member of a discount health care program;

(5) has engaged in fraudulent or dishonest acts or practices; or

(6) has been convicted of a felony.

(b) Chapter 2001, Government Code, applies to an action taken

under this section.

Added by Acts 2009, 81st Leg., R.S., Ch.

1331, Sec. 2, eff. September 1, 2009.


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