Texas Statutes
Subtitle G - Health Coverage Availability
Chapter 1501 - Health Insurance Portability and Availability Act

Section 1501.003. Applicability: Small Employer Health Benefit Plans - Sec. 1501.003. APPLICABILITY: SMALL EMPLOYER HEALTH BENEFIT PLANS. An individual...

Section 1501.004. Applicability: Large Employer Health Benefit Plans - Sec. 1501.004. APPLICABILITY: LARGE EMPLOYER HEALTH BENEFIT PLANS. An individual...

Section 1501.005. Exception: Certain Individually Underwritten Policies - Sec. 1501.005. EXCEPTION: CERTAIN INDIVIDUALLY UNDERWRITTEN POLICIES. Except as provided...

Section 1501.006. Certification - Sec. 1501.006. CERTIFICATION. (a) In accordance with rules adopted by...

Section 1501.007. Affiliates - Sec. 1501.007. AFFILIATES. (a) In this section, "affiliate" has the...

Section 1501.008. Late Enrollees - Sec. 1501.008. LATE ENROLLEES. (a) For purposes of this chapter,...

Section 1501.009. School District Election - Sec. 1501.009. SCHOOL DISTRICT ELECTION. (a) An independent school district...

Section 1501.0095. School District Employee Election - Sec. 1501.0095. SCHOOL DISTRICT EMPLOYEE ELECTION. (a) Notwithstanding any other...

Section 1501.010. General Rules - Sec. 1501.010. GENERAL RULES. The commissioner shall adopt rules necessary...

Section 1501.011. Determination of Employer Status for Certain Employers - Sec. 1501.011. DETERMINATION OF EMPLOYER STATUS FOR CERTAIN EMPLOYERS. (a)...

Subchapter B. Coalitions and Cooperatives

Section 1501.051. Definitions - Sec. 1501.051. DEFINITIONS. In this subchapter: (1) "Board of directors"...

Section 1501.052. Texas Health Benefits Purchasing Cooperative; Board of Trustees - Sec. 1501.052. TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE; BOARD OF TRUSTEES....

Section 1501.053. Texas Health Benefits Purchasing Cooperative: Executive Director and Other Employees - Sec. 1501.053. TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE: EXECUTIVE DIRECTOR AND...

Section 1501.054. Regional Subdivisions of Texas Health Benefits Purchasing Cooperative - Sec. 1501.054. REGIONAL SUBDIVISIONS OF TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE....

Section 1501.055. Applicability of Public Information Law to Texas Health Benefits Purchasing Cooperative - Sec. 1501.055. APPLICABILITY OF PUBLIC INFORMATION LAW TO TEXAS HEALTH...

Section 1501.056. Private Purchasing Cooperatives and Health Group Cooperatives - Sec. 1501.056. PRIVATE PURCHASING COOPERATIVES AND HEALTH GROUP COOPERATIVES. (a)...

Section 1501.057. Immunity - Sec. 1501.057. IMMUNITY. (a) The Texas cooperative or a member...

Section 1501.0575. Voluntary Participation by Issuer in Cooperative - Sec. 1501.0575. VOLUNTARY PARTICIPATION BY ISSUER IN COOPERATIVE. A health...

Section 1501.058. Powers and Duties of Cooperatives - Sec. 1501.058. POWERS AND DUTIES OF COOPERATIVES. (a) A cooperative...

Section 1501.0581. Special Provisions Relating to Health Group Cooperatives - Sec. 1501.0581. SPECIAL PROVISIONS RELATING TO HEALTH GROUP COOPERATIVES. (a)...

Section 1501.0582. Health Group Cooperative: Expedited Approval Process - Sec. 1501.0582. HEALTH GROUP COOPERATIVE: EXPEDITED APPROVAL PROCESS. The department...

Section 1501.059. Self-Insured or Self-Funded Plan Prohibited - Sec. 1501.059. SELF-INSURED OR SELF-FUNDED PLAN PROHIBITED. A cooperative may...

Section 1501.060. Scope of Group Coverage - Sec. 1501.060. SCOPE OF GROUP COVERAGE. Subchapter B, Chapter 1251,...

Section 1501.061. Requirements Applicable to Health Benefit Plan Issuers With Which Cooperative May Contract - Sec. 1501.061. REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN ISSUERS WITH...

