Texas Insurance Code 1305.053 – Contents of Application
Terms Used In Texas Insurance Code 1305.053
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Contract: A legal written agreement that becomes binding when signed.
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
- Population: means the population shown by the most recent federal decennial census. See Texas Government Code 311.005
- Rule: includes regulation. See Texas Government Code 311.005
Each certificate application must include:
(1) a description or a copy of the applicant’s basic organizational structure documents and other related documents, including organizational charts or lists that show:
(A) the relationships and contracts between the applicant and any affiliates of the applicant; and
(B) the internal organizational structure of the applicant’s management and administrative staff;
(2) biographical information regarding each person who governs or manages the affairs of the applicant, accompanied by information sufficient to allow the commissioner to determine the competence, fitness, and reputation of each officer or director of the applicant or other person having control of the applicant;
(3) a copy of the form of any contract between the applicant and any provider or group of providers, and with any third party performing services on behalf of the applicant under Subchapter D;
(4) a copy of the form of each contract with an insurance carrier, as described by § 1305.154;
(5) a financial statement, current as of the date of the application, that is prepared using generally accepted accounting practices and includes:
(A) a balance sheet that reflects a solvent financial position;
(B) an income statement;
(C) a cash flow statement; and
(D) the sources and uses of all funds;
(6) a statement acknowledging that lawful process in a legal action or proceeding against the network on a cause of action arising in this state is valid if served in the manner provided by Chapter 804 for a domestic company;
(7) a description and a map of the applicant’s service area or areas, with key and scale, that identifies each county or part of a county to be served;
(8) a description of programs and procedures to be utilized, including:
(A) a complaint system, as required under Subchapter I;
(B) a quality improvement program, as required under Subchapter G; and
(C) the utilization review program described in Subchapter H;
(9) a list of all contracted network providers that demonstrates the adequacy of the network to provide comprehensive health care services sufficient to serve the population of injured employees within the service area and maps that demonstrate that the access and availability standards under Subchapter G are met; and
(10) any other information that the commissioner requires by rule to implement this chapter.