State Codes and Statutes

Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1207-enrollment-of-medical-assistance-recipients-and-children-eligible-for-state-child-healt

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE A. HEALTH COVERAGE IN GENERAL

CHAPTER 1207. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND

CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN

Sec. 1207.001. APPLICABILITY OF CHAPTER. This chapter applies

only to a group health benefit plan, including a small employer

health benefit plan written under Chapter 1501, a plan provided

under Chapter 1551, 1575, or 1601, or a successor to a plan

provided under one of those chapters, or a medical savings

account plan or other health reimbursement arrangement authorized

by law, that provides benefits for medical or surgical expenses

incurred as a result of a health condition, accident, or

sickness, including a group, blanket, or franchise insurance

policy or insurance agreement, a group hospital service contract,

or a group evidence of coverage or similar group coverage

document that is offered by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter

842;

(3) a fraternal benefit society operating under Chapter 885;

(4) a stipulated premium company operating under Chapter 884;

(5) a reciprocal exchange operating under Chapter 942;

(6) a health maintenance organization operating under Chapter

843;

(7) a multiple employer welfare arrangement that holds a

certificate of authority under Chapter 846; or

(8) an approved nonprofit health corporation that holds a

certificate of authority under Chapter 844.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.025(a), eff. September 1, 2005.

Sec. 1207.002. ENROLLMENT REQUIRED. (a) A group health benefit

plan issuer shall permit an individual who is otherwise eligible

for enrollment in the plan to enroll in the plan, without regard

to any enrollment period restriction, on receipt of written

notice from the Health and Human Services Commission that the

individual is:

(1) a recipient of medical assistance under the state Medicaid

program and is a participant in the health insurance premium

payment reimbursement program under Section 32.0422, Human

Resources Code; or

(2) a child eligible for the state child health plan under

Chapter 62, Health and Safety Code, and eligible to participate

in the health insurance premium assistance program under Section

62.059, Health and Safety Code.

(b) A group health benefit plan issuer shall permit an

individual who is otherwise eligible for enrollment in the plan

to enroll in the plan, without regard to any enrollment period

restriction, if the individual:

(1) becomes ineligible for medical assistance under the state

Medicaid program or enrollment in the state child health plan

under Chapter 62, Health and Safety Code, after initially

establishing eligibility; and

(2) provides a written request for enrollment in the group

health benefit plan not later than the 30th day after the date

the individual's eligibility for the state Medicaid program or

the state child health plan terminated.

(c) If an individual described by Subsection (a)(1) or (2) or

Subsection (b) is not eligible to enroll in the group health

benefit plan unless a family member of the individual is also

enrolled in the plan, the plan issuer, on receipt of written

notice under Subsection (a) or a written request under Subsection

(b), shall enroll both the individual and the family member in

the plan.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(a), eff. September 1, 2007.

Sec. 1207.003. EFFECTIVE DATE OF ENROLLMENT. (a) Unless

enrollment occurs during an established enrollment period,

enrollment in a group health benefit plan under Section 1207.002

takes effect on:

(1) the eligibility enrollment date specified in the written

notice from the Health and Human Services Commission under

Section 1207.002(a); or

(2) the first day of the first calendar month that begins at

least 30 days after the date written notice or a written request

is received by the plan issuer under Section 1207.002(a) or (b),

as applicable.

(b) Notwithstanding Subsection (a), the individual must comply

with a waiting period required under the state child health plan

under Chapter 62, Health and Safety Code, or under the health

insurance premium assistance program under Section 62.059, Health

and Safety Code, as applicable.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(b), eff. September 1, 2007.

Sec. 1207.004. TERMINATION OF ENROLLMENT. (a) Notwithstanding

any other requirement of a group health benefit plan, the plan

issuer shall permit an individual who is enrolled in the plan

under Section 1207.002(a)(1), and any family member of the

individual enrolled under Section 1207.002(c), to terminate

enrollment in the plan not later than the 60th day after the date

on which the individual provides satisfactory proof to the issuer

that the individual is no longer:

(1) a recipient of medical assistance under the state Medicaid

program; or

(2) a participant in the health insurance premium payment

reimbursement program under Section 32.0422, Human Resources

Code.

(b) Notwithstanding any other requirement of a group health

benefit plan, the plan issuer shall permit an individual who is

enrolled in the plan under Section 1207.002(a)(2), and any family

member of the individual enrolled under Section 1207.002(c), to

terminate enrollment in the plan not later than the 60th day

after the date on which the individual provides a written request

to disenroll from the plan because the individual no longer

wishes to participate in the health insurance premium assistance

program under Section 62.059, Health and Safety Code.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(c), eff. September 1, 2007.

