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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle G. HEALTH COVERAGE AVAILABILITY |
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Chapter 1501. HEALTH INSURANCE PORTABILITY AND AVAILABILITY ACT |
| Subchapter A. GENERAL PROVISIONS |
| § 1501.001. SHORT TITLE |
| § 1501.002. DEFINITIONS |
| § 1501.003. APPLICABILITY: SMALL EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.004. APPLICABILITY: LARGE EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.005. EXCEPTION: CERTAIN INDIVIDUALLY UNDERWRITTEN POLICIES |
| § 1501.006. CERTIFICATION |
| § 1501.007. AFFILIATES |
| § 1501.008. LATE ENROLLEES |
| § 1501.009. SCHOOL DISTRICT ELECTION |
| § 1501.0095. SCHOOL DISTRICT EMPLOYEE ELECTION |
| § 1501.010. GENERAL RULES |
| § 1501.011. DETERMINATION OF EMPLOYER STATUS FOR CERTAIN EMPLOYERS |
| Subchapter B. COALITIONS AND COOPERATIVES |
| § 1501.051. DEFINITIONS |
| § 1501.052. TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE; BOARD OF TRUSTEES |
| § 1501.053. TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE: EXECUTIVE DIRECTOR AND OTHER EMPLOYEES |
| § 1501.054. REGIONAL SUBDIVISIONS OF TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE |
| § 1501.055. APPLICABILITY OF PUBLIC INFORMATION LAW TO TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE |
| § 1501.056. PRIVATE PURCHASING COOPERATIVES AND HEALTH GROUP COOPERATIVES |
| § 1501.057. IMMUNITY |
| § 1501.0575. VOLUNTARY PARTICIPATION BY ISSUER IN COOPERATIVE |
| § 1501.058. POWERS AND DUTIES OF COOPERATIVES |
| § 1501.0581. SPECIAL PROVISIONS RELATING TO HEALTH GROUP COOPERATIVES |
| § 1501.0582. HEALTH GROUP COOPERATIVE: EXPEDITED APPROVAL PROCESS |
| § 1501.059. SELF-INSURED OR SELF-FUNDED PLAN PROHIBITED |
| § 1501.060. SCOPE OF GROUP COVERAGE |
| § 1501.061. REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH WHICH COOPERATIVE MAY CONTRACT |
| § 1501.062. COOPERATIVE NOT INSURER; AGENTS AND ADMINISTRATORS |
| § 1501.063. STATUS AS EMPLOYER |
| § 1501.064. CERTAIN USE OF APPROPRIATED MONEY PROHIBITED |
| § 1501.065. CERTAIN ACTIONS BASED ON RISK CHARACTERISTICS OR HEALTH STATUS PROHIBITED |
| § 1501.066. ELECTION TO TREAT PARTICIPATING EMPLOYERS SEPARATELY FOR RATING PURPOSES |
| § 1501.067. ELIGIBLE SINGLE-EMPLOYEE BUSINESS |
| Subchapter C. PROVISION OF COVERAGE |
| § 1501.101. GEOGRAPHIC SERVICE AREAS |
| § 1501.102. PREEXISTING CONDITION PROVISION |
| § 1501.103. TREATMENT OF CERTAIN CONDITIONS AS PREEXISTING PROHIBITED |
| § 1501.104. AFFILIATION PERIOD |
| § 1501.105. WAITING PERIOD PERMITTED |
| § 1501.106. CERTAIN LIMITATIONS OR EXCLUSIONS OF COVERAGE PROHIBITED |
| § 1501.107. DISCOUNTS, REBATES, AND REDUCTIONS |
| § 1501.108. RENEWABILITY OF COVERAGE; CANCELLATION |
| § 1501.109. REFUSAL TO RENEW; DISCONTINUATION OF COVERAGE |
| § 1501.110. NOTICE TO COVERED PERSONS |
| § 1501.111. WRITTEN STATEMENT OF DENIAL, CANCELLATION, OR REFUSAL TO RENEW REQUIRED |
| Subchapter D. GUARANTEED ISSUE OF SMALL EMPLOYER HEALTH BENEFIT PLANS; CONTINUATION OF COVERAGE |
| § 1501.151. GUARANTEED ISSUE |
| § 1501.152. EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT PROHIBITED |
| § 1501.153. EMPLOYER CONTRIBUTION |
| § 1501.154. MINIMUM PARTICIPATION REQUIREMENT |
| § 1501.155. EXCEPTION TO MINIMUM PARTICIPATION REQUIREMENT |
| § 1501.156. EMPLOYEE ENROLLMENT; WAITING PERIOD |
| § 1501.157. COVERAGE FOR NEWBORN CHILDREN |
| § 1501.158. COVERAGE FOR ADOPTED CHILDREN |
| § 1501.159. CONTINUATION OF COVERAGE FOR CERTAIN DEPENDENTS |
| Subchapter E. UNDERWRITING AND RATING OF SMALL EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.201. DEFINITIONS |
| § 1501.202. ESTABLISHMENT OF CLASSES OF BUSINESS |
