Texas Insurance Code Title 8, Chapter 1508 - Healthy Texas Program

SUBCHAPTER A GENERAL PROVISIONS

• Texas Section 1508.001 - Purpose
  (a) The purposes of the Healthy Texas Program are to: (1) provide access to quality small employer health benefit plans at an affordable price; (2)...
• Texas Section 1508.002 - Definitions
  In this chapter: (1) "Dependent" has the meaning assigned by Section 1501.002(2). (2) "Eligible employee" has the meaning assigned by Section 1501.002(3). (3) "Fund" means...

SUBCHAPTER B EMPLOYER ELIGIBILITY; CONTRIBUTIONS

• Texas Section 1508.003 - Rules
  The commissioner may adopt rules as necessary to implement this chapter. Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff....
• Texas Section 1508.051 - Employer Eligibility To Participate
  (a) A small employer may participate in the program if: (1) during the 12-month period immediately preceding the date of application for a qualifying health...
• Texas Section 1508.052 - Commissioner Adjustments Authorized
  (a) The commissioner by rule may adjust the 12-month period described by Section 1508.051(a)(1) to an 18-month period if the commissioner determines that the 12-month...
• Texas Section 1508.053 - Minimum Employer Participation Requirements
  A small employer that meets the eligibility requirements described by Section 1508.051(a) may apply to purchase a qualifying health benefit plan if 60 percent or...

SUBCHAPTER C PROGRAM PARTICIPATION; REQUIRED COVERAGE AND BENEFITS

• Texas Section 1508.054 - Employer Contribution Requirements
  (a) A small employer that purchases a qualifying health benefit plan must: (1) pay 50 percent or more of the premium for each employee covered...
• Texas Section 1508.101 - Participating Plan Issuers
  (a) Subject to Subsection (b), any health benefit plan issuer may participate in the program. (b) The commissioner by rule may limit which health benefit...
• Texas Section 1508.102 - Preexisting Condition Provision Required
  A health benefit plan offered under the program must include a preexisting condition provision that meets the requirements described by Section 1501.102. Added by Acts...
• Texas Section 1508.103 - Exception From Mandated Benefit Requirements
  Except as expressly provided by this chapter, a small employer health benefit plan issued under the program is not subject to a law of this...

SUBCHAPTER D PROGRAM ADMINISTRATION

• Texas Section 1508.104 - Certain Coverage Prohibited Or Required
  (a) A qualifying health benefit plan may only provide coverage for in-plan services and benefits, except for: (1) emergency care; or (2) other services not...
• Texas Section 1508.151 - Employer Certification
  (a) At the time of initial application, a health benefit plan issuer shall obtain from a small employer that seeks to purchase a qualifying health...
• Texas Section 1508.152 - Application Process
  (a) Subject to Subsection (b), a health benefit plan issuer shall accept applications for qualifying health benefit plan coverage from small employers at all times...
• Texas Section 1508.153 - Employee Enrollment; Waiting Period
  (a) A qualifying health benefit plan must provide employees with an initial enrollment period that is 31 days or longer, and annually at least one...

SUBCHAPTER E RATING OF QUALIFIED HEALTH BENEFIT PLANS

• Texas Section 1508.154 - Reports
  A health benefit plan issuer that participates in the program shall submit reports to the department in the form and at the time the commissioner...
• Texas Section 1508.201 - Rating; Premium Practices In General
  (a) A health benefit plan issuer participating in the program must: (1) use rating practices for qualifying health benefit plans that are consistent with the...
• Texas Section 1508.202 - Premium Rate Development And Calculation
  (a) Rating factors used to underwrite qualifying health benefit plans must produce premium rates for identical groups that: (1) differ only by the amounts attributable...

SUBCHAPTER F HEALTHY TEXAS SMALL EMPLOYER PREMIUM STABILIZATION FUND

• Texas Section 1508.203 - Filing; Approval
  (a) A health benefit plan issuer shall file with the department, for review and approval by the commissioner, premium rates to be charged for qualifying...
• Texas Section 1508.251 - Establishment Of Fund
  (a) To the extent that funds appropriated to the department are available for this purpose, the commissioner shall establish a fund from which health benefit...
• Texas Section 1508.252 - Operation Of Fund; Claim Eligibility
  (a) A health benefit plan issuer is eligible to receive reimbursement in an amount that is equal to 80 percent of the dollar amount of...
• Texas Section 1508.253 - Reimbursement Request Submission
  (a) A health benefit plan issuer seeking reimbursement from the fund shall submit a request for reimbursement in the form prescribed by the commissioner by...
• Texas Section 1508.254 - Fund Availability
  (a) The commissioner shall compute the total claims reimbursement amount for all health benefit plan issuers participating in the program for the calendar year for...
• Texas Section 1508.255 - Program Reporting
  (a) Each health benefit plan issuer participating in the program shall provide the department, in the form prescribed by the commissioner, monthly reports of total...
• Texas Section 1508.256 - Claims Experience Data
  (a) Based on available data and appropriate actuarial assumptions, the commissioner shall separately estimate the per covered individual annual cost of total claims reimbursement from...
• Texas Section 1508.257 - Total Eligible Enrollment Determination
  (a) The commissioner shall determine total eligible enrollment under qualifying health benefit plans by dividing the total funds available for distribution from the fund by...
• Texas Section 1508.258 - Evaluation And Protection Of Fund; Employer Enrollment Suspension
  (a) The commissioner shall suspend the enrollment of new employers in qualifying health benefit plans if the commissioner determines that the total enrollment reported by...
• Texas Section 1508.259 - Employer Enrollment Reactivation
  If, at any point during a suspension of enrollment under Section 1508.258, the commissioner determines that funds are sufficient to provide for the addition of...
• Texas Section 1508.260 - Fund Administrator
  (a) The commissioner may obtain the services of an independent organization to administer the fund. (b) The commissioner shall establish guidelines for the submission of...
• Texas Section 1508.261 - Stop-loss Insurance; Reinsurance
  (a) The administrator of the fund, on behalf of and with the prior approval of the commissioner, may purchase stop-loss insurance or reinsurance from an...
• Texas Section 1508.262 - Public Education And Outreach
  (a) The commissioner may use an amount of the fund, not to exceed eight percent of the annual amount of the fund, for purposes of...

Last modified: September 28, 2016