28 Tex. Admin. Code § 21.5060 - Election Submission Requirements
(a) A
plan sponsor of a self-insured or self-funded plan may elect to participate
under Insurance Code Chapter 1275, concerning Balance Billing Prohibitions and
Out-of-Network Claim Dispute Resolution for Certain Plans, by providing
identifying information to the Texas Department of Insurance as specified on
the department's website at www.tdi.texas.gov, including:
(1) the name and contact information of the
plan sponsor;
(2) the name and
contact information of the administrator of the health benefit plan, if
applicable;
(3) the health benefit
plan year start and end dates;
(4)
the requested effective date, which, except as provided in subsection (d) of
this section, must be the same as the start date of the relevant plan year and
at least 30 days after the date the identifying information is
submitted;
(5) the group number of
the health benefit plan; and
(6)
the number of enrollees covered under the health benefit plan.
(b) Election under subsection (a)
of this section applies only to the relevant plan year. A plan sponsor must
elect to apply Insurance Code Chapter 1275 (which includes an election to
participate in out-of-network claim dispute resolution for applicable claims
incurred during the relevant plan year) with respect to each plan year and must
provide or update identifying information required by this section. A plan
sponsor that elects to apply Insurance Code Chapter 1275 to a plan for the
relevant plan year may not opt out until the end of that relevant plan
year.
(c) A plan sponsor or its
authorized representative may provide the identifying information required by
this section.
(d) A health benefit
plan with a plan year start date between September 1, 2023, and February 1,
2024, may make an election with a requested effective date that is after the
first day of the relevant plan year if the information required under
subsection (a) of this section is submitted not later than 45 days after the
effective date of this section. An election for a plan year with a start date
after February 1, 2024, must apply for the entirety of the plan year.
Notes
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