Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter GG - HEALTH CARE QUALITY ASSURANCE PRESUMED COMPLIANCE
Section 21.4104 - Health Benefit Plan Issuers Contracting with Delegated Entities, Delegated Third Parties, and Utilization Review Agents
Current through Reg. 50, No. 13; March 28, 2025
(a) Delegations by health benefit plan issuers with nonconditional accreditation. If a health benefit plan issuer with nonconditional accreditation has delegated one or more functions to a delegated entity, delegated third party, or utilization review agent, those delegated functions shall be presumed in compliance with state statutory and regulatory requirements if:
(b) Delegations by health benefit plan issuers without nonconditional accreditation. If a health benefit plan issuer without nonconditional accreditation has delegated one or more functions to a delegated entity, delegated third party, or utilization review agent, those delegated functions shall be presumed in compliance with state statutory and regulatory requirements if the delegated entity, delegated third party, or utilization review agent has received nonconditional accreditation or certification by a national accreditation organization that the department recognizes, as set forth in § 21.4103 of this subchapter (relating to Presumed Compliance).
