(a) Applicable Administrative Code provisions. The
following provisions of this title are applicable to an approved PEO,
or to its plan and trust, as appropriate, to the same extent as the
provisions apply to any entity TDI regulates under those provisions:
(1) Chapter 1 of this title (relating to General Administration);
(2) Chapter 3, Subchapter A of this title (relating
to Submission Requirements for Filings and Departmental Actions Related
to Such Filings);
(3) Chapter 3, Subchapter E of this title (relating
to Group Life, and/or Accident and Health Insurance Policies and Certificates);
(4) Chapter 3, Subchapter G of this title (relating
to Plain Language Requirements for Health Benefit Policies);
(5) Chapter 3, Subchapter M of this title (relating
to Discretionary Clauses);
(6) Chapter 3, Subchapter U of this title (relating
to Newborn Children Coverage);
(7) Section 3.3601 of this title (relating to Orthodontic
Coverages);
(8) Chapter 3, Subchapter V of this title (relating
to Coordination of Benefits);
(9) Chapter 3, Subchapter X of this title (relating
to Preferred and Exclusive Provider Plans);
(10) Chapter 3, Subchapter BB of this title (relating
to Pharmaceutical Services);
(11) Chapter 3, Subchapter HH of this title (relating
to Standards for Reasonable Cost Control and Utilization Review for
Chemical Dependency Treatment Centers);
(12) Chapter 7, Subchapter B of this title (relating
to Insurance Holding Company Systems);
(13) Chapter 12 of this title (relating to Independent
Review Organizations);
(14) Chapter 19, Subchapter R of this title (relating
to Utilization Review for Health Care Provided Under a Health Benefit
Plan or Health Insurance Policy);
(15) Chapter 21, Subchapter A of this title (relating
to Unfair Competition and Unfair Practices of Insurers, and Misrepresentation
of Policies);
(16) Chapter 21, Subchapter B of this title (relating
to Advertising, Certain Trade Practices, and Solicitation);
(17) Chapter 21, Subchapter C of this title (relating
to Unfair Claims Settlement Practices);
(18) Chapter 21, Subchapter E of this title (relating
to Unfair Discrimination Based on Sex or Marital Status);
(19) Chapter 21, Subchapter H of this title (relating
to Unfair Discrimination);
(20) Chapter 21, Subchapter K of this title (relating
to Certification of Creditable Coverage);
(21) Chapter 21, Subchapter L of this title (relating
to Medical Child Support, Unfair Practices);
(22) Chapter 21, Subchapter M of this title (relating
to Mandatory Benefit Notice Requirements);
(23) Chapter 21, Subchapter P of this title (relating
to Mental Health Parity);
(24) Chapter 21, Subchapter Q of this title (relating
to Complaint Records to be Maintained);
(25) Chapter 21, Subchapter R of this title (relating
to Diabetes);
(26) Chapter 21, Subchapter T of this title (relating
to Submission of Clean Claims);
(27) Chapter 21, Subchapter V of this title (relating
to Pharmacy Benefits);
(28) Chapter 21, Subchapter W of this title (relating
to Coverage for Acquired Brain Injury);
(29) Chapter 21, Subchapter Y of this title (relating
to Unfair Discrimination in Compensation for Women's Healthcare);
(30) Chapter 21, Subchapter Z of this title (relating
to Data Collecting and Reporting Relating to Mandated Health Benefits
and Mandated Offers of Coverage);
(31) Chapter 21, Subchapter AA of this title (relating
to Consumer Choice Health Benefit Plans);
(32) Chapter 21, Subchapter BB of this title (relating
to Dental Care Benefits);
(33) Chapter 21, Subchapter CC of this title (relating
to Electronic Health Care Transactions);
(34) Chapter 21, Subchapter DD of this title (relating
to Eligibility Statements);
(35) Chapter 21, Subchapter EE of this title (relating
to High Deductible Health Plans);
(36) Chapter 21, Subchapter FF of this title (relating
to Obligation to Continue Premium Payment and Coverage After Notice
of Lost Group Eligibility);
(37) Chapter 21, Subchapter II of this title (relating
to Recognition of National Certifying Organizations for Noninvasive
Screening of Cardiovascular Disease);
(38) Chapter 21, Subchapter JJ of this title (relating
to Autism Spectrum Disorder Coverage);
(39) Chapter 21, Subchapter KK of this title (relating
to Health Care Reimbursement Rate Information);
(40) Chapter 21, Subchapter MM of this title (relating
to Wellness Programs);
(41) Chapter 21, Subchapter NN of this title (relating
to Noninsurance Benefits and Features);
(42) Chapter 21, Subchapter PP of this title (relating
to Out-Of-Network Claim Dispute Resolution);
(43) Chapter 21, Subchapter RR of this title (relating
to Standard Proof of Health Insurance for Medical Benefits for Injuries
Incurred as a Result of a Motorcycle Accident);
(44) Chapter 21, Subchapter SS of this title (relating
to Continuation and Conversion Provisions);
(45) Chapter 22 of this title (relating to Privacy);
and
(46) Chapter 26 of this title (relating to Small Employer
Health Insurance Regulations).
(b) Plan as large employer plan. For purposes of applying
Chapter 21, Subchapter P or W of this title, a plan sponsored by an
approved PEO is the equivalent of a large employer health benefit
plan, regardless of the size of any of the approved PEO's clients.
(c) Approved PEO as insurer; client as group policyholder.
For purposes of applying Chapter 21, Subchapter FF of this title,
an approved PEO is the equivalent of a health insurer, and the approved
PEO's client is the equivalent of a group policyholder.
(d) Approved PEO as large employer carrier and large
employer. Except as provided in subsection (e) of this section, for
purposes of applying Chapter 26 of this title, an approved PEO is
the equivalent of both a large employer carrier and a large employer.
(e) Approved PEO as large employer carrier; client
as large employer. For purposes of applying §26.303 and §§26.307
- 26.309 of this title, (relating to Coverage Requirements, Fair Marketing,
Renewability of Coverage and Cancellation, and Refusal to Renew and
Application to Reenter Large Employer Market), an approved PEO is
the equivalent of a large employer carrier, and the approved PEO's
client is the equivalent of a large employer.
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