(a) Under the Insurance Code and this subchapter, a
person may form a health group cooperative for the purchase of employer
health benefit plans.
(b) A health carrier may not form, or be a member of,
a health group cooperative. A health carrier may associate with a
sponsoring entity of a health group cooperative, such as a business
association, chamber of commerce, or other organization representing
employers or serving an analogous function, to assist the sponsoring
entity in forming a health group cooperative.
(c) A health group cooperative must be incorporated
as a nonprofit organization and be authorized to transact business
in Texas, as required by the Business Organizations Code.
(d) A health group cooperative must file with TDI its
organizational documents and, if applicable, authorization to transact
business in Texas. The organizational documents must demonstrate the
health group cooperative's compliance with Insurance Code §§1501.058
(concerning Powers and Duties of Cooperatives), 1501.059 (concerning
Self-Insured or Self-funded Plan Prohibited), and 1501.061 (concerning
Requirements Applicable to Heath Benefit Plan Issuers with Which Cooperative
May Contract).
(e) A health group cooperative consisting only of small
employers that elects to restrict its membership to 50 eligible employees
in accordance with Insurance Code §1501.0581(o) (concerning Special
Provisions Relating to Health Group Cooperatives) must include that
election in the organizational documents filed under subsection (d)
of this section. A health group cooperative making this election may
not admit an eligible single-employee business, as defined in Insurance
Code §1501.051 (concerning Definitions).
(f) A health group cooperative may elect to admit eligible
single-employee businesses as members of the cooperative and allow
single-employee business members to enroll in health benefit plan
coverage as specified in Chapter 26, Subchapter D, Division 2 of this
title (relating to Single-employee Business Participation in Health
Group Cooperatives).
(g) The provisions of this subchapter do not limit
or restrict an employer's access to health benefit plans under this
chapter or Insurance Code Chapter 1501 (concerning Health Insurance
Portability and Availability Act).
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Source Note: The provisions of this §26.401 adopted to be effective August 31, 2004, 29 TexReg 8360; amended to be effective January 31, 2006, 31 TexReg 512; amended to be effective May 17, 2017, 42 TexReg 2539 |