Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS
Subchapter C - LARGE EMPLOYER HEALTH INSURANCE REGULATIONS
Section 26.302 - Status of Health Carriers as Large Employer Carriers

Universal Citation: 28 TX Admin Code § 26.302

Current through Reg. 50, No. 13; March 28, 2025

(a) With the original filing to enter the large 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 large 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 changed in accordance with this section, and provide a statement that:

(1) the health carrier intends to offer, renew, issue, and issue for delivery health benefit plans to large 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 large 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 large employers in Texas; intends to nonrenew all health benefit plans issued to large employers in Texas; and will provide notice to the commissioner and employers in accordance with § 26.309 of this title (relating to Refusal to Renew and Application to Reenter Large Employer Market) and Insurance Code § 1501.110 (concerning Notice to Covered Persons); or

(4) the health carrier has no health benefit plans issued to large employers or to employees of a large employer and does not intend to offer, issue, or issue for delivery health benefit plans to large 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.

(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 Large Employer Carrier Status Certification.

(d) The large 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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