reglab/housing_qa huggingface dataset:
TX Ins Code § 846.205 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter E. Provision of Coverage|Section 846.205. Certain Limitations or Exclusions of Coverage Prohibited

Sec. 846.205.  CERTAIN LIMITATIONS OR EXCLUSIONS OF COVERAGE PROHIBITED.  (a)  A multiple employer welfare arrangement's plan document may not limit or exclude, by use of a rider or amendment applicable to a specific individual, coverage by type of illness, treatment, medical condition, or accident.(b)  This section does not preclude a multiple employer welfare arrangement from limiting or excluding coverage for a preexisting condition in accordance with Section 846.202.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.206 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter E. Provision of Coverage|Section 846.206. Renewability of Coverage; Cancellation

Sec. 846.206.  RENEWABILITY OF COVERAGE;  CANCELLATION.  (a)  Except as provided by Section 846.207, a multiple employer welfare arrangement shall renew the health benefit plan, at the employer's option, unless:(1)  a contribution 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 health benefit plan document;(4)  the health benefit plan is ceasing to offer any coverage in a geographic area;  or(5)  there has been a failure to meet the terms of an applicable collective bargaining agreement or other agreement requiring or authorizing contributions to the health benefit plan, including a failure to renew the agreement or to employ employees covered by the agreement.(b)  A multiple employer welfare arrangement may refuse to renew the coverage of a participating employee or dependent for fraud or intentional misrepresentation of a material fact by that person.(c)  A multiple employer welfare arrangement may not cancel a health benefit plan except for a reason specified for refusal to renew under Subsection (a).  An arrangement may not cancel the coverage of a participating employee or dependent except for a reason specified for refusal to renew under Subsection (b).|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.207 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter E. Provision of Coverage|Section 846.207. Refusal to Renew

Sec. 846.207.  REFUSAL TO RENEW.  (a)  A multiple employer welfare arrangement may elect to refuse to renew all health benefit plans delivered or issued for delivery by the arrangement in this state.  The arrangement shall notify:(1)  the commissioner of the election not later than the 180th day before the date coverage under the first health benefit plan terminates under this subsection;  and(2)  each affected employer not later than the 180th day before the date on which coverage terminates for that employer.(b)  A multiple employer welfare arrangement that elects under this section to refuse to renew all health benefit plans may not write a health benefit plan in this state before the fifth anniversary of the date notice is delivered to the commissioner under Subsection (a).(c)  A multiple employer welfare arrangement may elect to discontinue a health benefit plan only if the arrangement:(1)  provides notice to each employer of the discontinuation before the 90th day preceding the date of the discontinuation of the plan;(2)  offers to each employer the option to purchase coverage under another health benefit plan offered by the arrangement;  and(3)  acts uniformly without regard to the claims experience of the employer or any health status related factor of participating employees or dependents or new employees or dependents who may become eligible for the coverage.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.208 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter E. Provision of Coverage|Section 846.208. Notice to Covered Persons

Sec. 846.208.  NOTICE TO COVERED PERSONS.  (a)  A multiple employer welfare arrangement that cancels or refuses to renew coverage under a health benefit plan under Section 846.206 or Section 846.207 shall notify the employer of the cancellation of or refusal to renew coverage not later than the 30th day before the date termination of coverage is effective.  The employer is responsible for notifying participating employees of the cancellation of or refusal to renew coverage.(b)  The notice provided under this section is in addition to any other notice required by Section 846.206 or Section 846.207.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.209 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter E. Provision of Coverage|Section 846.209. Written Statement of Denial, Cancellation, or Refusal to Renew

Sec. 846.209.  WRITTEN STATEMENT OF DENIAL, CANCELLATION, OR REFUSAL TO RENEW.  Denial by a multiple employer welfare arrangement of an application for coverage from an employer or cancellation of or refusal to renew must:(1)  be in writing;  and(2)  state the reason or reasons for the denial, cancellation, or refusal to renew.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.251 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.251. Participation Criteria

Sec. 846.251.  PARTICIPATION CRITERIA.  Participation criteria may not be based on health status related factors.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.252 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.252. Coverage Requirements

Sec. 846.252.  COVERAGE REQUIREMENTS.  (a)  A multiple employer welfare arrangement:(1)  may refuse to provide coverage to an employer in accordance with the arrangement's underwriting standards and criteria;(2)  shall accept or reject the entire group of individuals who meet the participation criteria and who choose coverage;  and(3)  may exclude only those employees or dependents who have declined coverage.(b)  On issuance of coverage to an employer, each multiple employer welfare arrangement shall provide coverage to the employees who meet the participation criteria without regard to an individual's health status related factors.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.253 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.253. Prohibition on Exclusion of Eligible Employee or Dependent

