28 Tex. Admin. Code § 26.10 - Establishment of Classes of Business

(a) A small employer carrier that establishes more than one class of business in accordance with the provisions of Insurance Code § 1501.202 (concerning Establishment of Classes of Business) and § 1501.203 (concerning Establishment of Classes of Business on Certain Bases Prohibited) must maintain on file for inspection by the commissioner the following information with respect to each class of business so established:

(1) a description of each criterion employed by the health carrier (or any of its agents) for determining membership in the class of business;

(2) a statement describing the justification for establishing the class as a separate class of business and documentation that the establishment of the class of business is intended to reflect substantial differences in expected claims experience or administrative costs related to the reasons set forth in Insurance Code Chapter 1501 (concerning Health Insurance Portability and Availability Act); and

(3) a statement disclosing which, if any, health benefit plans are currently available for purchase in the class and any significant limitations related to the purchase of the plans.

(b) A health carrier may not directly or indirectly use the number of employees and dependents of a small employer, the trade or occupation of the employees of a small employer, or the industry or type of business of the small employer as criteria for establishing eligibility for a health benefit plan or for a class of business, except as provided in Insurance Code § 1501.202 and § 1501.203.

(c) A health carrier may not establish a separate class of business based on minimum participation requirements or whether the coverage provided to a small employer group is provided on a guaranteed issue basis or is subject to underwriting or proof of insurability.

Notes

28 Tex. Admin. Code § 26.10

The provisions of this §26.10 adopted to be effective December 30, 1993, 18 TexReg 9375; amended to be effective April 9, 1996, 21 TexReg 2648; amended to be effective April 6, 2005, 30 TexReg 1931; Amended by Texas Register, Volume 42, Number 19, May 12, 2017, TexReg 2546, eff. 5/17/2017