Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter E - HEALTHY TEXAS PROGRAM › Division 3 - PARTICIPATION BY SMALL EMPLOYERS › Section 26.521 - Small Employer Participation

Current through Reg. 49, No. 28; July 12, 2024
(a) In
					 accordance with the Insurance Code §
											1508.002(7),
					 qualifying small employers must have at least two but no more than 50 eligible
					 employees.
(b) Qualifying small
					 employers must offer coverage to all persons who are considered to be eligible
					 employees as defined in §
											26.502(2)
					 of this subchapter (relating to Definitions) for the purpose of determining the
					 employer's eligibility to purchase a qualifying group health benefit plan, at
					 least 30 percent of which must be eligible employees who are earning annual
					 wages from the employer equal to or less than 300 percent of the poverty
					 guidelines for an individual as defined and updated annually by the United
					 States Department of Health and Human Services, or as adjusted by the
					 commissioner in accordance with the Insurance Code §
											1508.052(b).
(c) Qualifying small employers must offer
					 coverage to each dependent of an eligible employee. An eligible employee's
					 spouse and dependent children younger than age 25 shall be considered eligible
					 dependents under qualifying group health benefit plans.
(d) Qualifying small employers may offer
					 coverage to part-time employees working at least 20 hours per week, and their
					 dependents. Part-time employees or their dependents to whom coverage may be
					 offered are not eligible employees for purposes of determining the small
					 employer's eligibility to purchase a qualifying group health benefit plan
					 pursuant to the Insurance Code §
											1508.051(a)(2)
					 and §
											1508.053
					 and subsections (e) and (f) of this section.
(e) Qualifying small employers must, in
					 accordance with the Insurance Code §
											1508.051
					 and §
											1508.053,
					 have eligible employees as defined in §
											26.502(2)
					 of this subchapter who meet the criteria specified in paragraphs (1) - (3) of
					 this subsection.
(1) At least 30 percent of
					 eligible employees must earn annual wages from the employer equal to or less
					 than 300 percent of the poverty guidelines for an individual as defined and
					 updated annually by the United States Department of Health and Human Services,
					 or as adjusted by the commissioner in accordance with the Insurance Code §
												1508.052(b).
(2) At least 60 percent of eligible employees
					 must participate in group health insurance coverage through the Healthy Texas
					 Program.
(3) At least one eligible
					 employee earning annual wages from the employer equal to or less than 300
					 percent of the poverty guidelines for an individual as defined and updated
					 annually by the United States Department of Health and Human Services, or as
					 adjusted by the commissioner in accordance with the Insurance Code §
												1508.052(b)
					 must participate in group health insurance coverage through the Healthy Texas
					 Program.