reglab/housing_qa huggingface dataset:
TX Ins Code § 1501.107 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter C. Provision of Coverage|Section 1501.107. Discounts, Rebates, and Reductions

Sec. 1501.107.  DISCOUNTS, REBATES, AND REDUCTIONS.  (a)  A small or large employer health benefit plan issuer may establish premium discounts, rebates, or a reduction in otherwise applicable copayments, coinsurance, or deductibles, or any combination of these incentives, in return for participation in programs promoting disease prevention, wellness, and health.(b)  A discount, rebate, or reduction established under this section does not violate Section 541.056(a).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 112 (H.B. 2252), Sec. 3, eff. May 17, 2007.|
TX Ins Code § 1501.108 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter C. Provision of Coverage|Section 1501.108. Renewability of Coverage; Cancellation

Sec. 1501.108.  RENEWABILITY OF COVERAGE;  CANCELLATION.  (a)  Except as provided by this section and Section 1501.109, a small or large employer health benefit plan issuer shall renew the small or large employer health benefit plan for any covered small or large employer, as applicable, at the employer's option, unless:(1)  a premium has not been paid as required by the terms of the plan;(2)  the employer has committed fraud or has intentionally misrepresented a material fact;(3)  the employer has not complied with the terms of the plan;(4)  no enrollee in the plan resides or works in the geographic service area of the small or large employer health benefit plan issuer or in the area for which the issuer is authorized to do business;  or(5)  membership of the employer in an association terminates, but only if coverage is terminated uniformly without regard to a health status related factor of a covered individual.(b)  A small or large employer health benefit plan issuer may refuse to renew the coverage of a covered employee or dependent for fraud or intentional misrepresentation of a material fact by that individual.(c)  A small or large employer health benefit plan issuer may not cancel a small or large employer health benefit plan except for a reason specified for refusal to renew under Subsection (a).  A small or large employer health benefit plan issuer may not cancel the coverage of a covered employee or dependent except for a reason specified for refusal to renew under Subsection (b).(d)  Notwithstanding Subsection (a), a small or large employer health benefit plan issuer may modify a small or large employer health benefit plan in accordance with Section 1369.0541 or if:(1)  the modification occurs at the time of coverage renewal;(2)  the modification is effective uniformly among all small or large employers covered by that health benefit plan; and(3)  the issuer notifies the commissioner and each affected covered small or large employer of the modification not later than the 60th day before the date the modification is effective.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 891 (H.B. 2467), Sec. 1, eff. September 1, 2007.Acts 2011, 82nd Leg., R.S., Ch. 501 (H.B. 1405), Sec. 8, eff. September 1, 2011.|
TX Ins Code § 1501.109 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter C. Provision of Coverage|Section 1501.109. Refusal to Renew; Discontinuation of Coverage

Sec. 1501.109.  REFUSAL TO RENEW;  DISCONTINUATION OF COVERAGE.  (a)  A small or large employer health benefit plan issuer may elect to refuse to renew all small or large employer health benefit plans delivered or issued for delivery by the issuer in this state or in a geographic service area.  The issuer shall notify:(1)  the commissioner of the election not later than the 180th day before the date coverage under the first plan terminates under this subsection; and(2)  each affected covered small or large employer not later than the 180th day before the date coverage terminates for that employer.(b)  A small employer health benefit plan issuer that elects under this section to refuse to renew all small employer health benefit plans in this state or in a geographic service area may not write a new small employer health benefit plan in this state or in the geographic service area, as applicable, before the fifth anniversary of the date notice is provided to the commissioner under Subsection (a).(c)  A large employer health benefit plan issuer that elects under this section to refuse to renew all large employer health benefit plans in this state or in a geographic service area may not write a new large employer health benefit plan in this state or in the geographic service area, as applicable, before the fifth anniversary of the date notice is provided to the commissioner under Subsection (a).(d)  A small or large employer health benefit plan issuer may elect to discontinue a particular type of small or large employer coverage only if the issuer:(1)  before the 90th day preceding the date of the discontinuation of the coverage:(A)  provides notice of the discontinuation to the employer and the commissioner;  and(B)  offers to each employer the option to purchase other small or large employer coverage offered by the issuer at the time of the discontinuation;  and(2)  acts uniformly without regard to the claims experience of the employer or any health status related factors of eligible employees, eligible employees' dependents, or new employees or dependents who may become eligible for the coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 42 (S.B. 784), Sec. 2.01, eff. September 1, 2015.|
TX Ins Code § 1501.110 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter C. Provision of Coverage|Section 1501.110. Notice to Covered Persons

