reglab/housing_qa huggingface dataset:
TX Ins Code § 1501.312 (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 1501.312. Application to Operate as Risk-Assuming Health Benefit Plan Issuer

Sec. 1501.312.  APPLICATION TO OPERATE AS RISK-ASSUMING HEALTH BENEFIT PLAN ISSUER.  (a)  A small employer health benefit plan issuer may apply to operate as a risk-assuming health benefit plan issuer by filing an application with the commissioner in a form and manner prescribed by the commissioner.(b)  In evaluating an application, the commissioner shall consider the small employer health benefit plan issuer's:(1)  financial condition;(2)  history of rating and underwriting small employer groups;(3)  commitment to market fairly to all small employers in the state or in the issuer's established geographic service area;  and(4)  experience managing the risk of small employer groups.(c)  The commissioner shall provide public notice of an application and shall provide at least a 60-day period for public comment before making a decision on the application.  If the commissioner does not act on the application before the 90th day after the date the commissioner receives the application, the issuer may request and the commissioner shall grant a hearing.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.313 (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 1501.313. Rescission of Approval to Operate as Risk-Assuming Health Benefit Plan Issuer

Sec. 1501.313.  RESCISSION OF APPROVAL TO OPERATE AS RISK-ASSUMING HEALTH BENEFIT PLAN ISSUER.  The commissioner, after notice and hearing, may rescind approval to operate as a risk-assuming health benefit plan issuer if the commissioner finds that the issuer:(1)  is not financially able to support the assumption of risk from issuing coverage to small employers without the protection provided by the system;(2)  has failed to market fairly to all small employers in the state or in the issuer's established geographic service area;  or(3)  has failed to provide coverage to eligible small employers.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.314 (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 1501.314. Reinsurance

Sec. 1501.314.  REINSURANCE.  (a)  A small employer health benefit plan issuer may reinsure risks covered under a small employer health benefit plan with the system as provided by this subchapter.(b)  The system shall reinsure the level of coverage provided under the small employer health benefit plan.(c)  A small employer health benefit plan issuer may reinsure:(1)  an entire small employer group not later than the 60th day after the date the group's coverage under the small employer health benefit plan takes effect;(2)  an eligible employee of a small employer or the employee's dependent not later than the 60th day after the date the person's coverage takes effect;  or(3)  a newly eligible employee of a reinsured small employer group, the employee's dependent, or an individual covered under the small employer health benefit plan not later than the 60th day after the date the individual's coverage takes effect.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.315 (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 1501.315. Limits on Reinsurance

Sec. 1501.315.  LIMITS ON REINSURANCE.  (a)  The system may not reimburse a reinsured health benefit plan issuer for the claims of a reinsured individual until the issuer has incurred an initial level of claims of $5,000 in a calendar year for that individual for benefits covered by the system.  In addition, the reinsured health benefit plan issuer is responsible for 10 percent of the next $50,000 of benefit payments during a calendar year, and the system shall reinsure the remainder.  A reinsured health benefit plan issuer's liability to a reinsured individual may not exceed a maximum of $10,000 in a calendar year.(b)  The board annually shall adjust the initial level of claims and the maximum liability to be retained by a reinsured health benefit plan issuer under Subsection (a) to reflect increases in:(1)  costs;  and(2)  the use of small employer health benefit plans in this state.(c)  An adjustment under Subsection (b) may not be less than the annual change in the medical component of the Consumer Price Index for All Urban Consumers published by the Bureau of Labor Statistics of the United States Department of Labor unless the board proposes and the commissioner approves a lower adjustment factor.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.316 (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 1501.316. Termination of Reinsurance

Sec. 1501.316.  TERMINATION OF REINSURANCE.  A small employer health benefit plan issuer may terminate reinsurance with the system for one or more reinsured employees or dependents of employees of a small employer on a contract anniversary of the small employer health benefit plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.317 (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 1501.317. Application of Managed Care Procedures

Sec. 1501.317.  APPLICATION OF MANAGED CARE PROCEDURES.  Except as provided by the plan of operation, a reinsured health benefit plan issuer shall apply consistently with respect to reinsured and nonreinsured business all managed care procedures, including utilization review, individual case management, preferred provider provisions, and other managed care provisions or methods of operation.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.318 (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 1501.318. Premium Rates for Reinsurance

