| (a) A small employer carrier that establishes more
than one class of business in accordance with the provisions of Insurance
Code §1501.202 (concerning Establishment of Classes of Business)
and §1501.203 (concerning Establishment of Classes of Business
on Certain Bases Prohibited) must maintain on file for inspection
by the commissioner the following information with respect to each
class of business so established:
(1) a description of each criterion employed by the
health carrier (or any of its agents) for determining membership in
the class of business;
(2) a statement describing the justification for establishing
the class as a separate class of business and documentation that the
establishment of the class of business is intended to reflect substantial
differences in expected claims experience or administrative costs
related to the reasons set forth in Insurance Code Chapter 1501 (concerning
Health Insurance Portability and Availability Act); and
(3) a statement disclosing which, if any, health benefit
plans are currently available for purchase in the class and any significant
limitations related to the purchase of the plans.
(b) A health carrier may not directly or indirectly
use the number of employees and dependents of a small employer, the
trade or occupation of the employees of a small employer, or the industry
or type of business of the small employer as criteria for establishing
eligibility for a health benefit plan or for a class of business,
except as provided in Insurance Code §1501.202 and §1501.203.
(c) A health carrier may not establish a separate class
of business based on minimum participation requirements or whether
the coverage provided to a small employer group is provided on a guaranteed
issue basis or is subject to underwriting or proof of insurability.
|
| Source Note: The provisions of this §26.10 adopted to be effective December 30, 1993, 18 TexReg 9375; amended to be effective April 9, 1996, 21 TexReg 2648; amended to be effective April 6, 2005, 30 TexReg 1931; amended to be effective May 17, 2017, 42 TexReg 2539 |