Sec. 1501.110.  NOTICE TO COVERED PERSONS.  (a)  A small or large employer health benefit plan issuer that cancels or refuses to renew coverage under a small or large employer health benefit plan under Section 1501.108 or 1501.109 shall, not later than the 30th day before the date termination of coverage is effective, notify the small or large employer of the cancellation of or refusal to renew coverage.  The employer is responsible for notifying enrollees in the plan of the cancellation of or refusal to renew coverage.(b)  The notice provided to a small or large employer by a small or large employer health benefit plan issuer under this section is in addition to any other notice required by Section 1501.109.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.111 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter C. Provision of Coverage|Section 1501.111. Written Statement of Denial, Cancellation, or Refusal to Renew Required

Sec. 1501.111.  WRITTEN STATEMENT OF DENIAL, CANCELLATION, OR REFUSAL TO RENEW REQUIRED.  Denial by a small or large employer health benefit plan issuer of an application from a small or large employer for coverage from the issuer or cancellation of or refusal to renew coverage by a small or large employer health benefit plan issuer must:(1)  be in writing;  and(2)  state the reason or reasons for the denial, cancellation, or refusal to renew.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.151 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|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 plan issuer shall issue the small employer health benefit plan chosen by the small employer to each small employer that elects to be covered under the plan and agrees to satisfy the other requirements of the plan.(b)  A small employer health benefit plan issuer shall provide small employer health benefit plans without regard to health status related factors.(c)  This chapter does not require a small employer to purchase health coverage for the employer's employees.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.152 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.152. Exclusion of Eligible Employee or Dependent Prohibited

Sec. 1501.152.  EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT PROHIBITED.  A small employer health benefit plan issuer may not exclude an eligible employee or dependent, including a late enrollee, who would otherwise be covered under a small employer group.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.153. Employer Contribution

Sec. 1501.153.  EMPLOYER CONTRIBUTION.  (a)  This chapter does not require a small employer to make an employer contribution to the premium paid to a small employer health benefit plan issuer, but the issuer may require an employer contribution in accordance with the issuer's usual and customary practices applicable to the issuer's employer group health benefit plans in this state.  The issuer shall apply the employer contribution level uniformly to each small employer offered or issued coverage by the issuer in this state.(a-1)  Notwithstanding Subsection (a), a small employer health benefit plan issuer may offer a small employer the option of a small employer health benefit plan for which the employer is required to contribute 100 percent of the premium paid.  A plan offered under this subsection may be offered in addition to a plan offered by the issuer in accordance with Subsection (a) that requires a lower percentage of the premium paid to be contributed by the employer.  A plan issued under this subsection must require the employer to contribute 100 percent of the premium paid for each eligible participating employee.(b)  If two or more small employer health benefit plan issuers participate in a purchasing cooperative established under Section 1501.056, each participating issuer may use the employer contribution requirement established by the cooperative for policies marketed by the cooperative.(c)  A small employer that elects to make an employer contribution to the premium paid to a small employer health benefit plan issuer is not required to pay any amount with respect to an employee who elects not to be covered.(d)  A small employer may elect to pay the premium for additional coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 462 (S.B. 80), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1501.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.154. Minimum Participation Requirement

Sec. 1501.154.  MINIMUM PARTICIPATION REQUIREMENT.  (a)  Except as provided by Section 1501.155, coverage is available under a small employer health benefit plan if at least 75 percent of a small employer's eligible employees elect to participate in the plan.(b)  If a small employer offers multiple health benefit plans, the collective participation in those plans must be at least:(1)  75 percent of the employer's eligible employees;  or(2)  if applicable, the lower participation level offered by the small employer health benefit plan issuer under Section 1501.155.(c)  A small employer health benefit plan issuer may elect not to offer a health benefit plan to a small employer that offers multiple health benefit plans if:(1)  the plans are provided by more than one issuer; and(2)  the issuer would have less than 75 percent of the employer's eligible employees enrolled in the issuer's plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.054(a), eff. September 1, 2005.|
TX Ins Code § 1501.155 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.155. Exception to Minimum Participation Requirement

Sec. 1501.155.  EXCEPTION TO MINIMUM PARTICIPATION REQUIREMENT.  (a)  A small employer health benefit plan issuer may offer a small employer health benefit plan to a small employer with a participation level of less than 75 percent of the employer's eligible employees if the issuer permits the same qualifying participation level for each small employer health benefit plan offered by the issuer in this state.(b)  A small employer health benefit plan issuer may offer a small employer health benefit plan to a small employer even if the employer's participation level is less than the issuer's qualifying participation level established in accordance with Subsection (a) if:(1)  the employer obtains a written waiver from each eligible employee who declines coverage under a health benefit plan offered to the employer stating that the employee was not induced or pressured to decline coverage because of the employee's risk characteristics;  and(2)  the issuer accepts or rejects the entire group of eligible employees who choose to participate and excludes only those employees who have declined coverage.(c)  A small employer health benefit plan issuer may underwrite the group of eligible employees who do not decline coverage under Subsection (b).(d)  A small employer health benefit plan issuer may not provide coverage to a small employer or the employer's employees under Subsection (b) if the issuer or an agent for the issuer knows that the employer has induced or pressured an eligible employee or a dependent of the employee to decline coverage because of the individual's risk characteristics.(e)  A small employer health benefit plan issuer, a small employer, or an agent may not use the exception provided by Subsection (b) to circumvent the requirements of this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.156 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.156. Employee Enrollment; Waiting Period

