2005 Texas Insurance Code CHAPTER 521. CONSUMER INFORMATION AND COMPLAINTS

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.