28 Tex. Admin. Code § 26.6 - Status of Health Carriers as Small Employer Carriers
(a) With the original filing to enter the
small employer market or when notifying TDI of a change in status, each health
carrier providing health benefit plans in this state must file with the
commissioner a statement indicating whether the health carrier will or will not
offer, renew, issue, or issue for delivery health benefit plans to small
employers in this state. The filing must include a certification, signed by an
officer of the company, that the carrier intends to operate in accordance with
the status certification unless or until it is changed in accordance with this
section, and provide a statement to the effect of one of the following
statements:
(1) the health carrier intends to
offer, renew, issue, and issue for delivery health benefit plans to small
employers in Texas and will operate in accordance with Insurance Code Chapter
1501 (concerning Health Insurance Portability and Availability Act) and this
subchapter;
(2) the health carrier
does not intend to offer, issue, or issue for delivery health benefit plans to
small employers in Texas, but the health carrier intends to renew existing
health benefit plans;
(3) the
health carrier does not intend to offer, issue, or issue for delivery health
benefit plans to small employers in Texas; intends to nonrenew all health
benefit plans issued to small employers in Texas; and will provide notice to
the commissioner and employers in accordance with §
26.16 of this title (relating to
Refusal to Renew and Application to Reenter Small Employer Market) and
Insurance Code §
1501.110 (concerning
Notice to Covered Persons); or
(4)
the health carrier has no health benefit plans issued to small employers or to
employees of a small employer and does not intend to offer, issue, or issue for
delivery health benefit plans to small employers.
(b) If a health carrier chooses to change its
election or the date of implementing its election under subsection (a)(1), (2),
or (4) of this section, the health carrier must notify the commissioner of its
new election at least 30 days before the date the health carrier intends to
begin operations under the new election as required in subsection (a) of this
section.
(c) A form fulfilling the
requirements of subsections (a) and (b) of this section is available online at
www.tdi.texas.gov/forms/form10smgroup.html through the link for Small Employer
Carrier Status Certification.
(d)
Health carriers providing coverage under any health benefit plans issued to
small employers and their employees, whether on a group or franchise insurance
policy basis, will be considered small employer carriers for purposes of those
plans, and must comply with all provisions of Insurance Code Chapter 1501 and
this subchapter, as applicable.
(e)
The small employer carrier must also comply with any other applicable legal
requirements, including those for withdrawal from the market under Chapter 7,
Subchapter R of this title (relating to Withdrawal Plan Requirements and
Procedures).
Notes
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