| § 1501.203. ESTABLISHMENT OF CLASSES OF BUSINESS ON CERTAIN BASES PROHIBITED |
| § 1501.204. INDEX RATES |
| § 1501.205. PREMIUM RATES: ESTABLISHMENT |
| § 1501.206. PREMIUM RATES: ADJUSTMENTS |
| § 1501.207. PREMIUM RATE ADJUSTMENT IN CLOSED PLAN |
| § 1501.208. PREMIUM RATES: INDUSTRY CLASSIFICATION |
| § 1501.209. PREMIUM RATES: NUMBER OF EMPLOYEES |
| § 1501.210. PREMIUM RATES: NONDISCRIMINATION |
| § 1501.211. RULES CONCERNING PREMIUM RATES |
| § 1501.212. RESTRICTED PROVIDER NETWORK |
| § 1501.213. PREMIUM RATES: HEALTH MAINTENANCE ORGANIZATION HEALTH BENEFIT PLAN |
| § 1501.214. ENFORCEMENT |
| § 1501.215. REPORTING REQUIREMENTS |
| § 1501.216. PREMIUM RATES: NOTICE OF INCREASE |
| Subchapter F. COVERAGE UNDER SMALL EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.251. EXCEPTION FROM CERTAIN MANDATED BENEFIT REQUIREMENTS |
| § 1501.252. HEALTH BENEFIT PLANS |
| § 1501.254. ALCOHOL AND SUBSTANCE ABUSE BENEFITS |
| § 1501.255. HEALTH MAINTENANCE ORGANIZATION PLANS |
| § 1501.256. COORDINATION WITH FEDERAL LAW |
| § 1501.257. COST CONTAINMENT |
| § 1501.258. FORMS |
| § 1501.259. RIDERS; FILING WITH COMMISSIONER |
| § 1501.260. PLAIN LANGUAGE REQUIRED |
| Subchapter G. REINSURANCE FOR SMALL EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.301. DEFINITIONS |
| § 1501.302. TEXAS HEALTH REINSURANCE SYSTEM |
| § 1501.303. SYSTEM BOARD OF DIRECTORS |
| § 1501.304. OPEN MEETINGS; PUBLIC INFORMATION |
| § 1501.305. BOARD MEMBER IMMUNITY |
| § 1501.306. SYSTEM PLAN OF OPERATION |
| § 1501.307. SYSTEM POWERS |
| § 1501.308. SYSTEM NOTES AS LEGAL INVESTMENT FOR SMALL EMPLOYER HEALTH BENEFIT PLAN ISSUER |
| § 1501.309. SYSTEM AUDIT |
| § 1501.310. ELECTION OF STATUS |
| § 1501.311. CHANGE IN STATUS |
| § 1501.312. APPLICATION TO OPERATE AS RISK-ASSUMING HEALTH BENEFIT PLAN ISSUER |
| § 1501.313. RESCISSION OF APPROVAL TO OPERATE AS RISK-ASSUMING HEALTH BENEFIT PLAN ISSUER |
| § 1501.314. REINSURANCE |
| § 1501.315. LIMITS ON REINSURANCE |
| § 1501.316. TERMINATION OF REINSURANCE |
| § 1501.317. APPLICATION OF MANAGED CARE PROCEDURES |
| § 1501.318. PREMIUM RATES FOR REINSURANCE |
| § 1501.319. DETERMINATION OF NET LOSS |
| § 1501.320. ASSESSMENTS TO RECOVER NET LOSSES |
| § 1501.321. LIMITS ON ASSESSMENTS |
| § 1501.322. ADJUSTMENT TO ASSESSMENTS ON FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATIONS |
| § 1501.323. ADVANCE INTERIM ASSESSMENTS |
| § 1501.324. LIMIT ON TOTAL ASSESSMENTS |
| § 1501.325. ESTIMATE OF ASSESSMENTS; EVALUATION AND PROTECTION OF SYSTEM |
| § 1501.326. DEFERMENT OF ASSESSMENT |
| Subchapter H. MARKETING OF SMALL EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.351. MARKETING REQUIREMENTS |
| § 1501.352. HEALTH STATUS AND CLAIMS EXPERIENCE; PROHIBITED ACTS |
| § 1501.353. AGENT COMPENSATION |
| § 1501.354. REQUIRED DISCLOSURES |
| § 1501.355. RULES CONCERNING MARKETING AND AVAILABILITY |
| § 1501.356. REPORTING REQUIREMENTS |
| § 1501.357. VIOLATIONS |
| § 1501.358. APPLICABILITY TO THIRD-PARTY ADMINISTRATOR |
| Subchapter M. LARGE EMPLOYER HEALTH BENEFIT PLANS |
| § 1501.601. PARTICIPATION CRITERIA |
| § 1501.602. COVERAGE REQUIREMENTS |
| § 1501.603. EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT PROHIBITED |
| § 1501.604. DECLINING COVERAGE |
| § 1501.605. MINIMUM CONTRIBUTION OR PARTICIPATION REQUIREMENTS |
| § 1501.606. EMPLOYEE ENROLLMENT; WAITING PERIOD |
| § 1501.607. COVERAGE FOR NEWBORN CHILDREN |
| § 1501.608. COVERAGE FOR ADOPTED CHILDREN |
| § 1501.609. COVERAGE FOR UNMARRIED CHILDREN |
| § 1501.610. PREMIUM RATES; ADJUSTMENTS |
| § 1501.611. MARKETING REQUIREMENTS |
| § 1501.612. ENCOURAGING EXCLUSION OF EMPLOYEE PROHIBITED |
| § 1501.613. AGENTS |
| § 1501.615. ADDITIONAL REPORTING REQUIREMENTS |
| § 1501.616. APPLICABILITY TO THIRD-PARTY ADMINISTRATOR |