reglab/housing_qa huggingface dataset:
TX Ins Code § 1501.202 (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 1501.202. Establishment of Classes of Business

Sec. 1501.202.  ESTABLISHMENT OF CLASSES OF BUSINESS.  (a)  Except as otherwise provided by this subchapter, a small employer health benefit plan issuer may not establish a separate class or classes of business for small employers.(b)  A small employer health benefit plan issuer may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:(1)  the issuer uses more than one type of system to market and sell small employer health benefit plans to small employers;(2)  the issuer has acquired a class of business from another small employer health benefit plan issuer;  or(3)  the issuer provides coverage to one or more employer-based association groups.(c)  Except as provided by Subsection (e), a small employer health benefit plan issuer may not establish more than nine separate classes of business under this section.(d)  The commissioner may adopt rules to provide for a transition period to permit a small employer health benefit plan issuer to comply with Subsection (c) after acquiring an additional class of business from another small employer health benefit plan issuer.(e)  On application to the commissioner, the commissioner may approve the establishment of additional classes of business if the commissioner finds that the establishment of additional classes would enhance the efficiency and fairness of the health coverage market for small employers.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.203 (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 1501.203. Establishment of Classes of Business on Certain Bases Prohibited

Sec. 1501.203.  ESTABLISHMENT OF CLASSES OF BUSINESS ON CERTAIN BASES PROHIBITED.  (a)  A small employer health benefit plan issuer may not establish a separate class of business based on:(1)  participation requirements;  or(2)  whether the coverage provided to a small employer group is provided on a guaranteed issue basis or is subject to underwriting or proof of insurability.(b)  A small employer health benefit plan issuer may not directly or indirectly use as a criterion for establishing a separate class of business:(1)  the number of employees and dependents of a small employer;  or(2)  except as provided by Section 1501.202(b)(3), the trade or occupation of the employees of a small employer or the industry or type of business of the small employer.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.204 (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 1501.204. Index Rates

Sec. 1501.204.  INDEX RATES.  Under a small employer health benefit plan:(1)  the index rate for a class of business may not exceed the index rate for any other class of business by more than 20 percent;  and(2)  premium rates charged during a rating period to small employers in a class of business with similar case characteristics for the same or similar coverage, or premium rates that could be charged to those employers under the rating system for that class of business, may not vary from the index rate by more than 25 percent.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.205 (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 1501.205. Premium Rates: Establishment

Sec. 1501.205.  PREMIUM RATES:  ESTABLISHMENT.  (a)  In this section:(1)  "Risk characteristic" means:(A)  a health status related factor;(B)  the duration of coverage;  or(C)  any characteristic similar to a characteristic described by Paragraph (A) or (B) that is related to the health status or experience of a small employer group or of any member of a small employer group.(2)  "Risk load" means the percentage above the applicable base premium rate a small employer health benefit plan issuer charges to a small employer to reflect the risk characteristics associated with that particular small employer group.(b)  Small employer health benefit plan issuers shall develop premium rates for each small employer group in a two-step process.  In the first step, the small employer health benefit plan issuer shall develop a base premium rate for each small employer group without regard to any risk characteristic of the group.  In the second step, the small employer health benefit plan issuer may adjust the resulting base premium rate by the risk load of the group, subject to this subchapter, to reflect the risk characteristics of the group.(c)  The risk load assessed to a particular group shall reflect the risk characteristics of the particular group.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.206 (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 1501.206. Premium Rates: Adjustments

Sec. 1501.206.  PREMIUM RATES:  ADJUSTMENTS.  (a)  The percentage increase in the premium rate charged to a small employer for a new rating period may not exceed the sum of:(1)  the percentage change in the new business premium rate, measured from the first day of the preceding rating period to the first day of the new rating period;(2)  any adjustment, not to exceed 15 percent annually and adjusted pro rata for a rating period of less than one year, due to the claims experience, health status, or duration of coverage of the employees or dependents of employees of the small employer, as determined under the small employer health benefit plan issuer's rate manual for the class of business;  and(3)  any adjustment due to change in coverage or change in the case characteristics of the small employer, as determined under the issuer's rate manual for the class of business.(b)  An adjustment in the premium rate for claims experience, health status, or duration of coverage:(1)  may not be charged to individual employees or dependents;  and(2)  must be applied uniformly to the rates charged for all employees and dependents of employees of the small employer.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.207 (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 1501.207. Premium Rate Adjustment in Closed Plan

