| (a) Except as provided by Insurance Code §1501.109
(concerning Refusal to Renew; Discontinuation of Coverage), a large
employer carrier must renew any large employer health benefit plan
at the option of the large employer, unless:
(1) the premium has not been paid as required by the
terms of the plan;
(2) the large employer has committed fraud or intentional
misrepresentation of a material fact;
(3) the large employer has not complied with a material
provision of the health benefit plan relating to premium contribution,
group size, or minimum participation requirements;
(4) the large employer has no enrollee, in connection
with the plan, who resides or works in the service area of the large
employer carrier or in the area where the large employer carrier is
authorized to do business; or
(5) membership of an employer in an association terminates,
but only if coverage is terminated uniformly without regard to a health-status-related
factor of a covered individual.
(b) A large employer carrier may refuse to renew the
coverage of an eligible employee or dependent for fraud or intentional
misrepresentation of a material fact by that individual and, with
respect to an eligible employee or dependent who is a subscriber or
enrollee in an HMO, for the reasons specified in §11.506 of this
title (relating to Mandatory Contractual Provisions: Group, Individual
and Conversion Agreement and Group Certificate). The coverage is also
subject to any policy or contractual provisions relating to incontestability
or time limits on certain defenses.
|
| Source Note: The provisions of this §26.308 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 |
