| (a) Registration Requirement. An applicant for registration
to offer a discount health care program in this state is required
to submit all of the following to the department:
(1) the initial registration fee of $1,000 as provided
in Insurance Code §7001.006, concerning Fees, and §19.802
of this title (relating to Amount of Fees) that is nonrefundable and
nontransferable;
(2) a complete application for registration that contains
all the information required by Insurance Code §7001.005, concerning
Application for Registration and Renewal of Registration, and this
section, including:
(A) the applicant's full legal name and federal employer
identification number or social security number; daytime telephone
number with extension; toll free telephone number; website address;
physical address, including city, state, and ZIP code; mailing address,
including the city, state, and ZIP code; a contact person's name,
including the title, telephone number, and email address; the applicant's
agent for service of process, including the physical address, city,
state, and ZIP code;
(B) identification of whether the applicant is a corporation,
association, limited partnership, limited liability company, limited
liability partnership, sole proprietorship, or other legal entity;
(C) any and all assumed names to be used by the applicant
in operating a discount health care program. If a filing is required
under the Assumed Business or Professional Name Act under the Texas
Business and Commerce Code, or any similar statute, the discount health
care program operator applicant for registration must provide the
department with a copy of the assumed name certificate reflecting
the registration of each assumed name used by the discount health
care program operator applicant;
(D) a statement generally describing the applicant,
its facilities, personnel, and the health care services or products
for which a discount will be made available under its discount health
care programs;
(E) a copy of the form of all contracts made or to
be made between the applicant and any providers or provider networks
regarding the provision of health care services or products to members;
(F) a copy of the applicant's charter, certificate
of authority, or registration obtained from the Texas Secretary of
State's office;
(G) if the applicant is an entity subject to the bank
or farm credit administration, a copy of the documentation issued
by a federal or Texas state agency authorizing the entity to do business
in Texas;
(H) an original surety bond payable to the department
for the use and benefit of members in the principal amount of $50,000,
as required by Insurance Code §562.103(f)(1), concerning Program
Operator Duties, and §19.1603 of this title (relating to Financial
Responsibility Requirement), except that an insurer that holds a certificate
of authority under Texas Insurance Code Title 6, concerning Organization
of Insurers and Related Entities, is not required to maintain the
surety bond;
(I) lists of marketers, both entities and individuals,
separated as follows:
(i) a list of the marketers, both entities and individuals,
authorized to sell or distribute the program operator's programs under
the program operator's name; and
(ii) a list of the marketers, both entities and individuals,
authorized to private label the program operator's programs;
(J) a certification in writing to the department that
its programs comply with the requirements of Insurance Code Chapter
7001, concerning Registration of Discount Health Care Program Operators,
and Chapter 562, concerning Unfair Methods of Competition and Unfair
or Deceptive Acts or Practices Regarding Discount Health Care Programs;
(K) a list of names, addresses, official positions,
and biographical information of:
(i) the individuals responsible for conducting the
applicant's affairs;
(ii) each member of the board of directors, board of
trustees, executive committee, or other governing board or committee;
(iii) the officers;
(iv) any contracted management company personnel; and
(v) any person owning or having the right to acquire
10% or more of the voting securities of the applicant;
(L) a complete biographical certificate concerning
each individual whose biographical information is required under Insurance
Code §7001.005(a)(2) and this section, including:
(i) the identification of the individual's relationship
to the applicant;
(ii) the name of the applicant;
(iii) the full name; title; social security number;
date of birth; mailing address, including the city, state, and ZIP
code; telephone number; fax number; and email address of the individual;
(iv) excluding traffic violations and a first DWI offense,
a response to the following questions:
(I) whether the individual has any pending misdemeanor
or felony charges by indictment, information, or any other instrument
filed in Texas or in any other state or by the federal government;
(II) whether the individual has ever been convicted
of any misdemeanor or felony offense in Texas, in any other state,
or by the federal government;
(III) whether the individual has ever had deferred
adjudication on any misdemeanor or felony charge or offense in Texas,
in any other state, or by the federal government; and
(IV) whether the person has ever served any period
of probation for any misdemeanor or felony offense in Texas, in any
other state, or by the federal government;
(v) if the response is positive to any question under
clause (iv)(I) - (IV) of this subparagraph, the applicant for registration
as a discount health care program operator is required to provide
to the department original certified copies of the charging document,
indictment, information, or any other charging document, any judgment
of conviction, deferred adjudication order, or probation order, and
any order terminating probation, community supervision certificate,
or parole certificate for each offense. If the court does not maintain
the record, the submission of a letter on the court's letterhead will
be required. If the arrest did not result in a prosecution, the submission
of a records search from the appropriate jurisdiction indicating a
final disposition will be required. A statement describing the circumstances
leading to the offense and the individual's age at the time of the
offense will be required. Letters of recommendation from any person
aware of a particular criminal history may be provided;
(vi) a response to the question whether the individual
whose biographical information is required under Insurance Code §7001.005(a)(2)
and this section, or any entity in which the individual served as
a director, officer, shareholder, manager, member, or partner, has
ever been the subject of an administrative or legal action filed by
the department, or any other insurance department, financial regulatory
agency, or of an action filed on behalf of the State of Texas or any
other state or by the federal government based on alleged violations
of state or federal insurance, securities, or financial regulatory
laws that the individual has not previously reported to the department.
If the response is positive, the applicant for registration as a discount
health care program operator is required to provide to the department
a description of the circumstances regarding the administrative or
legal action and a copy of any document sent to the individual to
commence the administrative or legal action that described the nature
of the action;
(vii) a response to the question whether the individual,
whose biographical information is required under Insurance Code §7001.005(a)(2)
and this section, is indebted to any discount health care program
operator, policyholder, insurance or reinsurance company, insurance
agency, general agent, managing general agency, premium finance company
or court-appointed liquidator for membership refunds, premiums collected,
or commissions retained, or have any claims or judgments filed against
the individual for membership refunds, retaining premiums, or commissions.
If the response is positive, the applicant for registration as a discount
health care program operator is required to provide to the department
a description of the circumstances regarding the indebtedness, including
the name and contact information of the person or entity to whom the
individual is indebted;
(viii) a response to the question whether the individual
whose biographical information is required under Insurance Code §7001.005(a)(2)
and this section has ever had a discount health care program contract
cancelled for cause, such as for misrepresentation or misappropriation.
If the response is positive, the applicant for registration as a discount
health care program operator is required to provide to the department
a description of the circumstances regarding the cancellation including
the name and contact information of the individual or entity that
cancelled the contract;
Cont'd... |
