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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 13MISCELLANEOUS INSURERS AND OTHER REGULATED ENTITIES
SUBCHAPTER FPROFESSIONAL EMPLOYER ORGANIZATIONS SPONSORING SELF-FUNDED EMPLOYEE HEALTH BENEFIT PLANS
DIVISION 4CONDUCT OF APPROVED PEO
RULE §13.544Marketing Materials; Offers of Enrollment

(a) Marketing material. An approved PEO's marketing material discussing the plan and trust must be fair and accurate, and must not represent the plan or a prospective client's projected contributions to be assessed for coverage under the plan in a way that is materially inaccurate or misleading.

(b) Offer of enrollment. An approved PEO must offer enrollment in the plan to the covered employees of any client that agrees to meet the terms and conditions of the PEO's professional employer services agreement and elects to enroll its covered employees in the plan.

(c) Guaranteed renewability. A PEO may not deny a client whose employees are covered under the plan continued access to coverage under the terms of the plan, other than:

  (1) for nonpayment of contributions;

  (2) for fraud or other intentional misrepresentation of material fact by the client;

  (3) for noncompliance with material plan provisions;

  (4) because the plan is ceasing to offer any coverage in a geographic area;

  (5) in the case of a plan that offers benefits through a network plan, there is no longer any individual enrolled through the client who lives, resides, or works in the service area of the network plan and the plan applies this paragraph uniformly without regard to the claims experience of clients or any health status-related factor in relation to such individuals or their dependents; or

  (6) for failure to meet the terms of an applicable collective bargaining agreement, to renew a collective bargaining or other agreement requiring or authorizing contributions to the plan, or to employ employees covered by such an agreement.


Source Note: The provisions of this §13.544 adopted to be effective May 17, 2016, 41 TexReg 3479

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