Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter C - LARGE EMPLOYER HEALTH INSURANCE REGULATIONS › Section 26.304 - Requirement to Insure Entire Groups

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  large employer carrier that offers coverage to a large employer and its
				  employees must offer coverage to each eligible employee who meets the large
				  employer's participation criteria. If dependent coverage is offered to
				  enrollees under a large employer health benefit plan, a large employer carrier
				  must offer coverage to each eligible dependent. Except as provided in
				  subsection (b) of this section, the large employer carrier must provide the
				  same health benefit plan to each employee and dependent.
(b) If elected by the large employer, a large
				  employer carrier may offer one or more health benefit plans, provided that each
				  eligible employee who meets the participation criteria may choose any of the
				  plans offered. Except as provided in Insurance Code §
										1501.104
				  (concerning Affiliation Period) and §1501.106 (concerning Certain
				  Limitations or Exclusions of Coverage Prohibited), with respect to an
				  affiliation period or exclusions for preexisting conditions, the choice among
				  benefit plans may not be limited, restricted, or conditioned based on the
				  health-status-related factors of the employees or dependents, if
				  applicable.
(c) A large employer
				  carrier may require each large employer that applies for coverage, as part of
				  the application process, to provide a complete list of employees, eligible
				  employees, and if dependent coverage is offered to enrollees under a large
				  employer health benefit plan, a complete list of dependents of eligible
				  employees. The large employer carrier may also require the large employer to
				  provide reasonable and appropriate supporting documentation to verify the
				  information required under this subsection, and to confirm the applicant's
				  status as a large employer. The large employer carrier must make a
				  determination of eligibility within five business days of receipt of any
				  requested documentation. A large employer carrier may not condition the
				  issuance of coverage on an employer's production of a particular document,
				  where the employer can otherwise provide the information required by this
				  section. Similarly, if a particular document an employer produces does not
				  reasonably evidence the employer's compliance with this subsection, the
				  employer must produce other documentation to satisfy the requirements. Examples
				  of the types of reasonable and appropriate supporting documentation that a
				  large employer carrier may request from an employer as needed to fulfill the
				  purposes of this subsection are:
(1) a W-2
				  Summary Wage and Tax Form or other federal or state tax records;
(2) a loan agreement;
(3) an invoice;
(4) a business check;
(5) a sales tax license;
(6) articles of incorporation or other
				  business entity filings with the secretary of state ;
(7) assumed name filings;
(8) professional licenses; and
(9) reports required by the Texas Workforce
				  Commission.