reglab/housing_qa huggingface dataset:
TX Ins Code § 1501.255 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.255. Health Maintenance Organization Plans

Sec. 1501.255.  HEALTH MAINTENANCE ORGANIZATION PLANS.  (a)  In this section, "point-of-service contract" means a health benefit plan offered through a health maintenance organization that:(1)  includes corresponding indemnity benefits in addition to benefits relating to out-of-area or emergency services provided through insurers or group hospital service corporations;  and(2)  permits the covered individual to obtain coverage under either the health maintenance organization conventional plan or the indemnity plan as determined in accordance with the terms of the contract.(b)  A health maintenance organization:(1)  shall offer at least one state-approved basic health care plan that complies with this chapter, Chapters 843, 1271, 1272, and 1367, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Title XIII, Public Health Service Act (42 U.S.C. Section 300e et seq.), and its subsequent amendments, and rules adopted under those laws and may offer additional such plans;(2)  shall offer a standard health benefit plan under Subchapter B, Chapter 1507, and may offer additional benefit riders to the standard health benefit plan or offer standard health benefit plans with additional mandatory benefits; and(3)  may offer a point-of-service contract in connection with an insurer that includes optional coverage for out-of-area services, emergency care, or out-of-network care.(c)  A point-of-service contract offered under Subsection (b)(3) is subject to this chapter unless specifically exempted.  The insurer with which the health maintenance organization offers a point-of-service contract is not required to otherwise make available the health benefit plans adopted under this subchapter if the insurer's small employer products are limited to the point-of-service contract.|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. 11.057(a), eff. September 1, 2005.Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(i), eff. September 1, 2005.|
TX Ins Code § 1501.256 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.256. Coordination With Federal Law

Sec. 1501.256.  COORDINATION WITH FEDERAL LAW.  (a)  To the extent required to comply with federal law applicable to a small employer health benefit plan described by this subchapter, the commissioner by rule may:(1)  modify the plan;  or(2)  adopt a substitute for the plan.(b)  The commissioner shall use the Texas Health Benefits Purchasing Cooperative in implementing this section.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.2561 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.2561. Waiver of Certain Federal Requirements

Sec. 1501.2561.  WAIVER OF CERTAIN FEDERAL REQUIREMENTS.  The commissioner may apply to and negotiate with the United States secretary of health and human services to obtain a waiver under 42 U.S.C. Section 18052 for small employer health benefit plans of the actuarial value requirements and related levels of health plan coverage requirements imposed under 42 U.S.C. Section 18022(d)(3).|Added by Acts 2017, 85th Leg., R.S., Ch. 106 (S.B. 1406), Sec. 1, eff. May 23, 2017.|
TX Ins Code § 1501.257 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.257. Cost Containment

Sec. 1501.257.  COST CONTAINMENT.  (a)  A small employer health benefit plan issuer may use cost containment and managed care features in a small employer health benefit plan, including:(1)  utilization review of health care services, including review of the medical necessity of hospital and physician services;(2)  case management, including discharge planning and review of stays in hospitals or other health care facilities;(3)  selective contracting with hospitals, physicians, and other health care providers;(4)  reasonable benefit differentials applicable to health care providers that participate or do not participate in restricted network arrangements;(5)  precertification or preauthorization for certain covered services;  and(6)  coordination of benefits.(b)  A provision of a small employer health benefit plan that provides for coordination of benefits must comply with this chapter and guidelines established by the commissioner.(c)  Utilization review performed for any cost containment, case management, or managed care arrangement must comply with Chapter 4201.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.015, eff. April 1, 2009.|
TX Ins Code § 1501.258 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.258. Forms

Sec. 1501.258.  FORMS.  (a)  A small employer health benefit plan issuer shall comply with:(1)  Chapter 1701 as it relates to policy form approval; and(2)  Chapter 1271 as it relates to evidence of coverage approval.(b)  A small employer health benefit plan issuer may not offer benefit plans through a policy form or evidence of coverage that does not comply with this chapter.|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. 11.058(b), eff. September 1, 2005.|
TX Ins Code § 1501.259 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.259. Riders; Filing With Commissioner

Sec. 1501.259.  RIDERS;  FILING WITH COMMISSIONER.  (a)  A small employer health benefit plan issuer shall file with the commissioner, in a form and manner prescribed by the commissioner, each rider to a small employer health benefit plan to be used by the issuer, as authorized by Section 1501.252.(b)  A small employer health benefit plan issuer may use a rider filed under this section after the 30th day after the date the rider is filed unless the commissioner disapproves its use.(c)  The commissioner, after notice and an opportunity for a hearing, may disapprove the continued use of a rider by a small employer health benefit plan issuer if the rider does not meet the requirements of this chapter and other applicable statutes.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.260 (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 F. Coverage Under Small Employer Health Benefit Plans|Section 1501.260. Plain Language Required

