| (a) Each small employer carrier must file with the
commissioner, no later than with the first filing of a small employer
health benefit plan, notification of whether the carrier elects to
operate as a risk-assuming or reinsured carrier.
(1) A small employer carrier's operation as a risk-assuming
carrier is subject to approval by the commissioner, and each small
employer carrier electing to operate as a risk-assuming carrier must
file an application with the commissioner contemporaneously with its
election to operate as a risk-assuming carrier. A risk-assuming carrier's
application, in addition to the financial information already on file
with TDI, must include a:
(A) history of rating and underwriting small employer
groups, including a description of underwriting experience to identify
high risks and the percentage of aggregate rate increases for the
past three years for small employer groups for Texas and nationwide;
(B) description of the carrier's commitment to fairly
market to all small employers in Texas or in the small employer carrier's
established geographic service areas, including sample material used,
or planned to be used, to market to small employers;
(C) description of experience in managing the risk
of small groups, including;
(i) the number of years, volume of business, results,
etc.;
(ii) a list of other states with guaranteed issue requirements
where the carrier provides small employer group coverage;
(iii) the total number of lives currently covered under
those guaranteed issue plans; and
(iv) a list of other states where the carrier voluntarily
participates in reinsurance programs;
(D) description of plans to manage the risk of guaranteed
issue as a risk-assuming carrier;
(E) list of affiliated small employer carriers and
whether they have been approved as either a risk-assuming or reinsured
carrier;
(F) list of any other affiliated small employer carrier
applicants, indicating their requested designation as either a risk-assuming
or reinsured carrier; and
(G) the name, title, and signature of the chief executive
officer, attorney, or actuary for the named health carrier.
(2) A reinsured carrier's notification must include:
(A) a statement of the carrier's election to operate
as a reinsured carrier; and
(B) the name, title, and signature of the chief executive
officer, attorney, or actuary of the named health carrier.
(b) A small employer carrier seeking to change its
status as a risk-assuming or reinsured carrier must file an application
with the commissioner. If the carrier is requesting a change to be
a:
(1) risk-assuming carrier, the filing must include:
(A) the information requested in subsection (a) of
this section;
(B) information demonstrating good cause for the request
to change status; and
(C) the name, title, and signature of the chief executive
officer, attorney, or actuary for the named health carrier; or
(2) reinsured carrier, the filing must include:
(A) information demonstrating good cause for the request
to change status; and
(B) the name, title, and signature of the chief executive
officer, attorney, or actuary for the named health carrier.
(c) A small employer carrier's election is effective
until the fifth anniversary of the election. A small employer carrier
seeking to maintain its status after that date must file with the
commissioner, at least 90 days before the fifth anniversary of its
election, the same information required by subsection (a)(1) and (2)
of this section.
(d) A form fulfilling the requirements of this section
is available at www.tdi.texas.gov/forms/form10smgroup.html through
the link for Election and Application to be a Risk-Assuming or Reinsured
Carrier.
|
| Source Note: The provisions of this §26.18 adopted to be effective April 9, 1996, 21 TexReg 2648; amended 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 |