Section 1501.062. Cooperative Not Insurer; Agents and Administrators - Sec. 1501.062. COOPERATIVE NOT INSURER; AGENTS AND ADMINISTRATORS. (a) A...

Section 1501.063. Status as Employer - Sec. 1501.063. STATUS AS EMPLOYER. (a) A small employer health...

Section 1501.064. Certain Use of Appropriated Money Prohibited - Sec. 1501.064. CERTAIN USE OF APPROPRIATED MONEY PROHIBITED. The Texas...

Section 1501.065. Certain Actions Based on Risk Characteristics or Health Status Prohibited - Sec. 1501.065. CERTAIN ACTIONS BASED ON RISK CHARACTERISTICS OR HEALTH...

Section 1501.066. Election to Treat Participating Employers Separately for Rating Purposes - Sec. 1501.066. ELECTION TO TREAT PARTICIPATING EMPLOYERS SEPARATELY FOR RATING...

Section 1501.067. Eligible Single-Employee Business - Sec. 1501.067. ELIGIBLE SINGLE-EMPLOYEE BUSINESS. The commissioner shall adopt rules...

Subchapter C. Provision of Coverage

Section 1501.101. Geographic Service Areas - Sec. 1501.101. GEOGRAPHIC SERVICE AREAS. (a) Repealed by Acts 2015,...

Section 1501.102. Preexisting Condition Provision - Sec. 1501.102. PREEXISTING CONDITION PROVISION. (a) In this section, "creditable...

Section 1501.103. Treatment of Certain Conditions as Preexisting Prohibited - Sec. 1501.103. TREATMENT OF CERTAIN CONDITIONS AS PREEXISTING PROHIBITED. (a)...

Section 1501.104. Affiliation Period - Sec. 1501.104. AFFILIATION PERIOD. (a) In this section, "affiliation period"...

Section 1501.105. Waiting Period Permitted - Sec. 1501.105. WAITING PERIOD PERMITTED. Sections 1501.102-1501.104 do not preclude...

Section 1501.106. Certain Limitations or Exclusions of Coverage Prohibited - Sec. 1501.106. CERTAIN LIMITATIONS OR EXCLUSIONS OF COVERAGE PROHIBITED. (a)...

Section 1501.107. Discounts, Rebates, and Reductions - Sec. 1501.107. DISCOUNTS, REBATES, AND REDUCTIONS. (a) A small or...

Section 1501.108. Renewability of Coverage; Cancellation - Sec. 1501.108. RENEWABILITY OF COVERAGE; CANCELLATION. (a) Except as provided...

Section 1501.109. Refusal to Renew; Discontinuation of Coverage - Sec. 1501.109. REFUSAL TO RENEW; DISCONTINUATION OF COVERAGE. (a) A...

Section 1501.110. Notice to Covered Persons - Sec. 1501.110. NOTICE TO COVERED PERSONS. (a) A small or...

Section 1501.111. Written Statement of Denial, Cancellation, or Refusal to Renew Required - Sec. 1501.111. WRITTEN STATEMENT OF DENIAL, CANCELLATION, OR REFUSAL TO...

Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage

Section 1501.151. Guaranteed Issue - Sec. 1501.151. GUARANTEED ISSUE. (a) A small employer health benefit...

Section 1501.152. Exclusion of Eligible Employee or Dependent Prohibited - Sec. 1501.152. EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT PROHIBITED. A...

Section 1501.153. Employer Contribution - Sec. 1501.153. EMPLOYER CONTRIBUTION. (a) This chapter does not require...

Section 1501.154. Minimum Participation Requirement - Sec. 1501.154. MINIMUM PARTICIPATION REQUIREMENT. (a) Except as provided by...

Section 1501.155. Exception to Minimum Participation Requirement - Sec. 1501.155. EXCEPTION TO MINIMUM PARTICIPATION REQUIREMENT. (a) A small...

Section 1501.156. Employee Enrollment; Waiting Period - Sec. 1501.156. EMPLOYEE ENROLLMENT; WAITING PERIOD. (a) The initial enrollment...

Section 1501.157. Coverage for Newborn Children - Sec. 1501.157. COVERAGE FOR NEWBORN CHILDREN. (a) A small employer...

