| (a) With the original filing to enter the small employer
market or when notifying TDI of a change in status, each health carrier
providing health benefit plans in this state must file with the commissioner
a statement indicating whether the health carrier will or will not
offer, renew, issue, or issue for delivery health benefit plans to
small employers in this state. The filing must include a certification,
signed by an officer of the company, that the carrier intends to operate
in accordance with the status certification unless or until it is
changed in accordance with this section, and provide a statement to
the effect of one of the following statements:
(1) the health carrier intends to offer, renew, issue,
and issue for delivery health benefit plans to small employers in
Texas and will operate in accordance with Insurance Code Chapter 1501
(concerning Health Insurance Portability and Availability Act) and
this subchapter;
(2) the health carrier does not intend to offer, issue,
or issue for delivery health benefit plans to small employers in Texas,
but the health carrier intends to renew existing health benefit plans;
(3) the health carrier does not intend to offer, issue,
or issue for delivery health benefit plans to small employers in Texas;
intends to nonrenew all health benefit plans issued to small employers
in Texas; and will provide notice to the commissioner and employers
in accordance with §26.16 of this title (relating to Refusal
to Renew and Application to Reenter Small Employer Market) and Insurance
Code §1501.110 (concerning Notice to Covered Persons); or
(4) the health carrier has no health benefit plans
issued to small employers or to employees of a small employer and
does not intend to offer, issue, or issue for delivery health benefit
plans to small employers.
(b) If a health carrier chooses to change its election
or the date of implementing its election under subsection (a)(1),
(2), or (4) of this section, the health carrier must notify the commissioner
of its new election at least 30 days before the date the health carrier
intends to begin operations under the new election as required in
subsection (a) of this section.
(c) A form fulfilling the requirements of subsections
(a) and (b) of this section is available online at www.tdi.texas.gov/forms/form10smgroup.html
through the link for Small Employer Carrier Status Certification.
(d) Health carriers providing coverage under any health
benefit plans issued to small employers and their employees, whether
on a group or franchise insurance policy basis, will be considered
small employer carriers for purposes of those plans, and must comply
with all provisions of Insurance Code Chapter 1501 and this subchapter,
as applicable.
(e) The small employer carrier must also comply with
any other applicable legal requirements, including those for withdrawal
from the market under Chapter 7, Subchapter R of this title (relating
to Withdrawal Plan Requirements and Procedures).
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| Source Note: The provisions of this §26.6 adopted to be effective December 30, 1993, 18 TexReg 9375; amended to be effective April 9, 1996, 21 TexReg 2648; amended 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 |
