# 28 Tex. Admin. Code § 19.1702: 28 TAC § 19.1702. Applicability, DIVISION 1. UTILIZATION REVIEWS

> Texas · Regulations · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_1702

## Section

- **Citation:** 28 Tex. Admin. Code § 19.1702
- **Heading:** 28 TAC § 19.1702. Applicability, DIVISION 1. UTILIZATION REVIEWS
- **Jurisdiction:** Texas
- **Kind:** Regulations
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** Texas Administrative Code / Title 28 INSURANCE / Part 1 TEXAS DEPARTMENT OF INSURANCE / Chapter 19 LICENSING AND REGULATION OF INSURANCE PROFESSIONALS / 28 TAC § 19.1702

## Text

(a) Limitations on applicability. Except as provided
 in Insurance Code Chapter 4201, this subchapter applies to utilization
 review performed under a health benefit plan or a health insurance
 policy.
(1) This subchapter does not apply to utilization review
 performed under workers' compensation insurance coverage.
(2) This subchapter does not apply to a person who
 provides information to an enrollee; an individual acting on behalf
 of an enrollee; or an enrollee's physician, doctor, or other health
 care provider about scope of coverage or benefits, and does not determine
 the medical necessity, appropriateness, or the experimental or investigational
 nature of health care services.
(b) Applicability of other law. In addition to the
 requirements of this subchapter, provisions of Insurance Code Chapter
 843, concerning Health Maintenance Organizations; Insurance Code Chapter
 1222, concerning Preauthorization for Medical or Health Care Service;
 Insurance Code Chapter 1301, concerning Preferred Provider Benefit
 Plans; Insurance Code Chapter 1352, concerning Brain Injury; Insurance
 Code Chapter 1369, concerning Benefits Related to Prescription Drugs
 and Devices and Related Services; and Insurance Code Chapter 1451,
 Subchapter E, concerning Dental Care Benefits in Health Insurance
 Policies or Employee Benefit Plans, apply to this subchapter.

## Nearby sections

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_TAC_T28_P1_C19_S19_1702. Check the current official text before relying on it. Not legal advice.