Section 1501.158. Coverage for Adopted Children - Sec. 1501.158. COVERAGE FOR ADOPTED CHILDREN. (a) A small employer...

Section 1501.159. Continuation of Coverage for Certain Dependents - Sec. 1501.159. CONTINUATION OF COVERAGE FOR CERTAIN DEPENDENTS. An employee's...

Subchapter E. Underwriting and Rating of Small Employer Health Benefit Plans

Section 1501.201. Definitions - Sec. 1501.201. DEFINITIONS. In this subchapter: (1) "Base premium rate"...

Section 1501.202. Establishment of Classes of Business - Sec. 1501.202. ESTABLISHMENT OF CLASSES OF BUSINESS. (a) Except as...

Section 1501.203. Establishment of Classes of Business on Certain Bases Prohibited - Sec. 1501.203. ESTABLISHMENT OF CLASSES OF BUSINESS ON CERTAIN BASES...

Section 1501.204. Index Rates - Sec. 1501.204. INDEX RATES. Under a small employer health benefit...

Section 1501.205. Premium Rates: Establishment - Sec. 1501.205. PREMIUM RATES: ESTABLISHMENT. (a) In this section: (1)...

Section 1501.206. Premium Rates: Adjustments - Sec. 1501.206. PREMIUM RATES: ADJUSTMENTS. (a) The percentage increase in...

Section 1501.207. Premium Rate Adjustment in Closed Plan - Sec. 1501.207. PREMIUM RATE ADJUSTMENT IN CLOSED PLAN. For a...

Section 1501.208. Premium Rates: Industry Classification - Sec. 1501.208. PREMIUM RATES: INDUSTRY CLASSIFICATION. A small employer health...

Section 1501.209. Premium Rates: Number of Employees - Sec. 1501.209. PREMIUM RATES: NUMBER OF EMPLOYEES. A small employer...

Section 1501.210. Premium Rates: Nondiscrimination - Sec. 1501.210. PREMIUM RATES: NONDISCRIMINATION. (a) A small employer health...

Section 1501.211. Rules Concerning Premium Rates - Sec. 1501.211. RULES CONCERNING PREMIUM RATES. Rules adopted under Section...

Section 1501.212. Restricted Provider Network - Sec. 1501.212. RESTRICTED PROVIDER NETWORK. (a) A small employer health...

Section 1501.213. Premium Rates: Health Maintenance Organization Health Benefit Plan - Sec. 1501.213. PREMIUM RATES: HEALTH MAINTENANCE ORGANIZATION HEALTH BENEFIT PLAN....

Section 1501.214. Enforcement - Sec. 1501.214. ENFORCEMENT. If the commissioner determines that a small...

Section 1501.215. Reporting Requirements - Sec. 1501.215. REPORTING REQUIREMENTS. (a) Annually, each small employer health...

Section 1501.216. Premium Rates: Notice of Increase - Sec. 1501.216. PREMIUM RATES: NOTICE OF INCREASE. (a) Not less...

Subchapter F. Coverage Under Small Employer Health Benefit Plans

Section 1501.251. Exception From Certain Mandated Benefit Requirements - Sec. 1501.251. EXCEPTION FROM CERTAIN MANDATED BENEFIT REQUIREMENTS. Except as...

Section 1501.252. Health Benefit Plans - Sec. 1501.252. HEALTH BENEFIT PLANS. (a) A small employer health...

Section 1501.254. Alcohol and Substance Abuse Benefits - Sec. 1501.254. ALCOHOL AND SUBSTANCE ABUSE BENEFITS. (a) This section...

Section 1501.255. Health Maintenance Organization Plans - Sec. 1501.255. HEALTH MAINTENANCE ORGANIZATION PLANS. (a) In this section,...

Section 1501.256. Coordination With Federal Law - Sec. 1501.256. COORDINATION WITH FEDERAL LAW. (a) To the extent...

Section 1501.2561. Waiver of Certain Federal Requirements - Sec. 1501.2561. WAIVER OF CERTAIN FEDERAL REQUIREMENTS. The commissioner may...

Section 1501.257. Cost Containment - Sec. 1501.257. COST CONTAINMENT. (a) A small employer health benefit...

Section 1501.258. Forms - Sec. 1501.258. FORMS. (a) A small employer health benefit plan...