Sec. 1501.260.  PLAIN LANGUAGE REQUIRED.  (a)  A health benefit plan issuer may not issue and the commissioner may not approve a health benefit plan certificate or policy or a rider to a health benefit plan certificate or policy unless it is written in plain language.(b)  Each provision of a health benefit plan certificate or policy or a rider to a health benefit plan certificate or policy relating to renewal of coverage, conditions of coverage, or per occurrence or aggregate dollar limitations on coverage must be clearly explained in plain language.(c)  A health benefit plan issuer may not use and the commissioner may not approve a health benefit plan application form unless it is written in plain language.(d)  Subsections (a)-(c) do not apply if the specific language to be used is required by federal law or state statute or by rules implementing federal law.(e)  For purposes of Subsections (a)-(d), a health benefit plan certificate or policy, a rider to or a provision of a health benefit plan certificate or policy, or a health benefit plan application form is written in plain language if it achieves the minimum score established by the commissioner on the Flesch reading ease test or an equivalent test selected by the commissioner.(f)  This section does not apply to:(1)  a health benefit plan group master policy;  or(2)  a policy application or enrollment form for a health benefit plan group master policy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.301 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.301. Definitions

Sec. 1501.301.  DEFINITIONS.  In this subchapter:(1)  "Board" means the board of directors of the Texas Health Reinsurance System.(2)  "Plan of operation" means the plan of operation of the system established under Section 1501.306.(3)  "Reinsured health benefit plan issuer" means a small employer health benefit plan issuer that participates in the system.(4)  "Risk-assuming health benefit plan issuer" means a small employer health benefit plan issuer that does not participate in the system.(5)  "System" means the Texas Health Reinsurance System established under this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.302 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.302. Texas Health Reinsurance System

Sec. 1501.302.  TEXAS HEALTH REINSURANCE SYSTEM.  (a)  The Texas Health Reinsurance System is a nonprofit entity administered by a board of directors and subject to the supervision and control of the commissioner.(b)  The system may operate only during the period an order authorizing operation of the system under Section 1501.3021 is in effect.  The system may not operate after the effective date of an order of suspension of operation of the system under Section 1501.3022 until a subsequent order authorizing the operation of the system under Section 1501.3021, if any, is effective.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2017, 85th Leg., R.S., Ch. 105 (S.B. 1171), Sec. 1, eff. May 23, 2017.|
TX Ins Code § 1501.3021 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.3021. Authorization of Operation

Sec. 1501.3021.  AUTHORIZATION OF OPERATION.  (a)  The commissioner shall hold a hearing if:(1)  the commissioner believes small employer health benefit plan issuers in this state are threatened with the inability to secure reinsurance coverage in the open market; or(2)  the commissioner receives a petition requesting the hearing from an association of health benefit plan issuers in this state or a group of at least 15 small employer health benefit plan issuers operating in this state.(b)  If, after a hearing under Subsection (a), the commissioner finds that the operation of the system is in the public interest, the commissioner by order shall:(1)  authorize the operation of the system;(2)  appoint a board of directors under Section 1501.303; and(3)  direct the board to develop a plan of operation under Section 1501.306 to ensure the system is fully implemented on a date specified in the order that is not later than the 60th day after the effective date of the order.(c)  Sections 1501.307-1501.326 apply to the operation of the system after the date the system is implemented as described by Subsection (b)(3).|Added by Acts 2017, 85th Leg., R.S., Ch. 105 (S.B. 1171), Sec. 2, eff. May 23, 2017.|
TX Ins Code § 1501.303 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.303. System Board of Directors

Sec. 1501.303.  SYSTEM BOARD OF DIRECTORS.  (a)  The board of directors of the system is composed of:(1)  nine members appointed by the commissioner;  and(2)  the commissioner or the commissioner's representative, who serves as an ex officio member.(b)  Five of the appointed members must be representatives of reinsured health benefit plan issuers selected from individuals nominated by small employer health benefit plan issuers in this state according to procedures developed by the commissioner.(c)  Four of the appointed members must represent the public.  A member representing the public may not:(1)  be an officer, director, or employee of an insurance company, agency, agent, broker, solicitor, or adjuster or any other business entity regulated by the department;(2)  be a person required to register under Chapter 305, Government Code;  or(3)  be related to a person described by Subdivision (1) or (2) within the second degree by affinity or consanguinity.(d)  Appointed members serve two-year terms expiring December 31 of each odd-numbered year.  A member's term continues until a successor is appointed.(e)  A member of the board may not be compensated for serving on the board but is entitled to reimbursement for actual expenses incurred in performing functions as a member of the board as provided by the General Appropriations Act.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.304 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.304. Open Meetings; Public Information

