Texas Insurance Code Title 6, Chapter 846 - Multiple Employer Welfare Arrangements

SUBCHAPTER A GENERAL PROVISIONS

• Texas Section 846.001 - Definitions
  In this chapter: (1) "Board" means the board of trustees or directors, as applicable, of a multiple employer welfare arrangement. (2) "Employee welfare benefit plan"...
• Texas Section 846.002 - Applicability Of Chapter
  (a) In this section, "fully insured multiple employer welfare arrangement" means an arrangement that provides to its participating employees and beneficiaries benefits for which 100...
• Texas Section 846.003 - Limited Exemption From Insurance Laws; Applicability Of Certain Laws
  (a) A multiple employer welfare arrangement is exempt from the operation of all insurance laws of this state, except laws that are made applicable by...
• Texas Section 846.004 - Late-participating Employee Or Dependent
  (a) For purposes of this chapter, an employee or dependent eligible for enrollment in a participating employer's health benefit plan is a late-participating employee or...
• Texas Section 846.005 - Rules; Orders
  (a) The commissioner may, on notice and opportunity for all interested persons to be heard, adopt rules and issue orders reasonably necessary to augment and...
• Texas Section 846.006 - Appeal Of Orders
  A person affected by an order of the commissioner issued under this chapter may appeal that order by filing suit in a district court in...

SUBCHAPTER B FORMATION AND STRUCTURE OF MULTIPLE EMPLOYER WELFARE ARRANGEMENTS

• Texas Section 846.007 - Premium Rates; Adjustments
  (a) A multiple employer welfare arrangement may charge premiums in accordance with this section to the group of employees or dependents who meet the participation...
• Texas Section 846.051 - Certificate Of Authority Required
  A person may not establish or maintain an employee welfare benefit plan that is a multiple employer welfare arrangement in this state unless the arrangement...
• Texas Section 846.052 - Application For Initial Certificate Of Authority
  (a) A person who wants to establish an employee welfare benefit plan that is a multiple employer welfare arrangement must apply for an initial certificate...
• Texas Section 846.053 - Eligibility Requirements For Initial Certificate Of Authority
  (a) An applicant for an initial certificate of authority as a multiple employer welfare arrangement must meet the requirements of this section. (b) The employers...
• Texas Section 846.054 - Issuance Of Initial Certificate Of Authority
  (a) The commissioner shall approve, deny, or disapprove an application for an initial certificate of authority that meets the requirements of Section 846.053 not later...
• Texas Section 846.055 - Extension Of Term Of Initial Certificate Of Authority
  The commissioner may extend the term of an initial certificate of authority for a period not to exceed one year if the commissioner determines that...
• Texas Section 846.056 - Final Certificate Of Authority
  (a) A multiple employer welfare arrangement that holds an initial certificate of authority must apply for a final certificate of authority not later than the...
• Texas Section 846.057 - Denial Of Final Certificate Of Authority
  (a) The commissioner shall deny a final certificate of authority to an applicant that does not comply with this chapter. (b) If the commissioner denies...
• Texas Section 846.058 - Disqualification
  (a) A multiple employer welfare arrangement, each board member and officer of the arrangement, and any agent or other person associated with the arrangement shall...
• Texas Section 846.059 - Fees; Service Of Process
  (a) Each multiple employer welfare arrangement shall pay to the department in the amount set by the commissioner: (1) an application fee for an initial...
• Texas Section 846.060 - Suspension, Revocation, Or Limitation Of Certificate Of Authority
  In addition to any requirement or remedy under a law cited under Section 846.003, the commissioner may suspend, revoke, or limit the certificate of authority...