Section 1501.259. Riders; Filing With Commissioner - Sec. 1501.259. RIDERS; FILING WITH COMMISSIONER. (a) A small employer...

Section 1501.260. Plain Language Required - Sec. 1501.260. PLAIN LANGUAGE REQUIRED. (a) A health benefit plan...

Subchapter G. Reinsurance for Small Employer Health Benefit Plans

Section 1501.301. Definitions - Sec. 1501.301. DEFINITIONS. In this subchapter: (1) "Board" means the...

Section 1501.302. Texas Health Reinsurance System - Sec. 1501.302. TEXAS HEALTH REINSURANCE SYSTEM. (a) The Texas Health...

Section 1501.3021. Authorization of Operation - Sec. 1501.3021. AUTHORIZATION OF OPERATION. (a) The commissioner shall hold...

Section 1501.3022. Suspension of Operation - Sec. 1501.3022. SUSPENSION OF OPERATION. (a) The commissioner shall hold...

Section 1501.303. System Board of Directors - Sec. 1501.303. SYSTEM BOARD OF DIRECTORS. (a) The board of...

Section 1501.304. Open Meetings; Public Information - Sec. 1501.304. OPEN MEETINGS; PUBLIC INFORMATION. The board is subject...

Section 1501.305. Board Member Immunity - Sec. 1501.305. BOARD MEMBER IMMUNITY. (a) A member of the...

Section 1501.306. System Plan of Operation - Sec. 1501.306. SYSTEM PLAN OF OPERATION. (a) The board shall...

Section 1501.307. System Powers - Sec. 1501.307. SYSTEM POWERS. (a) The system has the general...

Section 1501.308. System Notes as Legal Investment for Small Employer Health Benefit Plan Issuer - Sec. 1501.308. SYSTEM NOTES AS LEGAL INVESTMENT FOR SMALL EMPLOYER...

Section 1501.309. System Audit - Sec. 1501.309. SYSTEM AUDIT. (a) The transactions of the system...

Section 1501.310. Election of Status - Sec. 1501.310. ELECTION OF STATUS. (a) Each small employer health...

Section 1501.311. Change in Status - Sec. 1501.311. CHANGE IN STATUS. (a) The commissioner shall establish...

Section 1501.312. Application to Operate as Risk-Assuming Health Benefit Plan Issuer - Sec. 1501.312. APPLICATION TO OPERATE AS RISK-ASSUMING HEALTH BENEFIT PLAN...

Section 1501.313. Rescission of Approval to Operate as Risk-Assuming Health Benefit Plan Issuer - Sec. 1501.313. RESCISSION OF APPROVAL TO OPERATE AS RISK-ASSUMING HEALTH...

Section 1501.314. Reinsurance - Sec. 1501.314. REINSURANCE. (a) A small employer health benefit plan...

Section 1501.315. Limits on Reinsurance - Sec. 1501.315. LIMITS ON REINSURANCE. (a) The system may not...

Section 1501.316. Termination of Reinsurance - Sec. 1501.316. TERMINATION OF REINSURANCE. A small employer health benefit...

Section 1501.317. Application of Managed Care Procedures - Sec. 1501.317. APPLICATION OF MANAGED CARE PROCEDURES. Except as provided...

Section 1501.318. Premium Rates for Reinsurance - Sec. 1501.318. PREMIUM RATES FOR REINSURANCE. (a) As part of...

Section 1501.319. Determination of Net Loss - Sec. 1501.319. DETERMINATION OF NET LOSS. (a) Not later than...

Section 1501.320. Assessments to Recover Net Losses - Sec. 1501.320. ASSESSMENTS TO RECOVER NET LOSSES. (a) The board...

Section 1501.321. Limits on Assessments - Sec. 1501.321. LIMITS ON ASSESSMENTS. (a) The formula established under...

Section 1501.322. Adjustment to Assessments on Federally Qualified Health Maintenance Organizations - Sec. 1501.322. ADJUSTMENT TO ASSESSMENTS ON FEDERALLY QUALIFIED HEALTH MAINTENANCE...

Section 1501.323. Advance Interim Assessments - Sec. 1501.323. ADVANCE INTERIM ASSESSMENTS. (a) The system may make...

Section 1501.324. Limit on Total Assessments - Sec. 1501.324. LIMIT ON TOTAL ASSESSMENTS. The maximum assessment amount...

