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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 26EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS
SUBCHAPTER EHEALTHY TEXAS PROGRAM
DIVISION 2PARTICIPATION BY HEALTH BENEFIT PLAN ISSUERS
RULE §26.513Annual Recertification of Eligibility

(a) A participating health benefit plan issuer shall, at least 90 days prior to the annual renewal date of the group health benefit plan, provide any forms necessary for small employers to submit recertification of eligibility.

(b) A participating health benefit plan issuer shall annually collect certifications of continued eligibility for the Healthy Texas Program and shall be responsible for examination of such certifications to verify that small employers and enrollees participating in the program continue to meet eligibility requirements and continue to comply with the terms of the program. The commissioner may prescribe a standardized health benefit plan renewal certification form to be utilized for employer renewal certification purposes. A participating health benefit plan issuer shall determine whether the small employer and enrollees continue to meet the requirements for participation in the Healthy Texas Program and shall provide written notice of such eligibility determination to the small employer within two weeks of receipt of the annual recertification.

(c) The failure of an employer to provide written certification demonstrating continued eligibility and continued compliance with the terms of the Healthy Texas Program shall be a basis for nonrenewal of a qualifying health benefit plan.


Source Note: The provisions of this §26.513 adopted to be effective March 16, 2010, 35 TexReg 2174

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