SUBCHAPTER C BOARD MEMBERS; OTHER OFFICERS AND PERSONNEL

• Texas Section 846.061 - Action By Attorney General
  (a) The commissioner may notify the attorney general of a violation of this chapter, and the attorney general may apply to a district court in...
• Texas Section 846.101 - Board Members; Notice Of Elections
  (a) Except as otherwise provided, the powers of a multiple employer welfare arrangement shall be exercised by a board elected to carry out the purposes...
• Texas Section 846.102 - Duties Of Board Members
  (a) The board members of a multiple employer welfare arrangement are responsible for all operations of the arrangement and shall take all necessary precautions to...
• Texas Section 846.103 - Limitation On Action Against Board Member
  A board member may not be held liable in a private cause of action for any delinquency under Section 846.102 after the expiration of the...
• Texas Section 846.104 - Compensation Of Board Members
  A board member serves without compensation from the multiple employer welfare arrangement except for actual and necessary expenses. Added by Acts 2001, 77th Leg., ch....
• Texas Section 846.105 - Officers; Agents
  (a) The board shall select officers for the multiple employer welfare arrangement as designated in the organizational documents and may appoint agents as necessary for...
• Texas Section 846.106 - Compensation Of Officers, Agents, And Employees
  (a) A multiple employer welfare arrangement may pay the officers and agents of the arrangement suitable compensation. An officer, employee, or agent of an arrangement...

SUBCHAPTER D POWERS AND DUTIES OF MULTIPLE EMPLOYER WELFARE ARRANGEMENTS

• Texas Section 846.107 - Receipt Of Thing Of Value; Criminal Penalty
  (a) A board member, officer, or employee of a multiple employer welfare arrangement may not, knowingly and intentionally, directly or indirectly: (1) receive money or...
• Texas Section 846.151 - General Powers
  (a) Unless otherwise provided by or inconsistent with this chapter, each multiple employer welfare arrangement may exercise the powers provided by this section. (b) A...
• Texas Section 846.152 - Filing Of Organizational Documents
  A multiple employer welfare arrangement shall file with the commissioner its organizational documents and all appurtenant amendments before those documents take effect. Added by Acts...
• Texas Section 846.153 - Required Filings
  (a) A multiple employer welfare arrangement engaging in business in this state shall file the following with the commissioner on forms approved by the commissioner:...
• Texas Section 846.154 - Cash Reserve Requirements
  (a) The amount of cash reserves recommended under Section 846.153(c)(2) may not be less than the greater of: (1) 20 percent of the total contributions...
• Texas Section 846.155 - Adjustment Of Contributions
  If the recommended cash reserves required by Section 846.154(a) exceed the greater of 40 percent of the total contributions for the preceding plan year or...
• Texas Section 846.156 - Waiver Or Reduction Of Required Stop-loss Insurance Or Cash Reserves
  On the application of a multiple employer welfare arrangement, the commissioner may waive or reduce the requirement for aggregate stop-loss insurance coverage and the amount...
• Texas Section 846.157 - Renewal Of Certificate; Additional Actuarial Review
  (a) The commissioner shall review the forms required by Section 846.153 and shall renew a multiple employer welfare arrangement's certificate of authority unless the commissioner...
• Texas Section 846.158 - Examination Of Multiple Employer Welfare Arrangements
  (a) The commissioner or the commissioner's appointee may examine the affairs of any multiple employer welfare arrangement. (b) For the purposes of this section the...
• Texas Section 846.159 - Name Of Multiple Employer Welfare Arrangement
  (a) A multiple employer welfare arrangement shall transact business under the arrangement's own name and may not adopt any assumed name. An arrangement may not...

