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.