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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 |
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Subchapter E. UNDERWRITING AND RATING OF SMALL EMPLOYER HEALTH BENEFIT PLANS |
Sec. 1501.201. DEFINITIONS
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In this subchapter:
(1) "Base premium rate" means, for each class of business and for a specific rating period, the lowest premium rate that is charged or that could be charged under a rating system for that class of business by a small employer health benefit plan issuer to small employers with similar case characteristics for small employer health benefit plans that provide the same or similar coverage.
(2) "Case characteristics" means, with respect to a small employer, the geographic area in which the employer's employees reside, the age and gender of the individual employees and their dependents, the number of employees and dependents, the appropriate industry classification as determined by the small employer health benefit plan issuer, and other objective criteria established by the issuer that are considered by the issuer in setting premium rates for the employer. The term does not include:
(A) health status related factors;
(B) duration of coverage since the date of issuance of a health benefit plan; or
(C) whether a covered individual is or may become pregnant.
(3) "Class of business" means all small employers or a separate grouping of small employers established under this subchapter.
(4) "Index rate" means, for each class of business and for a specific rating period for small employers with similar case characteristics, the arithmetic average of the applicable base premium rate and corresponding highest premium rate.
(5) "New business premium rate" means, for each class of business and for a specific rating period, the lowest premium rate that is charged or offered or that could be charged or offered by a small employer health benefit plan issuer to small employers with similar case characteristics for newly issued small employer health benefit plans that provide the same or similar coverage.
(6) "Rating period" means a calendar period during which premium rates established by a small employer health benefit plan issuer are assumed to be in effect.