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 26.308 - Renewability of Coverage and Cancellation

Universal Citation: 28 TX Admin Code § 26.308

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

(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.

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