(a) Except for withdrawing HMOs, which are addressed
under subsection (b) of this section and insurers meeting the criteria
under §7.1804(b) of this title (relating to When a Plan is Required),
a withdrawing insurer must file a plan of orderly withdrawal with
the Commissioner that is constructed to protect the interests of the
people of this state. The plan must be signed by at least one officer
of the insurer and must contain the following:
(1) identification, in accordance with the line of
insurance designations in §7.1803 of this title (relating to
What Constitutes a Line of Insurance), of the line or lines of insurance
being withdrawn;
(2) identification of the policy forms by number and
type affected by the withdrawal;
(3) the dates the insurer intends to begin and complete
its withdrawal;
(4) an explanation of the reasons for the withdrawal;
(5) provisions for notifying all of the affected Texas
policyholders and certificate holders of the dates of the beginning
and completion of the withdrawal and how the withdrawal will affect
them, including, but not limited to:
(A) a copy of the notice and an explanation of the
manner in which the notice will be provided to policyholders and certificate
holders;
(B) either affirmation that such notice will be provided
within 30 days of the approval of the withdrawal plan or a request
to provide the notice at some other specified date or time, and such
request must be approved by the Commissioner; and
(C) identification of any provision of the Insurance
Code or Texas Administrative Code under which notice is mandated;
(6) provisions for meeting all of the insurer's contractual
obligations, including, but not limited to:
(A) notification of all affected agents of the insurer
of the date the insurer intends to begin and complete the withdrawal;
(B) for fire and casualty insurers, a statement affirming
the insurer's compliance with the provisions of Insurance Code Chapter
4051, Subchapter H, relating to cancellation of agency contracts;
(C) for insurers writing liability coverage as specified
in Insurance Code Chapter 551, Subchapter B, a statement affirming
the insurer's compliance with the provisions of Insurance Code Chapter
551, Subchapter B, relating to cancellation and nonrenewal of certain
liability insurance coverage;
(D) for insurers writing property and casualty coverage
as specified in Insurance Code Chapter 551, Subchapter C, a statement
affirming the insurer's compliance with the provisions of Insurance
Code Chapter 551, Subchapter C, relating to cancellation and nonrenewal
of certain property and casualty policies; and
(E) for insurers writing guaranteed renewable or noncancelable
coverage, a statement affirming the insurer's compliance with the
provisions of Insurance Code §1202.051, concerning renewability
and continuation of individual health insurance policies, and Insurance
Code §1501.109, concerning refusal to renew and discontinuation
of coverage, and any corresponding regulations;
(7) provisions for providing service to the insurer's
Texas policyholders and claimants;
(8) information on Texas business, including:
(A) the total annual premium volume and the number
of policies and certificates and covered persons in Texas by county
for each line to be withdrawn and the estimated total annual premium
volume and number of policies and certificates and covered persons
in Texas by county after withdrawal;
(B) an estimate of what percentage of the market for
each affected line of insurance in each county the withdrawal impacts;
(C) any other information necessary to assist the Commissioner
in determining whether a market availability problem is created by
the withdrawal; and
(D) if an insurer is unable to provide the exact number
of policies and certificates and covered persons, the insurer must
provide estimates and explain how the estimates were determined;
(9) provisions for identifying policyholders or certificate
holders of special circumstances;
(10) identification of any third party contracts which
may provide for the continuity of care to enrollees of special circumstances;
(11) number of and estimated amount of all losses outstanding
in Texas, including claims incurred but not reported;
(12) a plan to handle the losses specified in paragraph
(11) of this subsection, including, but not limited to:
(A) identification of what assets will be available
for paying outstanding incurred but not reported claims, claims in
the course of settlement, and associated loss adjustment expenses;
and
(B) identification of who specifically will administer
the run off of the business;
(13) if Texas policyholders or certificate holders
are to be reinsured, the filing of a reinsurance agreement under all
statutory and regulatory requirements and, when applicable, the filing
of an assumption certificate;
(14) provisions for meeting any applicable statutory
obligations, including, but not limited to:
(A) payment of any guaranty fund assessments;
(B) participation in any assigned risk plan, pool,
fund, facility, or joint underwriting arrangement; and
(C) payment of any taxes;
(15) a list of any other products the insurer will
continue to offer in Texas; and
(16) affirmation that the insurer will comply with §7.1808
of this title (relating to Requirements to Resume Writing Insurance),
as applicable.
(b) Unless it meets the criteria under §7.1804(b)
of this title, a withdrawing HMO must file a plan of orderly withdrawal
with the Commissioner that is constructed to protect the interests
of the people of Texas. The plan must be signed by at least one officer
of the HMO and must contain the following:
(1) identification, in accordance with the line of
insurance designations in §7.1803 of this title, of the line
or lines of insurance being withdrawn;
(2) identification by form number of the evidences
of coverage affected by withdrawal;
(3) the dates the HMO intends to begin and complete
its withdrawal;
(4) an explanation of the reasons for the withdrawal;
(5) provisions for notifying all of the affected Texas
enrollees and contract holders of the dates of the beginning and completion
of the withdrawal and how the withdrawal will affect them, including,
but not limited to:
(A) a copy of the notice and an explanation of the
manner in which the notice will be provided to enrollees or contract
holders;
(B) either an affirmation that such notice will be
provided within 30 days of the approval of the withdrawal plan or
a request to provide the notice at some other specified date or time,
and such request must be approved by the Commissioner; and
(C) identification of any provisions of the Insurance
Code or the Texas Administrative Code under which notice is mandated;
(6) provisions for meeting all of the HMO's contractual
obligations, including, but not limited to:
(A) notification to all affected agents of the HMO
of the dates the HMO intends to begin and complete the withdrawal;
and
(B) for HMOs writing guaranteed renewable or noncancelable
coverage, a statement affirming the HMO's compliance with the provisions
of Insurance Code §843.208, concerning cancellation or nonrenewal
of coverage; §1271.307, concerning renewability of coverage for
individual health care plans and conversion contracts; and §1501.109,
concerning refusal to renew and discontinuation of coverage, and any
corresponding regulations;
(7) provisions for providing service to the HMO's Texas
enrollees and providers;
(8) information on Texas business, including:
(A) the total annual premium volume and the number
of affected contract holders and enrollees in Texas by county in all
service areas for each line to be withdrawn and the estimated total
annual premium volume and number of enrollees and contract holders
in Texas by county in all service areas after withdrawal;
(B) an estimate of what percentage of the market for
each affected line of insurance by county in all service areas the
withdrawal impacts, as measured by enrollee; and
(C) any other information necessary to assist the Commissioner
in determining whether a market availability problem is created by
the withdrawal;
(9) provisions for identifying enrollees of special
circumstance;
(10) identification of any third-party contracts that
may provide for the continuity of care to enrollees of special circumstance;
Cont'd... |