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1207-enrollment-of-medical-assistance-recipients-and-children-eligible-for-state-child-healt

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE A. HEALTH COVERAGE IN GENERAL

CHAPTER 1207. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND

CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN

Sec. 1207.001. APPLICABILITY OF CHAPTER. This chapter applies

only to a group health benefit plan, including a small employer

health benefit plan written under Chapter 1501, a plan provided

under Chapter 1551, 1575, or 1601, or a successor to a plan

provided under one of those chapters, or a medical savings

account plan or other health reimbursement arrangement authorized

by law, that provides benefits for medical or surgical expenses

incurred as a result of a health condition, accident, or

sickness, including a group, blanket, or franchise insurance

policy or insurance agreement, a group hospital service contract,

or a group evidence of coverage or similar group coverage

document that is offered by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter

842;

(3) a fraternal benefit society operating under Chapter 885;

(4) a stipulated premium company operating under Chapter 884;

(5) a reciprocal exchange operating under Chapter 942;

(6) a health maintenance organization operating under Chapter

843;

(7) a multiple employer welfare arrangement that holds a

certificate of authority under Chapter 846; or

(8) an approved nonprofit health corporation that holds a

certificate of authority under Chapter 844.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.025(a), eff. September 1, 2005.

Sec. 1207.002. ENROLLMENT REQUIRED. (a) A group health benefit

plan issuer shall permit an individual who is otherwise eligible

for enrollment in the plan to enroll in the plan, without regard

to any enrollment period restriction, on receipt of written

notice from the Health and Human Services Commission that the

individual is:

(1) a recipient of medical assistance under the state Medicaid

program and is a participant in the health insurance premium

payment reimbursement program under Section 32.0422, Human

Resources Code; or

(2) a child eligible for the state child health plan under

Chapter 62, Health and Safety Code, and eligible to participate

in the health insurance premium assistance program under Section

62.059, Health and Safety Code.

(b) A group health benefit plan issuer shall permit an

individual who is otherwise eligible for enrollment in the plan

to enroll in the plan, without regard to any enrollment period

restriction, if the individual:

(1) becomes ineligible for medical assistance under the state

Medicaid program or enrollment in the state child health plan

under Chapter 62, Health and Safety Code, after initially

establishing eligibility; and

(2) provides a written request for enrollment in the group

health benefit plan not later than the 30th day after the date

the individual's eligibility for the state Medicaid program or

the state child health plan terminated.

(c) If an individual described by Subsection (a)(1) or (2) or

Subsection (b) is not eligible to enroll in the group health

benefit plan unless a family member of the individual is also

enrolled in the plan, the plan issuer, on receipt of written

notice under Subsection (a) or a written request under Subsection

(b), shall enroll both the individual and the family member in

the plan.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(a), eff. September 1, 2007.

Sec. 1207.003. EFFECTIVE DATE OF ENROLLMENT. (a) Unless

enrollment occurs during an established enrollment period,

enrollment in a group health benefit plan under Section 1207.002

takes effect on:

(1) the eligibility enrollment date specified in the written

notice from the Health and Human Services Commission under

Section 1207.002(a); or

(2) the first day of the first calendar month that begins at

least 30 days after the date written notice or a written request

is received by the plan issuer under Section 1207.002(a) or (b),

as applicable.

(b) Notwithstanding Subsection (a), the individual must comply

with a waiting period required under the state child health plan

under Chapter 62, Health and Safety Code, or under the health

insurance premium assistance program under Section 62.059, Health

and Safety Code, as applicable.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(b), eff. September 1, 2007.

Sec. 1207.004. TERMINATION OF ENROLLMENT. (a) Notwithstanding

any other requirement of a group health benefit plan, the plan

issuer shall permit an individual who is enrolled in the plan

under Section 1207.002(a)(1), and any family member of the

individual enrolled under Section 1207.002(c), to terminate

enrollment in the plan not later than the 60th day after the date

on which the individual provides satisfactory proof to the issuer

that the individual is no longer:

(1) a recipient of medical assistance under the state Medicaid

program; or

(2) a participant in the health insurance premium payment

reimbursement program under Section 32.0422, Human Resources

Code.

(b) Notwithstanding any other requirement of a group health

benefit plan, the plan issuer shall permit an individual who is

enrolled in the plan under Section 1207.002(a)(2), and any family

member of the individual enrolled under Section 1207.002(c), to

terminate enrollment in the plan not later than the 60th day

after the date on which the individual provides a written request

to disenroll from the plan because the individual no longer

wishes to participate in the health insurance premium assistance

program under Section 62.059, Health and Safety Code.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(c), eff. September 1, 2007.


