28 Tex. Admin. Code § 26.307 - Fair Marketing

(a) On request, a large employer carrier must provide to the large employer a summary of all health benefit plans offered by the large employer carrier for which the large employer qualifies.

(b) Denial by a large employer carrier of an application for coverage or cancellation, or refusal to renew, must be in writing and must state with specificity the reasons for the denial, cancellation, or refusal to renew (subject to any restrictions related to confidentiality of medical information). The large employer carrier must notify the large employer in accordance with Insurance Code § 1501.109 (concerning Refusal to Renew; Discontinuation of Coverage) and §1501.110 (concerning Notice to Covered Persons).

(c) A large employer carrier may not require, as a condition to the offer or sale of a health benefit plan to a large employer, that the large employer purchase or qualify for any other insurance product or service.

(d) The large employer carrier may not require a large employer to join or contribute to any association or group as a condition of being accepted for coverage by the large employer carrier, except that, if membership in an association or other group is a requirement for accepting a large employer into a particular health benefit plan, a large employer carrier may apply that requirement, subject to the requirements of Insurance Code Chapter 1501 (concerning Health Insurance Portability and Availability Act).

(e) Health carriers offering individual and group health benefit plans in this state are responsible for determining whether the plans are subject to the requirements of Insurance Code Chapter 1501 and this subchapter. At the time of application, health carriers must obtain the following information from applicants for those plans:

(1) whether any portion of the premium will be paid by a large employer;

(2) whether the prospective policyholder, certificate holder, or any prospective insured intends to treat the health benefit plan as part of a plan or program under the United States Internal Revenue Code of 1986 (26 U.S.C. § 106, concerning Contributions by Employer to Accident and Health Plans, or §162, concerning Trade or Business Expenses);

(3) whether the health plan is an employee welfare benefit plan under 29 C.F.R. § 2510.3-1 (concerning Employee Welfare Benefit Plan); or

(4) whether the applicant is a large employer.

(f) If a health carrier fails to comply with subsection (e) of this section, the health carrier is deemed to be on notice of any information that could reasonably have been attained if the health carrier had complied with subsection (e) of this section.

(g) A large employer carrier may not terminate, fail to renew, limit its contract or agreement of representation with, or take any other negative action against an agent for any reason related to the agent's request that the carrier issue or renew a health benefit plan to a large employer.

(h) If a large employer carrier issues coverage under Insurance Code Chapter 1507 (concerning Consumer Choice of Benefits Plans) to a large employer, it must comply with Chapter 21, Subchapter AA of this title (relating to Consumer Choice Health Benefit Plans).

Notes

28 Tex. Admin. Code § 26.307

The provisions of this §26.307 adopted to be effective March 5, 1998, 23 TexReg 2297; amended to be effective April 6, 2005, 30 TexReg 1931; Amended by Texas Register, Volume 42, Number 19, May 12, 2017, TexReg 2557, eff. 5/17/2017