Tex.
Ins. Code Section 848.108
Delegation Agreements
(a)
Except as provided by Subsection (b), a health care collaborative that enters into a delegation agreement described by Section 1272.001 (Definitions) is subject to the requirements of Chapter 1272 (Delegation of Certain Functions by Health Maintenance Organization) in the same manner as a health maintenance organization.(b)
Section 1272.301 (Access to Out-of-network Services) does not apply to a delegation agreement entered into by a health care collaborative.(c)
A health care collaborative may enter into a delegation agreement with an entity licensed under Chapter 841 (Life, Health, or Accident Insurance Companies), 842 (Group Hospital Service Corporations), or 883 (Mutual Insurance Companies Other than Mutual Life Insurance Companies) if the delegation agreement assigns to the entity responsibility for:(1)
a function regulated by:(A)
Chapter 222 (Life, Health, and Accident Insurance Premium Tax);(B)
Chapter 841 (Life, Health, or Accident Insurance Companies);(C)
Chapter 842 (Group Hospital Service Corporations);(D)
Chapter 883 (Mutual Insurance Companies Other than Mutual Life Insurance Companies);(E)
Chapter 1272 (Delegation of Certain Functions by Health Maintenance Organization);(F)
Chapter 1301 (Preferred Provider Benefit Plans);(G)
Chapter 4201 (Utilization Review Agents);(H)
Section 1367.053 (Coverage Required); or(I)
Subchapter A, Chapter 1507 (Consumer Choice of Benefits Plans); or(2)
another function specified by commissioner rule.(d)
A health care collaborative that enters into a delegation agreement under this section shall maintain reserves and capital in addition to the amounts required under Chapter 1272 (Delegation of Certain Functions by Health Maintenance Organization), in an amount and form determined by rule of the commissioner to be necessary for the liabilities and risks assumed by the health care collaborative.(e)
A health care collaborative that enters into a delegation agreement under this section is subject to Chapters 404 (Financial Condition), 441 (Supervision and Conservatorship), and 443 (Insurer Receivership Act) and is considered to be an insurer for purposes of those chapters.
Source:
Section 848.108 — Delegation Agreements, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.848.htm#848.108 (accessed Jun. 5, 2024).