Sec. 846.253.  PROHIBITION ON EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT.  A multiple employer welfare arrangement may not exclude an employee who meets the participation criteria or an eligible dependent, including a late-participating employee or dependent, who would otherwise be covered.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.254 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.254. Written Notice to Employees Covered

Sec. 846.254.  WRITTEN NOTICE TO EMPLOYEES COVERED.  A multiple employer welfare arrangement, in connection with an employee welfare benefit plan, shall provide to each participating employee covered by the plan a written notice at the time the employee's coverage becomes effective that states that:(1)  individuals covered by the plan are only partially insured;  and(2)  if the plan or the arrangement does not ultimately pay medical expenses that are eligible for payment under the plan for any reason, the participating employer or its participating employee covered by the plan may be liable for those expenses.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.255 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.255. Declining Coverage

Sec. 846.255.  DECLINING COVERAGE.  (a)  A multiple employer welfare arrangement shall obtain a written waiver from each employee who meets the participation criteria and declines coverage under a health plan offered to an employer.  The waiver must ensure that the employee was not induced or pressured to decline coverage because of the employee's health status related factors.(b)  A multiple employer welfare arrangement may not provide coverage to an employer or the employees of an employer if the arrangement or an agent for the arrangement knows that the employer has induced or pressured an employee who meets the participation criteria or a dependent of the employee to decline coverage because of that individual's health status related factors.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.256 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.256. Minimum Contribution or Participation Requirements

Sec. 846.256.  MINIMUM CONTRIBUTION OR PARTICIPATION REQUIREMENTS.  (a)  A multiple employer welfare arrangement may require an employer to meet minimum contribution or participation requirements as a condition of issuance and renewal of coverage in accordance with the terms of the arrangement's plan document.(b)  The minimum contribution and participation requirements must be stated in the plan document and must be applied uniformly to each employer offered or issued coverage by the multiple employer welfare arrangement in this state.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.257 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.257. Enrollment; Waiting Period

Sec. 846.257.  ENROLLMENT;  WAITING PERIOD.  (a)  The initial enrollment period for employees meeting the participation criteria must be at least 31 days, with a 31-day annual open enrollment period.  The enrollment period must consist of an entire calendar month, beginning on the first day of the month and ending on the last day of the month.  If the month is February, the period must last through March 2.(b)  A multiple employer welfare arrangement may establish a waiting period.(c)  A new employee who meets the participation criteria may not be denied coverage if the application for coverage is received by the multiple employer welfare arrangement not later than the 31st day after the later of:(1)  the date on which the employment begins;  or(2)  the date on which the waiting period established under Subsection (b) expires.(d)  If dependent coverage is offered to participating employees under the terms of a multiple employer welfare arrangement's plan document:(1)  the initial enrollment period for the dependents must be at least 31 days, with a 31-day annual open enrollment period;  and(2)  a dependent of a new employee meeting the participation criteria established by the arrangement may not be denied coverage if the application for coverage is received by the arrangement not later than the 31st day after the later of:(A)  the date on which the employment begins;(B)  the date on which the waiting period established under Subsection (b) expires;  or(C)  the date on which the dependent becomes eligible for enrollment.(e)  A late-participating employee or dependent may be excluded from coverage until the next annual open enrollment period and may be subject to a one-year preexisting condition provision as described by Section 846.202.  The period during which a preexisting condition provision applies may not exceed 18 months after the date of the initial application.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.258 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.258. Coverage for Newborn Children

Sec. 846.258.  COVERAGE FOR NEWBORN CHILDREN.  (a)  A multiple employer welfare arrangement's plan document may not limit or exclude initial coverage of a newborn child of a participating employee.(b)  Coverage of a newborn child of a participating employee under this section ends on the 32nd day after the date of the child's birth unless:(1)  children are eligible for coverage under the multiple employer welfare arrangement's plan document;  and(2)  not later than the 31st day after the date of birth, the arrangement receives:(A)  notice of the birth;  and(B)  any required additional premium.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.219(a), eff. Sept. 1, 2003.|
TX Ins Code § 846.259 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.259. Coverage for Adopted Children

Sec. 846.259.  COVERAGE FOR ADOPTED CHILDREN.  (a)  This section applies only if children are eligible for coverage under the terms of a multiple employer welfare arrangement's plan document.(b)  A multiple employer welfare arrangement plan document may not limit or exclude initial coverage of an adopted child of a participating employee.  A child is considered to be the child of a participating employee if the participating employee is a party to a suit in which the employee seeks to adopt the child.(c)  An adopted child of a participating employee may be enrolled, at the employee's option, not later than the 31st day after:(1)  the date the employee becomes a party to a suit in which the employee seeks to adopt the child;  or(2)  the date the adoption becomes final.(d)  Coverage of an adopted child of a participating employee under this section ends unless the multiple employer welfare arrangement receives notice of the adoption and any required additional premiums not later than the 31st day after:(1)  the date the participating employee becomes a party to a suit in which the employee seeks to adopt the child;  or(2)  the date the adoption becomes final.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.  Amended by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.219(b), eff. Sept. 1, 2003.|
TX Ins Code § 846.260 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter F. Participation in Coverage|Section 846.260. Limiting Age Applicable to Unmarried Child

