Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter A - DEFINITIONS, SEVERABILITY, AND SMALL EMPLOYER HEALTH REGULATIONS › Section 26.19 - Filing Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) Each small
				  employer carrier must file each form, including, but not limited to, each
				  policy, contract, certificate, agreement, evidence of coverage, endorsement,
				  amendment, enrollment form, and application that will be used to provide a
				  health benefit plan in the small employer market, in accordance with Insurance
				  Code Chapter 1701 (concerning Policy Forms), and Chapter 3, Subchapter A of
				  this title (relating to Submission Requirements for Filings and Departmental
				  Actions Related to Such Filings), or Insurance Code Chapter 1271 (concerning
				  Benefits Provided by Health Maintenance Organizations; Evidence of Coverage;
				  Charges), and §
										11.301 of
				  this title (relating to Filing Requirements) or §
										11.302
				  of this title (relating to Service Area Expansion or Reduction Applications),
				  as applicable.
(b) Each small
				  employer carrier, other than an HMO, must use a policy shell format for any
				  group or individual health benefit plan form used to provide a health benefit
				  plan in the small employer market. To expedite the review and approval process,
				  all group and individual health benefit plan form filings (excluding HMO
				  filings that are covered in subsection (c) of this section) must be submitted
				  in the following order:
(1) a group policy
				  face page or individual policy face page, as applicable;
(2) the group certificate page or individual
				  data page, as applicable;
(3) as
				  applicable under Chapter 3, Subchapter A of this title, the toll-free number
				  and complaint notice page, as required by Chapter 1, Subchapter E of this title
				  (relating to Notice of Toll-Free Telephone Numbers and Procedures for Obtaining
				  Information and Filing Complaints);
(4) the table of contents;
(5) insert pages for the general
				  provisions;
(6) insert pages for
				  the required provisions and any optional provisions, if elected and as
				  applicable;
(7) for small employer
				  health benefit plans, an insert page for the benefits section of the health
				  benefit plan, including but not limited to schedule of benefits; definitions;
				  benefits provided; exclusions and limitations; continuation provisions; and, if
				  applicable, alternative cost containment, preferred provider, conversion and
				  coordination of benefits provisions, and riders;
(8) insert pages for any amendments,
				  applications, enrollment forms, or other form filings that comprise part of the
				  contract;
(9) insert pages for any
				  required outline of coverage for individual products;
(10) any additional form filings and
				  documentation as outlined in Chapter 3, Subchapter A of this title and Chapter
				  3, Subchapter G of this title (relating to Plain Language Requirements for
				  Health Benefit Policies);
(11) the
				  certifications required under this section and any other rating information
				  required under §
											26.10
				  of this title (relating to Establishment of Classes of Business) and §
											26.11
				  of this title (relating to Restrictions Relating to Premium Rates);
				  and
(12) the rate schedule
				  applicable to any individual health benefit plan, as required by Chapter 3,
				  Subchapter A of this title.