1. (a) An insurer who otherwise collects premiums or contributions from or adjusts or settles claims in connection with life, health, and accident benefits or annuities for residents of this state may not act as or hold itself out as an administrator unless it has notified the commissioner of its intent to do business under the Insurance Code, Article 21.07-6, except to the extent its operations or activities are exempt as described in subsection (b) of this section.

2. (b) Exempt operations or activities are those operations described in paragraphs (1) and (2) of this subsection which exclusively consist of either:

   1. (1) an insurance company which is collecting premiums for or adjusting or settling claims under its own insurance policies or annuities; or

   2. (2) a health maintenance organization authorized to operate in this state under the Texas Health Maintenance Organization Act for the following purposes:

      1. (A) collecting revenues on its own behalf for evidences of coverage that it has issued and delivered under state law;
      2. (B) adjusting or settling claims under evidences of coverage issued and delivered by it under state law, including the contracting with and payment to providers for performing services, verification of eligibility, and subrogation;
      3. (C) collecting premiums, adjusting, or settling claims for insurance which was issued incidental or supplemental to its lawfully issued and delivered evidences of coverage; and
      4. (D) performing any other activity that is specifically regulated by the Texas Health Maintenance Organization Act, or exempt under this Act or through operation of federal law.

3. (c) Insurers specifically described in subsection (a) of this section are subject to all the provisions of this subchapter except §7.1603 of this title (relating to Application for Certificate of Authority), §7.1605 of this title (relating to Application Procedures), §7.1612 of this title (relating to Supplemental Information/Annual Report), and §7.1613 of this title (relating to Fidelity Bond) and are subject to any other appropriate statutes and regulations. The following provisions in paragraphs (1)-(3) of this subsection apply to such insurers.

   1. (1) Each insurer must transact business under the name in which it holds a certificate of authority.
   2. (2) Every insurer that is operating as an administrator must notify the commissioner, on TPA Form 6, of its activities as an administrator prior to commencing operations.
   3. (3) Every insurer shall, on or before March 1 of each calendar year, prepare and submit to the commissioner an annual report, on TPA Form 6, concerning the insurer's organization, operation, and status as an administrator with respect to Texas risks for the preceding calendar year.

Source Note:The provisions of this §7.1607 adopted to be effective September 14, 1994, 19 TexReg 6855.