28 TAC § 26.6. Status of Health Carriers as Small Employer Carriers

(a) With the original filing to enter the small employer market or when notifying TDI of a change in status, each health carrier providing health benefit plans in this state must file with the commissioner a statement indicating whether the health carrier will or will not offer, renew, issue, or issue for delivery health benefit plans to small employers in this state. The filing must include a certification, signed by an officer of the company, that the carrier intends to operate in accordance with the status certification unless or until it is changed in accordance with this section, and provide a statement to the effect of one of the following statements:

(1) the health carrier intends to offer, renew, issue, and issue for delivery health benefit plans to small employers in Texas and will operate in accordance with Insurance Code Chapter 1501 (concerning Health Insurance Portability and Availability Act) and this subchapter;

(2) the health carrier does not intend to offer, issue, or issue for delivery health benefit plans to small employers in Texas, but the health carrier intends to renew existing health benefit plans;

(3) the health carrier does not intend to offer, issue, or issue for delivery health benefit plans to small employers in Texas; intends to nonrenew all health benefit plans issued to small employers in Texas; and will provide notice to the commissioner and employers in accordance with §26.16 of this title (relating to Refusal to Renew and Application to Reenter Small Employer Market) and Insurance Code §1501.110 (concerning Notice to Covered Persons); or

(4) the health carrier has no health benefit plans issued to small employers or to employees of a small employer and does not intend to offer, issue, or issue for delivery health benefit plans to small employers.

(b) If a health carrier chooses to change its election or the date of implementing its election under subsection (a)(1), (2), or (4) of this section, the health carrier must notify the commissioner of its new election at least 30 days before the date the health carrier intends to begin operations under the new election as required in subsection (a) of this section.

(c) A form fulfilling the requirements of subsections (a) and (b) of this section is available online at www.tdi.texas.gov/forms/form10smgroup.html through the link for Small Employer Carrier Status Certification.

(d) Health carriers providing coverage under any health benefit plans issued to small employers and their employees, whether on a group or franchise insurance policy basis, will be considered small employer carriers for purposes of those plans, and must comply with all provisions of Insurance Code Chapter 1501 and this subchapter, as applicable.

(e) The small employer carrier must also comply with any other applicable legal requirements, including those for withdrawal from the market under Chapter 7, Subchapter R of this title (relating to Withdrawal Plan Requirements and Procedures).