28 Tex. Admin. Code § 26.18 - Election and Application to Be Risk-Assuming or Reinsured Carrier
(a) Each small employer carrier must file
with the commissioner, no later than with the first filing of a small employer
health benefit plan, notification of whether the carrier elects to operate as a
risk-assuming or reinsured carrier.
(1) A
small employer carrier's operation as a risk-assuming carrier is subject to
approval by the commissioner, and each small employer carrier electing to
operate as a risk-assuming carrier must file an application with the
commissioner contemporaneously with its election to operate as a risk-assuming
carrier. A risk-assuming carrier's application, in addition to the financial
information already on file with TDI, must include a:
(A) history of rating and underwriting small
employer groups, including a description of underwriting experience to identify
high risks and the percentage of aggregate rate increases for the past three
years for small employer groups for Texas and nationwide;
(B) description of the carrier's commitment
to fairly market to all small employers in Texas or in the small employer
carrier's established geographic service areas, including sample material used,
or planned to be used, to market to small employers;
(C) description of experience in managing the
risk of small groups, including;
(i) the
number of years, volume of business, results, etc.;
(ii) a list of other states with guaranteed
issue requirements where the carrier provides small employer group
coverage;
(iii) the total number of
lives currently covered under those guaranteed issue plans; and
(iv) a list of other states where the carrier
voluntarily participates in reinsurance programs;
(D) description of plans to manage the risk
of guaranteed issue as a risk-assuming carrier;
(E) list of affiliated small employer
carriers and whether they have been approved as either a risk-assuming or
reinsured carrier;
(F) list of any
other affiliated small employer carrier applicants, indicating their requested
designation as either a risk-assuming or reinsured carrier; and
(G) the name, title, and signature of the
chief executive officer, attorney, or actuary for the named health
carrier.
(2) A reinsured
carrier's notification must include:
(A) a
statement of the carrier's election to operate as a reinsured carrier;
and
(B) the name, title, and
signature of the chief executive officer, attorney, or actuary of the named
health carrier.
(b) A small employer carrier seeking to
change its status as a risk-assuming or reinsured carrier must file an
application with the commissioner. If the carrier is requesting a change to be
a:
(1) risk-assuming carrier, the filing must
include:
(A) the information requested in
subsection (a) of this section;
(B)
information demonstrating good cause for the request to change status;
and
(C) the name, title, and
signature of the chief executive officer, attorney, or actuary for the named
health carrier; or
(2)
reinsured carrier, the filing must include:
(A) information demonstrating good cause for
the request to change status; and
(B) the name, title, and signature of the
chief executive officer, attorney, or actuary for the named health
carrier.
(c)
A small employer carrier's election is effective until the fifth anniversary of
the election. A small employer carrier seeking to maintain its status after
that date must file with the commissioner, at least 90 days before the fifth
anniversary of its election, the same information required by subsection (a)(1)
and (2) of this section.
(d) A form
fulfilling the requirements of this section is available at
www.tdi.texas.gov/forms/form10smgroup.html through the link for Election and
Application to be a Risk-Assuming or Reinsured Carrier.
Notes
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