Sec. 1501.318.  PREMIUM RATES FOR REINSURANCE.  (a)  As part of the plan of operation, the board shall adopt a method to determine premium rates to be charged by the system for reinsuring small employer groups and individuals under this subchapter.(b)  The method adopted must:(1)  include a classification system for small employer groups that reflects the variations in premium rates allowed by this chapter;  and(2)  provide for the development of base reinsurance premium rates that reflect the allowable variations.(c)  Subject to approval by the commissioner, the board shall establish the base reinsurance premium rates at levels that reasonably approximate the gross premiums charged to small employers by small employer health benefit plan issuers for small employer health benefit plans, adjusted to reflect retention levels required under this subchapter.(d)  The board shall periodically review the method adopted under this section, including the classification system and any rating factors, to ensure that the method reasonably reflects the claims experience of the system.  The board may propose changes to the method.  Any changes are subject to approval by the commissioner.(e)  An entire small employer group may be reinsured at a rate that is 1-1/2 times the base reinsurance premium rate for that group.  An eligible employee of a small employer or the employee's dependent covered under a small employer health benefit plan may be reinsured at a rate that is five times the base reinsurance premium rate for that individual.(f)  The board may consider adjustments to the premium rates charged by the system to reflect the use of effective cost containment and managed care arrangements.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.319 (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 1501.319. Determination of Net Loss

Sec. 1501.319.  DETERMINATION OF NET LOSS.  (a)  Not later than March 1 of each year, the board shall determine the system's net loss for the preceding calendar year, including administrative expenses and incurred losses for the year, and report the net loss to the commissioner.(b)  In determining the net loss, the board shall take into account investment income and other appropriate gains and losses.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.320 (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 1501.320. Assessments to Recover Net Losses

Sec. 1501.320.  ASSESSMENTS TO RECOVER NET LOSSES.  (a)  The board shall recover any net loss of the system by assessing each reinsured health benefit plan issuer an amount determined annually by the board based on information in annual statements and other reports required by and filed with the board.(b)  The board shall establish, as part of the plan of operation, a formula by which to make assessments against reinsured health benefit plan issuers.  With the approval of the commissioner, the board may periodically change the assessment formula as appropriate.  The board shall base the assessment formula on each reinsured issuer's share of:(1)  the total premiums earned in the preceding calendar year from small employer health benefit plans delivered or issued for delivery by reinsured health benefit plan issuers to small employer groups in this state;  and(2)  the premiums earned in the preceding calendar year from newly issued small employer health benefit plans delivered or issued for delivery during the calendar year by reinsured health benefit plan issuers to small employer groups in this state.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.321 (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 1501.321. Limits on Assessments

Sec. 1501.321.  LIMITS ON ASSESSMENTS.  (a)  The formula established under Section 1501.320(b) may not result in an assessment for a reinsured health benefit plan issuer that is less than 50 percent or more than 150 percent of an amount based on the proportion of the total premiums earned in the preceding calendar year from small employer health benefit plans delivered or issued for delivery to small employer groups in this state by that issuer to the total premiums earned in the preceding calendar year from small employer health benefit plans delivered or issued for delivery to small employer groups in this state by all reinsured health benefit plan issuers.(b)  In determining assessments, the board may not consider premiums earned by a reinsured health benefit plan issuer that are less than an amount determined by the board to justify the cost of collecting an assessment based on those premiums.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.322 (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 1501.322. Adjustment to Assessments on Federally Qualified Health Maintenance Organizations

Sec. 1501.322.  ADJUSTMENT TO ASSESSMENTS ON FEDERALLY QUALIFIED HEALTH MAINTENANCE ORGANIZATIONS.  With the commissioner's approval, the board may adjust the formula established under Section 1501.320(b) for a reinsured health benefit plan issuer that is an approved health maintenance organization that is federally qualified under Title XIII, Public Health Service Act (42 U.S.C. Section 300e et seq.), to the extent that any restriction is imposed on that issuer that is not imposed on other issuers.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.323 (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 1501.323. Advance Interim Assessments

Sec. 1501.323.  ADVANCE INTERIM ASSESSMENTS.  (a)  The system may make advance interim assessments as reasonable and necessary for organizational and interim operating expenses.(b)  After the end of the fiscal year, the system shall credit an interim assessment made under this section as an offset against regular assessments due.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.324 (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 1501.324. Limit on Total Assessments

Sec. 1501.324.  LIMIT ON TOTAL ASSESSMENTS.  The maximum assessment amount payable for a calendar year may not exceed five percent of the total premiums earned in the preceding calendar year from small employer health benefit plans delivered or issued for delivery by reinsured health benefit plan issuers in this state.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.325 (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 1501.325. Estimate of Assessments; Evaluation and Protection of System

