INSURANCE CODE
TITLE 5. PROTECTION OF CONSUMER INTERESTS
SUBTITLE A. PUBLIC INSURANCE COUNSEL
CHAPTER 501. OFFICE OF PUBLIC INSURANCE COUNSEL
SUBCHAPTER A. GENERAL PROVISIONS
§ 501.001. DEFINITION. In this chapter, "office" means
the office of public insurance counsel.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.002. OFFICE OF PUBLIC INSURANCE COUNSEL. The
independent office of public insurance counsel represents the
interests of insurance consumers in this state.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.003. SUNSET PROVISION. The office is subject to
Chapter 325, Government Code (Texas Sunset Act). Unless continued
in existence as provided by that chapter, the office is abolished
September 1, 2005.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.004. PUBLIC INTEREST INFORMATION. (a) The
office shall prepare information of public interest describing the
functions of the office.
(b) The office shall make the information available to the
public and appropriate state agencies.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.005. ACCESS TO PROGRAMS AND FACILITIES. (a) The
office shall prepare and maintain a written plan that describes how
a person who does not speak English can be provided reasonable
access to the office's programs.
(b) The office shall comply with federal and state laws for
program and facility accessibility.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER B. PUBLIC COUNSEL
§ 501.051. APPOINTMENT; TERM. (a) The governor, with
the advice and consent of the senate, shall appoint a public counsel
to serve as the executive director of the office. The public
counsel serves a two-year term that expires on February 1 of each
odd-numbered year.
(b) The governor shall appoint the public counsel without
regard to the race, color, disability, sex, religion, age, or
national origin of the appointee.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.052. QUALIFICATIONS. To be eligible to serve as
public counsel, a person must:
(1) be licensed to practice law in this state;
(2) have demonstrated a strong commitment to and
involvement in efforts to safeguard the rights of the public; and
(3) possess the knowledge and experience necessary to
practice effectively in insurance proceedings.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.053. BUSINESS INTEREST; SERVICE AS PUBLIC
COUNSEL. A person is not eligible for appointment as public
counsel if the person or the person's spouse:
(1) is employed by or participates in the management
of a business entity or other organization regulated by or
receiving funds from the department;
(2) owns or controls, directly or indirectly, more
than a 10 percent interest in a business entity or other
organization regulated by or receiving funds from the department or
the office; or
(3) uses or receives a substantial amount of tangible
goods, services, or funds from the department or the office, other
than compensation or reimbursement authorized by law for department
or office membership, attendance, or expenses.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.054. LOBBYING ACTIVITIES. A person may not serve
as public counsel or act as general counsel to the office if the
person is required to register as a lobbyist under Chapter 305,
Government Code, because of the person's activities for
compensation related to the operation of the department or the
office.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.055. GROUNDS FOR REMOVAL. (a) It is a ground for
removal from office if the public counsel:
(1) does not have at the time of appointment or
maintain during service as public counsel the qualifications
required by Section 501.052;
(2) violates a prohibition established by Section
501.053, 501.054, 501.056, or 501.102; or
(3) cannot, because of illness or disability,
discharge the public counsel's duties for a substantial part of the
public counsel's term.
(b) The validity of an action of the office is not affected
by the fact that the action is taken when a ground for removal of the
public counsel exists.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.056. PROHIBITED REPRESENTATION OR EMPLOYMENT. A
former public counsel may not represent any person or receive
compensation for services rendered on behalf of any person
regarding a case pending before the commissioner or department
before the second anniversary of the date the person ceases to serve
as public counsel.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER C. PERSONNEL
§ 501.101. OFFICE PERSONNEL. (a) The public counsel
shall employ professional, technical, and other employees
necessary to implement this chapter.
(b) Compensation for an employee shall be set under the
General Appropriations Act as provided by the legislature.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.102. TRADE ASSOCIATIONS. (a) In this section,
"trade association" means a nonprofit, cooperative, and
voluntarily joined association of business or professional
competitors designed to assist its members and its industry or
profession in dealing with mutual business or professional problems
and in promoting their common interest.
(b) A person may not serve as public counsel or be an
employee of the office who is exempt from the state's position
classification plan or is compensated at or above the amount
prescribed by the General Appropriations Act for step 1, salary
group A17, of the position classification salary schedule if the
person is:
(1) an officer, employee, or paid consultant of a
trade association in the field of insurance; or
(2) the spouse of an officer, manager, or paid
consultant of a trade association in the field of insurance.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.103. CAREER LADDER PROGRAM; PERFORMANCE
EVALUATIONS. (a) The public counsel or the public counsel's
designee shall develop an intra-agency career ladder program. The
program must require intra-agency posting of all nonentry level
positions concurrently with any public posting.
