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Texas Administrative Code (Last Updated: March 27,2024) |
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TITLE 28. INSURANCE |
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PART 1. TEXAS DEPARTMENT OF INSURANCE |
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CHAPTER 26. EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS |
| SUBCHAPTER A. DEFINITIONS, SEVERABILITY, AND SMALL EMPLOYER HEALTH REGULATIONS |
| § 26.3. Severability |
| § 26.4. Definitions |
| § 26.5. Applicability and Scope |
| § 26.6. Status of Health Carriers as Small Employer Carriers |
| § 26.7. Requirement to Insure Entire Groups |
| § 26.8. Guaranteed Issue, Contribution, and Participation Requirements |
| § 26.9. Exclusions, Limitations, Waiting Periods, Affiliation Periods, Preexisting Conditions, and Restrictive Riders |
| § 26.10. Establishment of Classes of Business |
| § 26.11. Restrictions Relating to Premium Rates |
| § 26.12. Disclosure |
| § 26.13. Fair Marketing |
| § 26.14. Coverage |
| § 26.15. Renewability of Coverage and Cancellation |
| § 26.16. Refusal to Renew and Application to Reenter Small Employer Market |
| § 26.18. Election and Application to be Risk-Assuming or Reinsured Carrier |
| § 26.19. Filing Requirements |
| § 26.20. Reporting Requirements |
| § 26.25. Unfair Competition and Unfair Practices |
| § 26.28. Territorial Exclusions |
| § 26.30. Composite Premiums |
| SUBCHAPTER B. TEXAS HEALTH REINSURANCE SYSTEM PLAN OF OPERATION |
| § 26.201. The Texas Health Reinsurance System Plan of Operation |
| SUBCHAPTER C. LARGE EMPLOYER HEALTH INSURANCE REGULATIONS |
| § 26.301. Applicability, Definitions, and Scope |
| § 26.302. Status of Health Carriers as Large Employer Carrier |
| § 26.303. Coverage Requirements |
| § 26.304. Requirement to Insure Entire Groups |
| § 26.305. Enrollment |
| § 26.306. Exclusions, Limitations, Waiting Periods, Affiliation Periods, Preexisting Conditions, and Restrictive Riders |
| § 26.307. Fair Marketing |
| § 26.308. Renewability of Coverage and Cancellation |
| § 26.309. Refusal to Renew and Application to Reenter Large Employer Market |
| § 26.310. Unfair Competition and Unfair Practices |
| § 26.312. Point-of-service Coverage |
| § 26.313. Filing Requirements |
| § 26.314. Territorial Exclusions |
| SUBCHAPTER D. COOPERATIVES |
| DIVISION 1. NONPROFIT HEALTH GROUP COOPERATIVES |
| § 26.400. Definitions and Filing |
| § 26.401. Establishment of Health Group Cooperatives |
| § 26.402. Membership of Health Group Cooperatives |
| § 26.403. Marketing Activities of Health Group Cooperatives |
| § 26.405. Premium Tax Exemption for Previously Uninsured |
| § 26.406. Standard Presentation Form |
| § 26.407. Health Carrier Filing Before Issuance of Coverage to a Health Group Cooperative |
| § 26.408. Issuance of Coverage to Health Group Cooperatives |
| § 26.409. Health Benefit Plans Offered Through Health Group Cooperatives |
| § 26.410. Expedited Approval for Plans Offered Through a Health Group Cooperative |
| § 26.411. Service Areas for Health Carriers Offering Coverage Through a Health Group Cooperative |
| DIVISION 2. SINGLE-EMPLOYEE BUSINESS PARTICIPATION IN HEALTH GROUP COOPERATIVES |
| § 26.421. Election to Permit Single-Employee Businesses to Participate in a Health Group Cooperative |
| § 26.422. Condition Precedent to Filing Election to Admit Single-Employee Businesses as Members |
| § 26.423. Initial and Annual Enrollment Periods |
| § 26.424. Membership Eligibility Requirements for Single-Employee Businesses |
| § 26.425. Plan Issuance, Rating Requirements, and Mandated Benefits |
| § 26.426. Rescission of Election |
| DIVISION 3. HEALTH GROUP COOPERATIVE ELECTION TO TREAT MEMBERS AS SEPARATE EMPLOYERS FOR RATING PURPOSES |
| § 26.431. Election to Treat Members as Separate Employers for Rating Purposes |
| DIVISION 4. PRIVATE PURCHASING COOPERATIVES |
| § 26.441. Private Purchasing Cooperatives |
| § 26.442. Powers and Duties of Texas Health Benefits Purchasing Cooperative and Private Purchasing Cooperatives |
| SUBCHAPTER E. HEALTHY TEXAS PROGRAM |
| DIVISION 1. GENERAL PROVISIONS |
| § 26.501. Purpose |
| § 26.502. Definitions |
| DIVISION 2. PARTICIPATION BY HEALTH BENEFIT PLAN ISSUERS |
| § 26.511. Health Benefit Plan Issuer Participation |
| § 26.512. Application, Initial Certification of Eligibility, and Enrollment |
| § 26.513. Annual Recertification of Eligibility |
| § 26.514. Health Plan Renewal Provisions |
| § 26.515. Notice of Discontinuance of Health Plan; Issuer Withdrawal from Participation |
| § 26.516. Grace Period |
| § 26.517. Health Plan Contact Information |
| DIVISION 3. PARTICIPATION BY SMALL EMPLOYERS |
| § 26.521. Small Employer Participation |
| § 26.522. Verification of Income |
| DIVISION 4. PARTICIPATION BY REGIONAL AND LOCAL HEALTH CARE PROGRAMS |
| § 26.531. Purpose |
| § 26.532. Applicability and Scope |
| § 26.533. Submission of Election to Participate in Healthy Texas |
| § 26.534. Participation Through Direct Purchase of Health Benefit Plan |
| § 26.535. Participation Through Eligible Regional or Local Health Care Program Implementation |
| § 26.536. Withdrawal from Participation |
| § 26.537. Program Certification |
| § 26.538. Applicability of Other Subchapter Provisions |
| DIVISION 5. RATING OF QUALIFIED HEALTH BENEFIT PLANS |
| § 26.551. Rating of Plans Eligible for Claims Reimbursements |
| § 26.552. Reinsurance Permitted |
| § 26.553. Required Policy Form and Rate Filings |
| DIVISION 6. HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION FUND |
| § 26.561. Definitions |
| § 26.562. Eligibility of Claims Paid for Reimbursement from the Fund |
| § 26.563. Fund Administration |
| § 26.564. Data Filing Requirements |