Sec. 1501.325.  ESTIMATE OF ASSESSMENTS;  EVALUATION AND PROTECTION OF SYSTEM.  (a)  Not later than March 1 of each year, the board shall file with the commissioner an estimate of the assessments necessary to fund the losses for small employer groups incurred by the system during the preceding calendar year.(b)  If the board determines that the necessary assessments exceed five percent of the total premiums earned in the preceding calendar year from small employer health benefit plans delivered or issued for delivery by reinsured health benefit plan issuers to small employer groups in this state, the board shall evaluate the operation of the system and shall report its findings, including any recommendations for changes to the plan of operation, to the commissioner not later than April 1 of the year following the calendar year in which the losses were incurred.  The evaluation must:(1)  include an estimate of future assessments;  and(2)  consider:(A)  the administrative costs of the system;(B)  the appropriateness of the premiums charged;(C)  the level of health benefit plan issuer retention under the system;  and(D)  the costs of coverage for small employer groups.(c)  If the board fails to timely file a report required by Subsection (b), the commissioner may:(1)  evaluate the operations of the system;  and(2)  implement amendments to the plan of operation that the commissioner considers necessary to reduce future losses and assessments.(d)  A reinsured health benefit plan issuer may not cede additional eligible lives to the system during a calendar year if the assessment amount payable for the preceding calendar year is at least five percent of the total premiums earned in that calendar year from small employer health benefit plans delivered or issued for delivery by reinsured health benefit plan issuers in this state.(d-1)  Expired.(e)  A reinsured health benefit plan issuer may not cede additional eligible lives to the system after the board determines that the expected loss from the reinsurance system for a year will exceed the total amount of assessments payable at a rate of five percent of the total premiums earned for the preceding calendar year.  A reinsured health benefit plan issuer may not resume ceding additional eligible lives to the system until the board determines that the expected loss will be less than the maximum established by this subsection.(e-1)  Expired.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2005, 79th Leg., Ch. 823 (S.B. 805), Sec. 5, eff. September 1, 2005.|
TX Ins Code § 1501.326 (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 1501.326. Deferment of Assessment

Sec. 1501.326.  DEFERMENT OF ASSESSMENT.  (a)  A reinsured health benefit plan issuer may petition the commissioner for a deferment in whole or in part of an assessment imposed by the board.(b)  The commissioner may defer all or part of the assessment if the commissioner determines that payment of the assessment would endanger the ability of the reinsured health benefit plan issuer to fulfill its contractual obligations.(c)  The board shall assess the amount of a deferred assessment against other reinsured health benefit plan issuers in a manner consistent with the basis for assessment established by this subchapter.(d)  A reinsured health benefit plan issuer that receives a deferment:(1)  is liable to the system for the amount deferred;  and(2)  until the issuer pays the outstanding assessment, may not:(A)  market, deliver, or issue for delivery a small employer health benefit plan;  or(B)  reinsure any individual or group with the system.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.351 (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 H. Marketing of Small Employer Health Benefit Plans|Section 1501.351. Marketing Requirements

Sec. 1501.351.  MARKETING REQUIREMENTS.  (a)  Each small employer health benefit plan issuer shall market a small employer health benefit plan to eligible small employers in this state through properly licensed agents.(b)  Each small employer purchasing a small employer health benefit plan must be given a summary, in a format prescribed by the commissioner, of the health benefit plans established by the commissioner under Subchapter F.(c)  An agent shall offer and explain to a small employer on inquiry and request by the employer each health benefit plan established by the commissioner under Subchapter F.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.352 (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 H. Marketing of Small Employer Health Benefit Plans|Section 1501.352. Health Status and Claims Experience; Prohibited Acts

Sec. 1501.352.  HEALTH STATUS AND CLAIMS EXPERIENCE;  PROHIBITED ACTS.  (a)  A small employer health benefit plan issuer or agent may not, because of the health status or claims experience of the eligible employees of a small employer and those employees' dependents, directly or indirectly encourage or direct the employer to:(1)  refrain from applying for coverage with the issuer;(2)  seek coverage from another issuer;(3)  apply for a particular small employer health benefit plan; or(4)  become or not become a member of a particular small employer health coalition.(b)  A small employer health benefit plan issuer may not directly or indirectly enter into an agreement or arrangement with an agent that provides for or results in compensation paid to the agent for the sale of small employer health benefit plans that varies because of health status or claims experience.(c)  Subsection (b) does not apply to an arrangement that provides compensation to an agent based on a percentage of premium, provided that:(1)  the percentage may not vary because of health status or claims experience; and(2)  the small employer health benefit plan issuer does not:(A)  exclude any additional premium charged to the small employer because of health status or claims experience from the premium amount to which the percentage is applied; or(B)  apply a smaller percentage to any additional premium charged to the small employer because of health status or claims experience than is applied to other premiums charged to the small employer.(d)  A small employer health benefit plan issuer or agent may not encourage a small employer to exclude an eligible employee from health coverage provided in connection with the employee's employment.(e)  A small employer health benefit plan issuer may not terminate, fail to renew, or limit its contract or agreement of representation with an agent for a reason related to the health status or claims experience of a small employer group placed by the agent with the issuer.|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. 11.059(a), eff. September 1, 2005.|