| (a) A private purchasing cooperative described in this
section and the Texas Health Benefits Purchasing Cooperative described
in Insurance Code Chapter 1501:
(1) must arrange for small or large employer health
benefit plan coverage for small or large employer groups that participate
in the cooperative by contracting with small or large employer carriers
that meet the criteria established in Insurance Code §1501.061
(concerning Requirements Applicable to Health Benefit Plan Issuers
with Which Cooperative May Contract) and subsection (b) of this section;
(2) must collect premiums to cover the cost of:
(A) small or large employer health benefit plan coverage
purchased through the cooperative; and
(B) the cooperative's administrative expenses;
(3) may contract with agents to market coverage issued
through the cooperative;
(4) must establish administrative and accounting procedures
for the operation of the cooperative;
(5) must establish procedures under which an applicant
for or participant in coverage issued through the cooperative may
have a grievance reviewed by an impartial person;
(6) may contract with a small or large employer carrier
or third-party administrator to provide administrative services to
the cooperative;
(7) must contract with small or large employer carriers
for the provision of services to small or large employers covered
through the cooperative;
(8) must develop and implement a plan to maintain public
awareness of the cooperative and publicize the eligibility requirements
for, and the procedures for enrollment in coverage through the cooperative;
(9) may negotiate the premiums paid by its members;
and
(10) may offer other ancillary products and services
to its members that are customarily offered in conjunction with health
benefit plans.
(b) A cooperative may contract only with small or large
employer carriers that desire to offer coverage through the cooperative
and that demonstrate:
(1) the carrier is a health carrier or HMO licensed
and in good standing with TDI;
(2) the capacity to administer the health benefit plans;
(3) the ability to monitor and evaluate the quality
and cost effectiveness of care and applicable procedures;
(4) the ability to conduct utilization management and
applicable procedures and policies;
(5) the ability to ensure enrollees adequate access
to health care providers, including adequate numbers and types of
providers;
(6) a satisfactory grievance procedure and the ability
to respond to enrollees' calls, questions, and complaints; and
(7) financial capacity, either through financial solvency
standards as applied by the commissioner or through appropriate reinsurance
or other risk-sharing mechanisms.
(c) A cooperative may not self-insure or self-fund
any health benefit plan or portion of a plan.
(d) A cooperative must comply with federal laws applicable
to cooperatives and health benefit plans issued through cooperatives.
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