Sec. 1501.207.  PREMIUM RATE ADJUSTMENT IN CLOSED PLAN.  For a closed health benefit plan under which a small employer health benefit plan issuer is no longer enrolling new small employers, the issuer shall use the percentage change in the base premium rate to adjust premium rates under Section 1501.206(a)(1).  The portion of change in premium rates computed under that subdivision may not exceed, on a percentage basis, the change in the new business premium rate for the most similar health benefit plan under which the issuer is enrolling new small employers.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.208 (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 1501.208. Premium Rates: Industry Classification

Sec. 1501.208.  PREMIUM RATES:  INDUSTRY CLASSIFICATION.  A small employer health benefit plan issuer may use the industry classification to which a small employer belongs as a case characteristic in establishing the premium rate, but the highest rate factor associated with any industry classification may not exceed by more than 15 percent the lowest rate factor associated with any industry classification.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.209 (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 1501.209. Premium Rates: Number of Employees

Sec. 1501.209.  PREMIUM RATES:  NUMBER OF EMPLOYEES.  A small employer health benefit plan issuer may use the number of employees and dependents of a small employer as a case characteristic in establishing premium rates for the group.  The highest rate factor associated with a classification based on the number of employees and dependents of a small employer may not exceed by more than 20 percent the lowest rate factor associated with a classification based on the number of employees and dependents of a small employer.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.210 (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 1501.210. Premium Rates: Nondiscrimination

Sec. 1501.210.  PREMIUM RATES:  NONDISCRIMINATION.  (a)  A small employer health benefit plan issuer shall apply rating factors, including case characteristics, consistently with respect to all small employers in a class of business.  Rating factors must produce premium rates for identical groups that:(1)  differ only by the amounts attributable to health benefit plan design;  and(2)  do not reflect differences because of the nature of the groups assumed to select particular health benefit plans.(b)  A small employer health benefit plan issuer shall treat each health benefit plan issued or renewed in the same calendar month as having the same rating period.(c)  Without the prior approval of the commissioner, a small employer health benefit plan issuer may not use case characteristics other than:(1)  the geographic area in which the small employer's employees reside;(2)  the age and gender of the individual employees and their dependents;(3)  the number of employees and dependents;  and(4)  the appropriate industry classification.(d)  Premium rates for a small employer health benefit plan must comply with the requirements of this chapter, notwithstanding any assessment paid or payable by a small employer health benefit plan issuer.(e)  A small employer health benefit plan issuer may not transfer a small employer involuntarily into or out of a class of business.  The issuer may not offer to transfer a small employer into or out of a class of business unless the offer is made to transfer all other small employers in the employer's class of business without regard to case characteristics, claims experience, health status, or duration of coverage since the issuance of the health benefit plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.211 (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 1501.211. Rules Concerning Premium Rates

Sec. 1501.211.  RULES CONCERNING PREMIUM RATES.  Rules adopted under Section 1501.010 may ensure that:(1)  rating practices used by small employer health benefit plan issuers are consistent with the purposes of this chapter;  and(2)  differences in premium rates charged for each small employer health benefit plan are reasonable and reflect objective differences in plan design.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.212 (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 1501.212. Restricted Provider Network

Sec. 1501.212.  RESTRICTED PROVIDER NETWORK.  (a)  A small employer health benefit plan may use a restricted provider network to provide benefits under the plan.(b)  A small employer health benefit plan that uses a restricted provider network does not provide similar coverage to a plan that does not use a restricted provider network if the use of the network results in reduced premium rates charged to the small employer or substantial differences in claim costs.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.213 (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 1501.213. Premium Rates: Health Maintenance Organization Health Benefit Plan

Sec. 1501.213.  PREMIUM RATES:  HEALTH MAINTENANCE ORGANIZATION HEALTH BENEFIT PLAN.  (a)  The premium rates for a state-approved health benefit plan offered by a health maintenance organization under Section 1501.255 must be established in accordance with formulas or schedules of charges filed with the department.(b)  A health maintenance organization that participates in a purchasing cooperative that provides employees of small employers a choice of health benefit plans may use rating methods in accordance with this subchapter that are used by other small employer health benefit plan issuers participating in the same cooperative, including rating by age and gender, if the health maintenance organization has established:(1)  a separate class of business, as provided by Section 1501.202; and(2)  a separate line of business, as provided under Section 1501.255(b).|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. 11.055(a), eff. September 1, 2005.|
TX Ins Code § 1501.214 (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 1501.214. Enforcement