State Codes and Statutes


Back To Homepage

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1207-enrollment-of-medical-assistance-recipients-and-children-eligible-for-state-child-healt

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE A. HEALTH COVERAGE IN GENERAL

CHAPTER 1207. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND

CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN

Sec. 1207.001. APPLICABILITY OF CHAPTER. This chapter applies

only to a group health benefit plan, including a small employer

health benefit plan written under Chapter 1501, a plan provided

under Chapter 1551, 1575, or 1601, or a successor to a plan

provided under one of those chapters, or a medical savings

account plan or other health reimbursement arrangement authorized

by law, that provides benefits for medical or surgical expenses

incurred as a result of a health condition, accident, or

sickness, including a group, blanket, or franchise insurance

policy or insurance agreement, a group hospital service contract,

or a group evidence of coverage or similar group coverage

document that is offered by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter

842;

(3) a fraternal benefit society operating under Chapter 885;

(4) a stipulated premium company operating under Chapter 884;

(5) a reciprocal exchange operating under Chapter 942;

(6) a health maintenance organization operating under Chapter

843;

(7) a multiple employer welfare arrangement that holds a

certificate of authority under Chapter 846; or

(8) an approved nonprofit health corporation that holds a

certificate of authority under Chapter 844.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.025(a), eff. September 1, 2005.

Sec. 1207.002. ENROLLMENT REQUIRED. (a) A group health benefit

plan issuer shall permit an individual who is otherwise eligible

for enrollment in the plan to enroll in the plan, without regard

to any enrollment period restriction, on receipt of written

notice from the Health and Human Services Commission that the

individual is:

(1) a recipient of medical assistance under the state Medicaid

program and is a participant in the health insurance premium

payment reimbursement program under Section 32.0422, Human

Resources Code; or

(2) a child eligible for the state child health plan under

Chapter 62, Health and Safety Code, and eligible to participate

in the health insurance premium assistance program under Section

62.059, Health and Safety Code.

(b) A group health benefit plan issuer shall permit an

individual who is otherwise eligible for enrollment in the plan

to enroll in the plan, without regard to any enrollment period

restriction, if the individual:

(1) becomes ineligible for medical assistance under the state

Medicaid program or enrollment in the state child health plan

under Chapter 62, Health and Safety Code, after initially

establishing eligibility; and

(2) provides a written request for enrollment in the group

health benefit plan not later than the 30th day after the date

the individual's eligibility for the state Medicaid program or

the state child health plan terminated.

(c) If an individual described by Subsection (a)(1) or (2) or

Subsection (b) is not eligible to enroll in the group health

benefit plan unless a family member of the individual is also

enrolled in the plan, the plan issuer, on receipt of written

notice under Subsection (a) or a written request under Subsection

(b), shall enroll both the individual and the family member in

the plan.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(a), eff. September 1, 2007.

Sec. 1207.003. EFFECTIVE DATE OF ENROLLMENT. (a) Unless

enrollment occurs during an established enrollment period,

enrollment in a group health benefit plan under Section 1207.002

takes effect on:

(1) the eligibility enrollment date specified in the written

notice from the Health and Human Services Commission under

Section 1207.002(a); or

(2) the first day of the first calendar month that begins at

least 30 days after the date written notice or a written request

is received by the plan issuer under Section 1207.002(a) or (b),

as applicable.

(b) Notwithstanding Subsection (a), the individual must comply

with a waiting period required under the state child health plan

under Chapter 62, Health and Safety Code, or under the health

insurance premium assistance program under Section 62.059, Health

and Safety Code, as applicable.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(b), eff. September 1, 2007.

Sec. 1207.004. TERMINATION OF ENROLLMENT. (a) Notwithstanding

any other requirement of a group health benefit plan, the plan

issuer shall permit an individual who is enrolled in the plan

under Section 1207.002(a)(1), and any family member of the

individual enrolled under Section 1207.002(c), to terminate

enrollment in the plan not later than the 60th day after the date

on which the individual provides satisfactory proof to the issuer

that the individual is no longer:

(1) a recipient of medical assistance under the state Medicaid

program; or

(2) a participant in the health insurance premium payment

reimbursement program under Section 32.0422, Human Resources

Code.

(b) Notwithstanding any other requirement of a group health

benefit plan, the plan issuer shall permit an individual who is

enrolled in the plan under Section 1207.002(a)(2), and any family

member of the individual enrolled under Section 1207.002(c), to

terminate enrollment in the plan not later than the 60th day

after the date on which the individual provides a written request

to disenroll from the plan because the individual no longer

wishes to participate in the health insurance premium assistance

program under Section 62.059, Health and Safety Code.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.026(a), eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

268, Sec. 24(c), eff. September 1, 2007.


Disclaimer
There is no confidential attorney-client relationship formed by using Laws.com website and information provided on this site is not legal advice. For legal advice, please contact your attorney. Attorneys listed on this website are not referred or endorsed by this website. By using Laws.com you agree to Laws.com Terms Of Use.
Copyright © 2017 Laws.com | All rights reserved

Loading..

Close Window

Loading, Please Wait!

This may take a second or two.