Sec. 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 claims paid between $5,000 and $75,000 in a calendar year for an enrollee in a qualifying health benefit plan.
(b) A health benefit plan issuer is eligible for reimbursement from the fund only for the calendar year in which claims are paid.
(c) Once the dollar amount of claims paid on behalf of a covered individual reaches or exceeds $75,000 in a given calendar year, a health benefit plan issuer may not receive reimbursement for any other claims paid on behalf of the individual in that calendar year.
Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle G - Health Coverage Availability
Chapter 1508 - Healthy Texas Program
Subchapter F. Healthy Texas Small Employer Premium Stabilization Fund
Section 1508.251. Establishment of Fund
Section 1508.252. Operation of Fund; Claim Eligibility
Section 1508.253. Reimbursement Request Submission
Section 1508.254. Fund Availability
Section 1508.255. Program Reporting
Section 1508.256. Claims Experience Data
Section 1508.257. Total Eligible Enrollment Determination
Section 1508.258. Evaluation and Protection of Fund; Employer Enrollment Suspension
Section 1508.259. Employer Enrollment Reactivation
Section 1508.260. Fund Administrator