Sec. 1501.304.  OPEN MEETINGS;  PUBLIC INFORMATION.  The board is subject to:(1)  the open meetings law, Chapter 551, Government Code;  and(2)  the public information law, Chapter 552, Government Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.305 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.305. Board Member Immunity

Sec. 1501.305.  BOARD MEMBER IMMUNITY.  (a)  A member of the board is not liable for an act performed, or omission made, in good faith in the performance of powers and duties under this subchapter.(b)  A cause of action does not arise against a member of the board for an act or omission described by Subsection (a).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.306 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.306. System Plan of Operation

Sec. 1501.306.  SYSTEM PLAN OF OPERATION.  (a)  The board shall submit to the commissioner a plan of operation and any amendments to that plan necessary or suitable to ensure the fair, reasonable, and equitable administration of the system.(b)  The commissioner, after notice and hearing, may approve the plan of operation if the commissioner determines the plan:(1)  is suitable to ensure the fair, reasonable, and equitable administration of the system;  and(2)  provides for the sharing of system gains or losses on an equitable and proportionate basis in accordance with this subchapter.(c)  The plan of operation is effective on the written approval of the commissioner.(d)  The plan of operation must:(1)  establish procedures for:(A)  handling and accounting for system assets and money;(B)  making an annual fiscal report to the commissioner;(C)  selecting an administering health benefit plan issuer or third-party administrator and establishing the powers and duties of the administering issuer or third-party administrator;(D)  reinsuring risks in accordance with this subchapter;  and(E)  collecting assessments from reinsured health benefit plan issuers to fund claims and administrative expenses incurred or estimated to be incurred by the system, including the imposition of penalties for late payment of an assessment;  and(2)  provide for any additional matter necessary to implement and administer the system.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.307 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.307. System Powers

Sec. 1501.307.  SYSTEM POWERS.  (a)  The system has the general powers and authority granted under state law to an insurer or a health maintenance organization authorized to engage in business, except that the system may not directly issue a health benefit plan.(b)  The system may:(1)  enter into contracts necessary or proper to implement this subchapter, including, with the commissioner's approval, contracts with similar programs of other states for the joint performance of common functions or with persons or other organizations for the performance of administrative functions;(2)  sue or be sued, including taking legal action necessary or proper to recover assessments and penalties for, on behalf of, or against the system or a reinsured health benefit plan issuer;(3)  take legal action necessary to avoid the payment of improper claims against the system;(4)  issue reinsurance contracts in accordance with this subchapter;(5)  establish guidelines, conditions, and procedures for reinsuring risks under the plan of operation;(6)  establish actuarial functions as appropriate for the operation of the system;(7)  assess reinsured health benefit plan issuers in accordance with Sections 1501.319-1501.323;(8)  appoint appropriate legal, actuarial, and other committees necessary to provide technical assistance in:(A)  the operation of the system;(B)  policy and other contract design;  and(C)  any other function within the authority of the system;  and(9)  borrow money for a period not to exceed one year to accomplish the purposes of the system.(c)  The system is exempt from all taxes.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.308 (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 G. Reinsurance for Small Employer Health Benefit Plans|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 HEALTH BENEFIT PLAN ISSUER.  A note or other evidence of indebtedness of the system that is not in default is a legal investment for a small employer health benefit plan issuer and may be carried as an admitted asset.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.309 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.309. System Audit

Sec. 1501.309.  SYSTEM AUDIT.  (a)  The transactions of the system are subject to audit by the state auditor in accordance with Chapter 321, Government Code.(b)  The state auditor shall report the cost of each audit conducted under this section to the board and the comptroller, and the board shall remit that amount to the comptroller.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.310 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.310. Election of Status

Sec. 1501.310.  ELECTION OF STATUS.  (a)  Each small employer health benefit plan issuer shall notify the commissioner of the issuer's election to operate as a risk-assuming health benefit plan issuer or as a reinsured health benefit plan issuer.  An issuer that elects to operate as a risk-assuming health benefit plan issuer shall file an application in accordance with Section 1501.312.(b)  A small employer health benefit plan issuer's election under this section is effective until the fifth anniversary of the date of the election.(c)  The commissioner may permit a small employer health benefit plan issuer to modify its election at any time for good cause shown.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.311 (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 G. Reinsurance for Small Employer Health Benefit Plans|Section 1501.311. Change in Status

Sec. 1501.311.  CHANGE IN STATUS.  (a)  The commissioner shall establish an application process for a small employer health benefit plan issuer that elects to change its status under this subchapter.(b)  A reinsured health benefit plan issuer that elects to change its status to operate as a risk-assuming health benefit plan issuer may not continue to reinsure a small employer health benefit plan with the system.  The issuer shall pay a prorated assessment based on business issued as a reinsured health benefit plan issuer for the portion of the year the business was reinsured.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|