(b) The public counsel or the public counsel's designee
shall develop a system of annual performance evaluations. All
merit pay for office employees must be based on the system
established under this subsection.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.104. EQUAL EMPLOYMENT OPPORTUNITY POLICY;
REPORT. (a) The public counsel or the public counsel's designee
shall prepare and maintain a written policy statement to ensure
implementation of an equal employment opportunity program under
which all personnel transactions are made without regard to race,
color, disability, sex, religion, age, or national origin. The
policy statement must include:
(1) personnel policies, including policies relating
to recruitment, evaluation, selection, appointment, training, and
promotion of personnel that are in compliance with the requirements
of Chapter 21, Labor Code;
(2) a comprehensive analysis of the office workforce
that meets federal and state guidelines;
(3) procedures by which a determination can be made
about areas of significant underuse in the office workforce of all
persons for whom federal or state guidelines encourage a more
equitable balance; and
(4) reasonable methods to appropriately address those
areas of significant underuse.
(b) A policy statement prepared under Subsection (a) must:
(1) cover an annual period;
(2) be updated at least annually;
(3) be reviewed by the Commission on Human Rights for
compliance with Subsection (a)(1); and
(4) be filed with the governor.
(c) The governor shall deliver a biennial report to the
legislature based on the information received under Subsection (b).
The report may be made separately or as a part of other biennial
reports to the legislature.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.105. QUALIFICATIONS AND STANDARDS OF
CONDUCT. The office shall provide to the public counsel and office
employees, as often as necessary, information regarding their:
(1) qualifications for office or employment under this
chapter; and
(2) responsibilities under applicable laws relating
to standards of conduct for state officers or employees.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER D. POWERS AND DUTIES
§ 501.151. POWERS AND DUTIES OF OFFICE. The office:
(1) may assess the impact of insurance rates, rules,
and forms on insurance consumers in this state; and
(2) shall advocate in the office's own name positions
determined by the public counsel to be most advantageous to a
substantial number of insurance consumers.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.152. ADMINISTRATION OF OFFICE. The public
counsel shall administer and enforce this chapter, including
preparing and submitting to the legislature a budget for the office
and approving expenditures for professional services, travel, per
diem, and other actual and necessary expenses incurred in
administering the office.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.153. AUTHORITY TO APPEAR, INTERVENE, OR
INITIATE. The public counsel:
(1) may appear or intervene, as a party or otherwise,
as a matter of right before the commissioner or department on behalf
of insurance consumers, as a class, in matters involving:
(A) rates, rules, and forms affecting:
(i) property and casualty insurance;
(ii) title insurance;
(iii) credit life insurance;
(iv) credit accident and health insurance;
or
(v) any other line of insurance for which
the commissioner or department promulgates, sets, adopts, or
approves rates, rules, or forms;
(B) rules affecting life, health, or accident
insurance; or
(C) withdrawal of approval of policy forms:
(i) in proceedings initiated by the
department under Sections 1701.055 and 1701.057; or
(ii) if the public counsel presents
persuasive evidence to the department that the forms do not comply
with this code, a rule adopted under this code, or any other law;
(2) may initiate or intervene as a matter of right or
otherwise appear in a judicial proceeding involving or arising from
an action taken by an administrative agency in a proceeding in which
the public counsel previously appeared under the authority granted
by this chapter;
(3) may appear or intervene, as a party or otherwise,
as a matter of right on behalf of insurance consumers as a class in
any proceeding in which the public counsel determines that
insurance consumers are in need of representation, except that the
public counsel may not intervene in an enforcement or parens
patriae proceeding brought by the attorney general; and
(4) may appear or intervene before the commissioner or
department as a party or otherwise on behalf of small commercial
insurance consumers, as a class, in a matter involving rates,
rules, or forms affecting commercial insurance consumers, as a
class, in any proceeding in which the public counsel determines
that small commercial consumers are in need of representation.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.154. ACCESS TO INFORMATION. The public counsel:
(1) is entitled to the same access as a party, other
than department staff, to department records available in a
proceeding before the commissioner or department under the
authority granted to the public counsel by this chapter; and
(2) is entitled to obtain discovery under Chapter
2001, Government Code, of any nonprivileged matter that is relevant
to the subject matter involved in a proceeding or submission before
the commissioner or department as authorized by this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.155. RECOMMENDATION OF LEGISLATION. The public
counsel may recommend legislation to the legislature that the
public counsel determines would positively affect the interests of
insurance consumers.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.156. CONSUMER BILL OF RIGHTS. The public counsel
shall submit to the department for adoption a consumer bill of
rights appropriate to each personal line of insurance regulated by
the department to be distributed on issuance of a policy by an
insurer to each policyholder under department rules.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.157. PROHIBITED INTERVENTIONS OR
APPEARANCES. The public counsel may not intervene or appear in:
(1) any proceeding or hearing before the commissioner
or department, or any other proceeding, that relates to approval or
consideration of an individual charter, license, certificate of
