| (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).
|
| Source Note: 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 to be effective May 17, 2017, 42 TexReg 2539 |