Sec. 1501.156.  EMPLOYEE ENROLLMENT;  WAITING PERIOD.  (a)  The initial enrollment period under a small employer health benefit plan for employees and dependents must be at least 31 days, with a 31-day open enrollment period provided annually.(b)  A small employer may establish a waiting period not to exceed 90 days from the first day of employment.(c)  A small employer health benefit plan issuer may not deny coverage to a new employee of a covered small employer or the employee's dependents if the issuer receives an application for coverage not later than the 31st day after the date employment begins or on completion of a waiting period established under Subsection (b).(d)  A small employer health benefit plan issuer may deny coverage to a late enrollee until the next annual open enrollment period and may subject the enrollee to a one-year preexisting condition provision as described by Section 1501.102.  The period during which the preexisting condition provision applies may not exceed 18 months from the date of the initial application.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.157 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.157. Coverage for Newborn Children

Sec. 1501.157.  COVERAGE FOR NEWBORN CHILDREN.  (a)  A small employer health benefit plan may not limit or exclude initial coverage of a newborn child of a covered employee.(b)  Coverage of a newborn child of a covered employee under this section ends on the 32nd day after the date of the child's birth unless, not later than the 31st day after the date of birth, the small employer health benefit plan issuer receives:(1)  notice of the birth;  and(2)  any required additional premium.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.158 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.158. Coverage for Adopted Children

Sec. 1501.158.  COVERAGE FOR ADOPTED CHILDREN.  (a)  A small employer health benefit plan may not limit or exclude initial coverage of an adopted child of an insured.  A child is considered to be the child of an insured if the insured is a party to a suit in which the insured seeks to adopt the child.(b)  An adopted child of an insured may be enrolled, at the insured's option, not later than the 31st day after:(1)  the date the insured becomes a party to a suit in which the insured seeks to adopt the child;  or(2)  the date the adoption becomes final.(c)  Coverage of an adopted child of an insured under this section ends unless the small employer health benefit plan issuer receives notice of the adoption and any required additional premium not later than the 31st day after:(1)  the date the insured becomes a party to a suit in which the insured seeks to adopt the child;  or(2)  the date the adoption becomes final.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.159 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|Subchapter D. Guaranteed Issue of Small Employer Health Benefit Plans; Continuation of Coverage|Section 1501.159. Continuation of Coverage for Certain Dependents

Sec. 1501.159.  CONTINUATION OF COVERAGE FOR CERTAIN DEPENDENTS.  An employee's dependent may choose to continue coverage under a small employer health benefit plan if:(1)  the dependent:(A)  is under one year of age;  or(B)  has been covered by the small employer under a plan for at least one year;(2)  the dependent loses eligibility for coverage because of the death, divorce, or retirement of the employee, as provided by Subchapter G, Chapter 1251;  and(3)  the Consolidated Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272) does not require continuation or conversion coverage for dependents of an employee.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1501 - Health Insurance Portability and Availability Act|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" means, for each class of business and for a specific rating period, the lowest premium rate that is charged or that could be charged under a rating system for that class of business by a small employer health benefit plan issuer to small employers with similar case characteristics for small employer health benefit plans that provide the same or similar coverage.(2)  "Case characteristics" means, with respect to a small employer, the geographic area in which the employer's employees reside, the age and gender of the individual employees and their dependents, the number of employees and dependents, the appropriate industry classification as determined by the small employer health benefit plan issuer, and other objective criteria established by the issuer that are considered by the issuer in setting premium rates for the employer.  The term does not include:(A)  health status related factors;(B)  duration of coverage since the date of issuance of a health benefit plan;  or(C)  whether a covered individual is or may become pregnant.(3)  "Class of business" means all small employers or a separate grouping of small employers established under this subchapter.(4)  "Index rate" means, for each class of business and for a specific rating period for small employers with similar case characteristics, the arithmetic average of the applicable base premium rate and corresponding highest premium rate.(5)  "New business premium rate" means, for each class of business and for a specific rating period, the lowest premium rate that is charged or offered or that could be charged or offered by a small employer health benefit plan issuer to small employers with similar case characteristics for newly issued small employer health benefit plans that provide the same or similar coverage.(6)  "Rating period" means a calendar period during which premium rates established by a small employer health benefit plan issuer are assumed to be in effect.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|