Sec. 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 which claims are reported and reimbursement requested.
(b) If the total amount requested by health benefit plan issuers participating in the program for reimbursement for a calendar year exceeds the amount of funds available for distribution for claims paid during that same calendar year, the commissioner shall provide for the pro rata distribution of any available funds. A health benefit plan issuer participating in the program is eligible to receive a proportional amount of any available funds that is equal to the proportion of total eligible claims paid by all participating health benefit plan issuers that the requesting health benefit plan issuer paid.
(c) If the amount of funds available for distribution for claims paid by all health benefit plan issuers participating in the program during a calendar year exceeds the total amount requested for reimbursement by all participating health benefit plan issuers during that calendar year, the commissioner shall carry forward any excess funds and make those excess funds available for distribution in the next calendar year. Excess funds carried over under this section are added to the fund in addition to any other money appropriated for the fund for the calendar year into which the funds are carried forward.
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