authority, acquisition, merger, or examination; or
(2) any proceeding concerning the solvency of an
individual insurer, a financial issue, a policy form, advertising,
or another regulatory issue affecting an individual insurer or
agent.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.158. CONFIDENTIALITY
REQUIREMENTS. Confidentiality requirements applicable to
examination reports under Article 1.18 and to the commissioner
under Section 3A, Article 21.28-A, apply to the public counsel.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER E. ASSESSMENTS
§ 501.201. OFFICE EXPENSES. Expenses of the office
shall be paid from the assessments collected under this subchapter.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.202. ASSESSMENT. To defray the costs of operating
the office, the comptroller shall collect assessments under this
subchapter annually in connection with the collection of other
taxes imposed on an insurer.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.203. ASSESSMENT ON PROPERTY AND CASUALTY
INSURERS. Each property and casualty insurer authorized to engage
in business in this state shall pay an annual assessment of 5.7
cents for each property and casualty insurance policy in force in
this state at the end of the year.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.204. ASSESSMENT ON LIFE, HEALTH, AND ACCIDENT
INSURERS AND RELATED ENTITIES. (a) This section applies to each
insurer authorized to engage in business in this state Under:
(1) Chapter 25;
(2) Chapter 841;
(3) Chapter 842;
(4) Chapter 843;
(5) Chapter 882;
(6) Chapter 884;
(7) Chapter 885;
(8) Chapter 887;
(9) Chapter 888;
(10) Chapter 961;
(11) Chapter 982;
(12) Subchapter B, Chapter 1103;
(13) Subchapter A, Chapter 1104;
(14) Chapter 1201, or a provision listed in Section
1201.005;
(15) Chapter 1551;
(16) Chapter 1578; or
(17) Chapter 1601.
(b) Each insurer subject to this section shall pay an annual
assessment of 5.7 cents for each individual policy, and for each
certificate of insurance evidencing coverage under a group policy,
of life, health, or accident insurance that is written for delivery
and placed in force in this state during each calendar year and for
which the initial premium is paid in full.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.205. ASSESSMENT ON TITLE INSURANCE
COMPANIES. Each title insurance company authorized to engage in
business in this state shall pay an annual assessment of 5.7 cents
for each owner and mortgage policy that is written for delivery in
this state during each calendar year and for which the full basic
premium is charged.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER F. DUTIES RELATING TO HEALTH MAINTENANCE ORGANIZATIONS
§ 501.251. COMPARISON OF HEALTH MAINTENANCE
ORGANIZATIONS. (a) The office shall develop and implement a
system to compare and evaluate, on an objective basis, the quality
of care provided by and the performance of health maintenance
organizations established under Chapter 843.
(b) In developing the system, the office may use information
or data from a person, agency, organization, or governmental unit
that the office considers reliable.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.252. ANNUAL CONSUMER REPORT CARDS. (a) The
office shall develop and issue annual consumer report cards that
identify and compare, on an objective basis, health maintenance
organizations in this state. The consumer report cards may be based
on information or data from any person, agency, organization, or
governmental unit that the office considers reliable.
(b) The office may not endorse or recommend a specific
health maintenance organization or plan, or subjectively rate or
rank health maintenance organizations or plans, other than through
comparison and evaluation of objective criteria.
(c) The office shall provide a copy of any consumer report
card on request on payment of a reasonable fee.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.253. ACCESS TO INFORMATION. (a) The office is
entitled to information that is confidential under a law of this
state, including Section 843.006 of this code, Chapter 108, Health
and Safety Code, and Chapter 552, Government Code.
(b) The department and the Texas Health Care Information
Council shall provide any information or data as requested by the
office in furtherance of the duties under this subchapter.
(c) The office shall use information collected or received
under this subchapter for the benefit of the public.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 501.254. CONFIDENTIALITY AND USE OF
INFORMATION. (a) Except as provided by this section, information
collected under this subchapter is subject to Chapter 552,
Government Code, and the office shall make determinations on
requests for information in favor of access.
(b) The office may not make public any confidential
information provided to the office under this subchapter but may
disclose a summary of the information that does not directly or
indirectly identify the health maintenance organization that is the
subject of the information. The office may not release, and a
person or entity may not gain access to, any information that:
(1) could reasonably be expected to reveal the
identity of a patient or physician;
(2) reveals the zip code of a patient's primary
residence;
(3) discloses a provider discount or a differential
between a payment and a billed charge; or
(4) relates to an actual payment made by a payer to an
identified provider.
(c) Information collected or used by the office under this
subchapter is subject to the confidentiality provisions and
criminal penalties of:
(1) Section 81.103, Health and Safety Code;
(2) Section 311.037, Health and Safety Code; and
(3) Chapter 159, Occupations Code.
(d) Information on patients and physicians that is in the
possession of the office and any compilation, report, or analysis
produced from the information that identifies patients and
physicians is not:
(1) subject to discovery, subpoena, or other means of
legal compulsion for release to any person or entity; or
(2) admissible in any civil, administrative, or
criminal proceeding.
(e) Notwithstanding Subsection (b)(2), the office may use
zip code information to analyze information on a geographical
basis.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