Sec. 846.260.  LIMITING AGE APPLICABLE TO UNMARRIED CHILD.  If children are eligible for coverage under the terms of a multiple employer welfare arrangement's plan document, any limiting age applicable to an unmarried child of an enrollee is 25 years of age.|Added by Acts 2003, 78th Leg., ch. 1276, Sec. 10A.219(c), eff. Sept. 1, 2003.|
TX Ins Code § 846.301 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter G. Marketing|Section 846.301. Marketing Requirements

Sec. 846.301.  MARKETING REQUIREMENTS.  On request, each employer purchasing a health benefit plan shall be given a summary of the plans for which the employer is eligible.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.302 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter G. Marketing|Section 846.302. Additional Reporting Requirements

Sec. 846.302.  ADDITIONAL REPORTING REQUIREMENTS.  The department may require periodic reports by multiple employer welfare arrangements and agents regarding the health benefit plans issued by the arrangements.  The reporting requirements must comply with federal law and regulations.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 846.303 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 846 - Multiple Employer Welfare Arrangements|Subchapter G. Marketing|Section 846.303. Applicability to Third-Party Administrator

Sec. 846.303.  APPLICABILITY TO THIRD-PARTY ADMINISTRATOR.  If a multiple employer welfare arrangement enters into an agreement with a third-party administrator to provide administrative, marketing, or other services related to offering health benefit plans to employers in this state, the third-party administrator is subject to this chapter.|Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.|
TX Ins Code § 848.002 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter A. General Provisions|Section 848.002. Exception: Delegated Entities

Sec. 848.002.  EXCEPTION:  DELEGATED ENTITIES.  (a)  This section applies only to an entity, other than a health maintenance organization, that:(1)  by itself or through a subcontract with another entity, undertakes to arrange for or provide medical care or health care services to enrollees in exchange for predetermined payments on a prospective basis; and(2)  accepts responsibility for performing functions that are required by:(A)  Chapter 222, 251, 258, or 1272, as applicable, to a health maintenance organization; or(B)  Chapter 843, Chapter 1271, Section 1367.053, Subchapter A, Chapter 1452, or Subchapter B, Chapter 1507, as applicable, solely on behalf of health maintenance organizations.(b)  An entity described by Subsection (a) is subject to Chapter 1272 and is not required to obtain a certificate of authority or determination of approval under this chapter.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.003 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter A. General Provisions|Section 848.003. Use of Insurance-Related Terms by Health Care Collaborative

Sec. 848.003.  USE OF INSURANCE-RELATED TERMS BY HEALTH CARE COLLABORATIVE.  A health care collaborative that is not an insurer or health maintenance organization may not use in its name, contracts, or literature:(1)  the following words or initials:(A)  "insurance";(B)  "casualty";(C)  "surety";(D)  "mutual";(E)  "health maintenance organization"; or(F)  "HMO"; or(2)  any other words or initials that are:(A)  descriptive of the insurance, casualty, surety, or health maintenance organization business; or(B)  deceptively similar to the name or description of an insurer, surety corporation, or health maintenance organization engaging in business in this state.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|
TX Ins Code § 848.004 (2021)
2021 Texas Statutes|Insurance Code|Title 6 - Organization of Insurers and Related Entities|Subtitle C - Life, Health, and Accident Insurers and Related Entities|Chapter 848 - Health Care Collaboratives|Subchapter A. General Provisions|Section 848.004. Applicability of Insurance Laws

Sec. 848.004.  APPLICABILITY OF INSURANCE LAWS.  (a)  An organization may not arrange for or provide health care services to enrollees on a prepaid or indemnity basis through health insurance or a health benefit plan, including a health care plan, as defined by Section 843.002, unless the organization as an insurer or health maintenance organization holds the appropriate certificate of authority issued under another chapter of this code.(b)  Except as provided by Subsection (c), the following provisions of this code apply to a health care collaborative in the same manner and to the same extent as they apply to an individual or entity otherwise subject to the provision:(1)  Section 38.001;(2)  Subchapter A, Chapter 542;(3)  Chapter 541;(4)  Chapter 543;(5)  Chapter 602;(6)  Chapter 701;(7)  Chapter 803; and(8)  Chapter 804.(c)  The remedies available under this chapter in the manner provided by Chapter 541 do not include:(1)  a private cause of action under Subchapter D, Chapter 541; or(2)  a class action under Subchapter F, Chapter 541.|Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 4.01, eff. September 28, 2011.|