SUBCHAPTER E PROVISION OF COVERAGE

• Texas Section 846.160 - Evidence Of Existence
  A certified copy of the multiple employer welfare arrangement's certificate of authority is prima facie evidence of the existence of the arrangement in a legal...
• Texas Section 846.201 - Benefits Allowed
  (a) A multiple employer welfare arrangement may only provide one or more of the following: (1) medical, dental, vision, surgical, or hospital care; (2) benefits...
• Texas Section 846.202 - Preexisting Condition Provision
  (a) In this section, "creditable coverage" has the meaning assigned by Section 1205.004. (b) A preexisting condition provision in a multiple employer welfare arrangement's plan...
• Texas Section 846.203 - Treatment Of Certain Conditions As Preexisting Prohibited
  (a) A multiple employer welfare arrangement may not treat genetic information as a preexisting condition described by Section 846.202 in the absence of a diagnosis...
• Texas Section 846.204 - Waiting Period Permitted
  Sections 846.202 and 846.203 do not preclude application of a waiting period that applies to all new participating employees under the health benefit plan in...
• Texas Section 846.205 - Certain Limitations Or Exclusions Of Coverage Prohibited
  (a) A multiple employer welfare arrangement's plan document may not limit or exclude, by use of a rider or amendment applicable to a specific individual,...
• Texas Section 846.206 - Renewability Of Coverage; Cancellation
  (a) Except as provided by Section 846.207, a multiple employer welfare arrangement shall renew the health benefit plan, at the employer's option, unless: (1) a...
• Texas Section 846.207 - Refusal To Renew
  (a) A multiple employer welfare arrangement may elect to refuse to renew all health benefit plans delivered or issued for delivery by the arrangement in...
• Texas Section 846.208 - Notice To Covered Persons
  (a) A multiple employer welfare arrangement that cancels or refuses to renew coverage under a health benefit plan under Section 846.206 or Section 846.207 shall...

SUBCHAPTER F PARTICIPATION IN COVERAGE

• Texas Section 846.209 - Written Statement Of Denial, Cancellation, Or Refusal To Renew
  Denial by a multiple employer welfare arrangement of an application for coverage from an employer or cancellation of or refusal to renew must: (1) be...
• Texas Section 846.251 - Participation Criteria
  Participation criteria may not be based on health status related factors. Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
• Texas Section 846.252 - Coverage Requirements
  (a) A multiple employer welfare arrangement: (1) may refuse to provide coverage to an employer in accordance with the arrangement's underwriting standards and criteria; (2)...
• Texas Section 846.253 - Prohibition On Exclusion Of Eligible Employee Or Dependent
  A multiple employer welfare arrangement may not exclude an employee who meets the participation criteria or an eligible dependent, including a late-participating employee or dependent,...
• Texas Section 846.254 - Written Notice To Employees Covered
  A multiple employer welfare arrangement, in connection with an employee welfare benefit plan, shall provide to each participating employee covered by the plan a written...
• Texas Section 846.255 - Declining Coverage
  (a) A multiple employer welfare arrangement shall obtain a written waiver from each employee who meets the participation criteria and declines coverage under a health...
• Texas Section 846.256 - Minimum Contribution Or Participation Requirements
  (a) A multiple employer welfare arrangement may require an employer to meet minimum contribution or participation requirements as a condition of issuance and renewal of...
• Texas Section 846.257 - Enrollment; Waiting Period
  (a) The initial enrollment period for employees meeting the participation criteria must be at least 31 days, with a 31-day annual open enrollment period. The...
• Texas Section 846.258 - Coverage For Newborn Children
  (a) A multiple employer welfare arrangement's plan document may not limit or exclude initial coverage of a newborn child of a participating employee. (b) Coverage...
• Texas Section 846.259 - Coverage For Adopted Children
  (a) This section applies only if children are eligible for coverage under the terms of a multiple employer welfare arrangement's plan document. (b) A multiple...

SUBCHAPTER G MARKETING

• Texas Section 846.260 - Limiting Age Applicable To Unmarried Child
  If children are eligible for coverage under the terms of a multiple employer welfare arrangement's plan document, any limiting age applicable to an unmarried child...
• Texas Section 846.301 - Marketing Requirements
  On request, each employer purchasing a health benefit plan shall be given a summary of the plans for which the employer is eligible. Added by...
• Texas Section 846.302 - Additional Reporting Requirements
  The department may require periodic reports by multiple employer welfare arrangements and agents regarding the health benefit plans issued by the arrangements. The reporting requirements...
• Texas Section 846.303 - Applicability To Third-party Administrator
  If a multiple employer welfare arrangement enters into an agreement with a third-party administrator to provide administrative, marketing, or other services related to offering health...

Last modified: September 28, 2016