| (A) the employer group or association would be a viable
entity in the absence of sponsoring an employee benefit plan;
(B) the member employers have a shared or common purpose
that is not generally applicable to the population at large; and
(C) the primary method of obtaining new members is
not through, or in conjunction with, the solicitation of insurance.
(4) When determining whether an entity is a bona fide
employer association, the department may consider whether the employer
group or association ever existed without offering a health benefit
plan.
(5) An employer group or association must not condition
employer membership in the group or association on any health-status-related
factor, as defined in §26.4 of this title (relating to Definitions),
of any individual who is or may become eligible to participate in
the group health plan sponsored by the bona fide group or association.
(6) If TDI approves an association as a bona fide employer
association, an issuer must treat the employer group or association
as a single large employer, including for purposes of compliance with
this chapter and Texas Insurance Code Chapter 1501.
(h) A large employer nonfederal governmental employee
health benefit plan that is not self-funded is subject to the Insurance
Code and this title, as applicable, including Chapter 1501 and this
chapter.
(i) If a large employer has employees in more than
one state, the provisions of Insurance Code Chapter 1501 and this
subchapter apply to a health benefit plan issued to the large employer
if the:
(1) majority of employees are employed in this state
on the issue date or renewal date; or
(2) primary business location is in this state on the
issue date or renewal date and no state contains a majority of the
employees.
(j) A carrier licensed in this state that issues a
certificate of insurance covering a Texas resident is responsible
for ensuring that the certificate complies with applicable Texas insurance
laws and rules, including Senate Bill 1264, 86th Legislature, 2019,
and other mandated benefits, regardless of whether the group policy
underlying the certificate was issued outside the state.
|
| Source Note: The provisions of this §26.301 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; amended to be effective December 24, 2020, 45 TexReg 9226; amended to be effective July 12, 2023, 48 TexReg 3666 |