Sec. 1501.214.  ENFORCEMENT.  If the commissioner determines that a small employer health benefit plan issuer subject to this chapter exceeds the applicable premium rate established under this subchapter, the commissioner may order restitution and assess penalties as provided by Chapter 82.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.215 (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 1501.215. Reporting Requirements

Sec. 1501.215.  REPORTING REQUIREMENTS.  (a)  Annually, each small employer health benefit plan issuer that offers a small employer health benefit plan shall file with the commissioner an actuarial certification stating that the issuer's underwriting and rating methods:(1)  comply with accepted actuarial practices;(2)  are uniformly applied to each small employer health benefit plan covering a small employer;  and(3)  comply with this subchapter.(b)  Each small employer health benefit plan issuer shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based on commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.(c)  A small employer health benefit plan issuer shall make the information and documentation described in Subsection (b) available to the commissioner on request.  Unless the information or documentation relates to a violation of this chapter, the information or documentation is considered proprietary and trade secret information and is not subject to disclosure by the commissioner to a person outside the department except as agreed to by the issuer or as ordered by a court.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.216 (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 1501.216. Premium Rates: Notice of Increase

Sec. 1501.216.  PREMIUM RATES: NOTICE OF INCREASE.  (a)  Not less than 60 days before the date on which a premium rate increase takes effect on a small employer health benefit plan delivered or issued for delivery in this state by an insurer, the insurer shall:(1)  give written notice to the small employer of the effective date of the increase; and(2)  provide the small employer a table that clearly lists:(A)  the actual dollar amount of the premium on the date of the notice;(B)  the actual dollar amount of the premium after the premium rate increase; and(C)  the percentage change between the amounts described by Paragraphs (A) and (B).(b)  The notice required by this section must be based on coverage in effect on the date of the notice.(c)  This section may not be construed to prevent an insurer, at the request of a small employer, from negotiating a change in benefits or rates after delivery of the notice required by this section.(d)  An insurer may not require a small employer entitled to notice under this section to respond to the insurer to renew the policy or take other action relating to the renewal or extension of the policy before the 45th day after the date the notice described by Subsection (a) is given.(e)  The notice required by this section must include:(1)  contact information for the department, including information concerning how to file a complaint with the department;(2)  contact information for the Texas Consumer Health Assistance Program, including information concerning how to request from the program consumer protection information or assistance with filing a complaint; and(3)  the addresses of Internet websites that provide consumer information related to rate increase justifications, including the websites of the department and the United States Department of Health and Human Services.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 3.003, eff. September 1, 2011.|
TX Ins Code § 1501.251 (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 1501.251. Exception From Certain Mandated Benefit Requirements

Sec. 1501.251.  EXCEPTION FROM CERTAIN MANDATED BENEFIT REQUIREMENTS.  Except as expressly provided by this chapter, a small employer health benefit plan is not subject to a law that requires coverage or the offer of coverage of a health care service or benefit.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1501.252 (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 1501.252. Health Benefit Plans

Sec. 1501.252.  HEALTH BENEFIT PLANS.  (a)  A small employer health benefit plan issuer shall offer a standard health benefit plan as authorized by Chapter 1507.(b)  A small employer health benefit plan issuer may offer to a small employer additional benefit riders to the standard health benefit plan or may design and offer standard health benefit plans with additional mandatory benefits.(c)  Subject to this chapter, a small employer health benefit plan issuer shall also offer to a small employer at least one other health benefit plan authorized under this code that provides state-mandated health benefits.  Section 1501.251 does not apply to a health benefit plan offered to a small employer under this subsection.|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. 11.056(a), eff. September 1, 2005.|
TX Ins Code § 1501.254 (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 1501.254. Alcohol and Substance Abuse Benefits

Sec. 1501.254.  ALCOHOL AND SUBSTANCE ABUSE BENEFITS.  (a)  This section applies only if the basic coverage health benefit plan developed by the commissioner under Section 1501.253 includes coverage for alcohol and substance abuse benefits.(b)  A small employer health benefit plan issuer may offer and the employees of a small employer group may accept a basic coverage health benefit plan without coverage for alcohol and substance abuse benefits if:(1)  at least 50 percent of the employees in writing:(A)  waive the benefits;  and(B)  indicate that they have undergone alcoholism or substance abuse treatment or counseling within the preceding three years;  and(2)  the exclusion of those benefits applies only to those employees.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|