INSURANCE CODE
SUBTITLE B. CONSUMER SERVICE PROVISIONS
CHAPTER 521. CONSUMER INFORMATION AND COMPLAINTS
SUBCHAPTER A. PUBLIC INTEREST INFORMATION AND COMPLAINT PROCEDURES
§ 521.001. PUBLIC INTEREST INFORMATION. (a) The
department shall prepare information of public interest describing
the department's functions and the procedures by which complaints
are filed with and resolved by the department.
(b) The department 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.
§ 521.002. COMPLAINT RESOLUTION PROGRAM. The
department shall establish a program to facilitate resolution of
policyholder complaints.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.003. NOTIFICATION OF COMPLAINT STATUS. If a
written complaint is filed with the department, the department, at
least quarterly and until final disposition of the complaint, shall
notify each party to the complaint of the complaint's status unless
the notice would jeopardize an undercover investigation.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.004. RECORDS OF COMPLAINTS. The department shall
keep an information file about each complaint filed with the
department that concerns an activity regulated by the department or
the commissioner.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.005. NOTICE TO ACCOMPANY POLICY. (a) Each
insurance policy delivered or issued for delivery in this state
shall include with the policy a brief written notice that includes:
(1) a suggested procedure to be followed by a
policyholder with a dispute concerning the policyholder's claim or
premium;
(2) the department's name and address; and
(3) the department's toll-free telephone number
maintained under Subchapter B.
(b) The commissioner shall adopt appropriate wording for
the notice.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER B. DEPARTMENT TOLL-FREE NUMBER FOR INFORMATION AND
COMPLAINTS
§ 521.051. DEPARTMENT TOLL-FREE NUMBER FOR INFORMATION
AND COMPLAINTS. The department shall maintain a toll-free
telephone number to:
(1) provide the information described by Section
521.052; and
(2) receive and aid in resolving complaints against
insurers.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.052. INFORMATION PROVIDED. The department shall
provide to the public through the department's toll-free telephone
number only the following information:
(1) information collected or maintained by the
department relating to the number and disposition of complaints
received against an insurer that are justified, verified as
accurate, and documented as valid, expressed as a percentage of the
total number of insurance policies written by the insurer and in
force on December 31 of the preceding year;
(2) the rating of an insurer, if any, as published by a
nationally recognized rating organization;
(3) the kinds of coverage available to a consumer
through any insurer writing insurance in this state;
(4) an insurer's admitted assets-to-liabilities
ratio; and
(5) other appropriate information collected and
maintained by the department.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.053. PUBLICITY REQUIREMENTS. The department
shall publicize the department's toll-free telephone number in
public service announcements and publish that number in telephone
books throughout the state, as the department finds appropriate.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.054. RECORD OF INQUIRY OR COMPLAINT REQUIRED. The
department shall maintain a written record of each inquiry and
complaint received through the department's toll-free telephone
number.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.055. COMPLAINT NOTIFICATION SYSTEM. The
department shall establish a system to notify insurers by
electronic transmission to a facsimile machine or other appropriate
system of complaints received by the department through the
department's toll-free telephone number.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.056. INFORMATION BULLETIN TO ACCOMPANY
POLICY. Each insurer that delivers, issues for delivery, or renews
an insurance policy in this state shall include with the policy an
information bulletin that includes:
(1) the department's toll-free telephone number; and
(2) a description of the services available through
the department's toll-free telephone number.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
SUBCHAPTER C. HEALTH MAINTENANCE ORGANIZATION OR INSURER TOLL-FREE
NUMBER FOR INFORMATION AND COMPLAINTS
§ 521.101. APPLICABILITY OF SUBCHAPTER. (a) Except as
provided by Subsection (b), this subchapter applies to a health
maintenance organization authorized to engage in the business of a
health maintenance organization in this state or an insurer
authorized to engage in the business of insurance in this state,
including:
(1) a capital stock insurance company;
(2) a mutual insurance company;
(3) a title insurance company;
(4) a fraternal benefit society;
(5) a local mutual aid association;
(6) a statewide mutual assessment company;
(7) a county mutual insurance company;
(8) a Lloyd's plan;
(9) a reciprocal or interinsurance exchange;
(10) a stipulated premium company;
(11) a group hospital service corporation; and
(12) a risk retention group.
(b) This subchapter does not apply to a health maintenance
organization or insurer:
(1) that has gross initial premium receipts collected
in this state of less than $2 million each year; or
(2) with regard to fidelity, surety, or guaranty
bonds.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.102. HEALTH MAINTENANCE ORGANIZATION OR INSURER
TOLL-FREE NUMBER FOR INFORMATION AND COMPLAINTS. A health
maintenance organization or insurer shall maintain a toll-free
telephone number to:
(1) provide information concerning evidences of
coverage or policies issued by the health maintenance organization
or insurer; and
(2) receive complaints from enrollees or
policyholders.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
§ 521.103. INFORMATION INCLUDED IN EVIDENCE OF COVERAGE
OR POLICY. (a) Each health maintenance organization or insurer
that delivers, issues for delivery, or renews an evidence of
coverage or insurance policy in this state shall print on the
evidence of coverage or policy the health maintenance
organization's or insurer's toll-free telephone number.
(b) The commissioner may adopt rules governing the manner in
which the toll-free telephone number appears on the evidence of
coverage or insurance policy.
Added by Acts 2003, 78th Leg., ch. 1274, § 2, eff. April 1, 2005.
