Tex. Ins. Code Section 4151.001
Definitions


In this chapter:

(1)

“Administrator” means a person who, in connection with annuities or life benefits, health benefits, accident benefits, pharmacy benefits, or workers’ compensation benefits, collects premiums or contributions from or adjusts or settles claims for residents of this state. The term includes a delegated entity under Chapter 1272 (Delegation of Certain Functions by Health Maintenance Organization) and a workers’ compensation health care network authorized under Chapter 1305 (Workers’ Compensation Health Care Networks) that administers a workers’ compensation claim for an insurer, including an insurer that establishes or contracts with the network to provide health care services. The term does not include a person described by Section 4151.002 (Exemptions).

(2)

“Insurer” means a person who engages in the business of life, health, accident, or workers’ compensation insurance under the law of this state. For purposes of this chapter only, the term also includes an “insurance carrier,” as defined by Section 401.011 (General Definitions)(27), Labor Code, other than a governmental entity or a workers’ compensation self-insurance group subject to regulation under Chapter 407A (Group Self-insurance Coverage), Labor Code.

(3)

“Person” means an individual, partnership, corporation, organization, government or governmental subdivision or agency, business trust, estate trust, association, or any other legal entity.

(4)

“Plan” means a plan, fund, or program established, adopted, or maintained by a plan sponsor or insurer to the extent that the plan, fund, or program is established, adopted, or maintained to provide indemnification or expense reimbursement for any type of life, health, or accident benefit.

(5)

“Plan sponsor” means a person, other than an insurer, who establishes, adopts, or maintains a plan that covers residents of this state, including a plan established, adopted, or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, an association, a committee, a joint board of trustees, or any similar group of representatives who establish, adopt, or maintain a plan.

(6)

“Workers’ compensation benefits” means benefits provided under Title 5, Labor Code, or services provided through a certified workers’ compensation health care network authorized under Chapter 1305 (Workers’ Compensation Health Care Networks).

(7)

“Workers’ compensation insurance coverage” means coverage subject to Subtitle E, Title 10. The term includes coverage described by Sections 401.011 (General Definitions)(44)(A) and (B), Labor Code.

(8)

“Workers’ compensation self-insurer” means a legal entity subject to regulation under Chapter 407 (Self-insurance Regulation), Labor Code.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 7, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 1176 (H.B. 472), Sec. 1.01, eff. September 1, 2007.

Source: Section 4151.001 — Definitions, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­4151.­htm#4151.­001 (accessed Jun. 5, 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

Accessed:
Jun. 5, 2024

§ 4151.001’s source at texas​.gov