28 Tex. Admin. Code § 26.30 - Composite Premiums

(a) Definitions. For purposes of this section:

(1) "Composite premiums" are premiums offered to enrollees of a small group health plan that are determined using the average premium per enrollee and corresponding average premiums for different coverage tiers, as described in this section.

(2) "Per-member premiums" are premiums offered to enrollees that are determined on an individual basis.

(3) "Tier" refers to each premium category in subsection (d).

(4) "Tier factor" is a multiplier used to determine premium for each tier.

(b) A small employer carrier may offer composite premiums in addition to per-member premiums. Composite premiums cannot be offered instead of per-member premiums.

(c) A small employer carrier that offers composite premiums in the small group market in Texas must determine composite premiums using the tiers and tier factors described in this section, as provided in 45 CFR § 147.102(c)(3) and other applicable law.

(d) The tiers and tier factors used to determine composite premiums are:

(1) employee only, with a tier factor of 1.0;

(2) employee and spouse, with a tier factor of 2.0;

(3) employee and child or children, with a tier factor of 2.0; and

(4) employee and family, with a tier factor of 3.0.

(e) This section applies to health benefit plans issued or renewed on or after November 1, 2015.

Notes

28 Tex. Admin. Code § 26.30

Adopted by Texas Register, Volume 40, Number 41, October 9, 2015, TexReg 7093, eff. 10/18/2015