28 Tex. Admin. Code § 13.580 - Withdrawal from Market
(a) Withdrawal
plan. An approved PEO that undertakes of its own initiative or is required by §
13.581 or §
13.582 of this title (relating to
Limitation, Suspension, or Cancellation of Certificate of Approval in Response
to TDLR Action and Limitation, Suspension, or Cancellation of Certificate of
Approval in Response to TDI Action) to terminate its health benefit plan must
file a withdrawal plan for review by the commissioner prior to terminating the
plan. The withdrawal plan must include:
(1)
the approved PEO's reasons for the withdrawal;
(2) a timeline for withdrawal, including the
date on which the approved PEO intends to complete the withdrawal
process;
(3) a copy of the proposed
notice to be sent to client employers and plan participants giving them at
least 180 days' notice of the plan's termination;
(4) the number and names of clients and the
number of plan participants affected by the proposed withdrawal;
(5) a procedure for handling plan
participants' claims for benefits;
(6) a procedure for identifying plan
participants with special circumstances, as defined in Insurance Code §
1301.153, concerning
Continuity of Care;
(7) provisions
for meeting all contractual obligations of the approved PEO;
(8) provisions for meeting any applicable
statutory obligations; and
(9)
verification of reserves to complete a solvent resolution of the plan's
obligations.
(b)
Novation and resolution of plan claim obligations. The commissioner will not
grant the request of an approved PEO to cancel its certificate of approval
unless the approved PEO novates its remaining plan obligations with an
unaffiliated authorized insurer or satisfies its remaining plan obligations
under an agreement filed with and approved in writing by the commissioner. For
purposes of this subsection, those obligations are:
(1) known claims and expenses associated with
those claims; and
(2) incurred but
not reported claims and expenses associated with those claims.
(c) Approval of withdrawal plan.
Except as provided by subsection (d) of this section, the commissioner will
approve a withdrawal plan that satisfies the requirements of subsections (a)
and (b) of this section.
(d)
Modification or denial of withdrawal plan. If the approved PEO is unable to
meet its contractual and financial obligations in a solvent and compliant
manner, the commissioner will modify or deny an approved PEO's filed withdrawal
plan, and take action authorized under Insurance Code Chapters 404, Financial
Condition; 406, concerning Special Deposits Required Under Potentially
Hazardous Conditions; 441, concerning Supervision and Conservatorship; 443,
concerning the Insurer Receivership Act; or all other applicable law.
(e) Notice of modification. The commissioner
will issue a written notice to an approved PEO stating the basis for a
modification under subsection (d) of this section. If within 30 days of
receiving a notice of modification the approved PEO submits a written request
for review by the commissioner and submits additional information that its
withdrawal plan satisfies the requirements of subsections (a) and (b) of this
section, the commissioner will reconsider the modification and give the PEO
written notice of his decision.
(f)
Notice of denial; State Office of Administrative Hearings hearing request. The
commissioner will issue a written notice of denial to an approved PEO stating
the basis for a denial under subsection (d) of this section. If within 30 days
of receiving the commissioner's notice the approved PEO submits a written
request for a hearing on denial of withdrawal plan, the commissioner will file
a request to set a hearing at the State Office of Administrative Hearings under
Government Code Chapter 2001, concerning Administrative Procedure; and
Insurance Code Chapter 40, concerning Duties of State Office of Administrative
Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings. At
the hearing the approved PEO will be given an opportunity to show compliance
with this section.
Notes
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