| (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.
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