Section 1501.325. Estimate of Assessments; Evaluation and Protection of System - Sec. 1501.325. ESTIMATE OF ASSESSMENTS; EVALUATION AND PROTECTION OF SYSTEM....

Section 1501.326. Deferment of Assessment - Sec. 1501.326. DEFERMENT OF ASSESSMENT. (a) A reinsured health benefit...

Subchapter H. Marketing of Small Employer Health Benefit Plans

Section 1501.351. Marketing Requirements - Sec. 1501.351. MARKETING REQUIREMENTS. (a) Each small employer health benefit...

Section 1501.352. Health Status and Claims Experience; Prohibited Acts - Sec. 1501.352. HEALTH STATUS AND CLAIMS EXPERIENCE; PROHIBITED ACTS. (a)...

Section 1501.353. Agent Compensation - Sec. 1501.353. AGENT COMPENSATION. (a) A small employer health benefit...

Section 1501.354. Required Disclosures - Sec. 1501.354. REQUIRED DISCLOSURES. (a) In connection with offering a...

Section 1501.355. Rules Concerning Marketing and Availability - Sec. 1501.355. RULES CONCERNING MARKETING AND AVAILABILITY. Rules adopted under...

Section 1501.356. Reporting Requirements - Sec. 1501.356. REPORTING REQUIREMENTS. (a) In this section, "case characteristics"...

Section 1501.357. Violations - Sec. 1501.357. VIOLATIONS. A violation of Section 1501.352 by a...

Section 1501.358. Applicability to Third-Party Administrator - Sec. 1501.358. APPLICABILITY TO THIRD-PARTY ADMINISTRATOR. If a small employer...

Subchapter M. Large Employer Health Benefit Plans

Section 1501.601. Participation Criteria - Sec. 1501.601. PARTICIPATION CRITERIA. (a) In this subchapter, "participation criteria"...

Section 1501.602. Coverage Requirements - Sec. 1501.602. COVERAGE REQUIREMENTS. (a) A large employer health benefit...

Section 1501.603. Exclusion of Eligible Employee or Dependent Prohibited - Sec. 1501.603. EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT PROHIBITED. A...

Section 1501.604. Declining Coverage - Sec. 1501.604. DECLINING COVERAGE. (a) A large employer health benefit...

Section 1501.605. Minimum Contribution or Participation Requirements - Sec. 1501.605. MINIMUM CONTRIBUTION OR PARTICIPATION REQUIREMENTS. (a) A large...

Section 1501.606. Employee Enrollment; Waiting Period - Sec. 1501.606. EMPLOYEE ENROLLMENT; WAITING PERIOD. (a) The initial enrollment...

Section 1501.607. Coverage for Newborn Children - Sec. 1501.607. COVERAGE FOR NEWBORN CHILDREN. (a) A large employer...

Section 1501.608. Coverage for Adopted Children - Sec. 1501.608. COVERAGE FOR ADOPTED CHILDREN. (a) This section applies...

Section 1501.609. Coverage for Unmarried Children - Sec. 1501.609. COVERAGE FOR UNMARRIED CHILDREN. (a) This section applies...

Section 1501.610. Premium Rates; Adjustments - Sec. 1501.610. PREMIUM RATES; ADJUSTMENTS. (a) A large employer health...

Section 1501.611. Marketing Requirements - Sec. 1501.611. MARKETING REQUIREMENTS. On request, each large employer purchasing...

Section 1501.612. Encouraging Exclusion of Employee Prohibited - Sec. 1501.612. ENCOURAGING EXCLUSION OF EMPLOYEE PROHIBITED. A large employer...

Section 1501.613. Agents - Sec. 1501.613. AGENTS. A large employer health benefit plan issuer...

Section 1501.615. Additional Reporting Requirements - Sec. 1501.615. ADDITIONAL REPORTING REQUIREMENTS. The department may require periodic...

Section 1501.616. Applicability to Third-Party Administrator - Sec. 1501.616. APPLICABILITY TO THIRD-PARTY ADMINISTRATOR. If a large employer...

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Texas Statutes Subtitle G - Health Coverage Availability Chapter 1501 - Health Insurance Portability and Availability Act

Texas Statutes
Subtitle G - Health Coverage Availability
Chapter 1501 - Health Insurance Portability and Availability Act