CHAPTER 1501. HEALTH INSURANCE PORTABILITY AND AVAILABILITY ACT

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1501-health-insurance-portability-and-availability-act

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE G. HEALTH COVERAGE AVAILABILITY

CHAPTER 1501. HEALTH INSURANCE PORTABILITY AND AVAILABILITY ACT

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 1501.001. SHORT TITLE. This chapter may be cited as the

Health Insurance Portability and Availability Act.

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

2005.

Sec. 1501.002. DEFINITIONS. In this chapter:

(1) "Agent" means a person who may act as an agent for the sale

of a health benefit plan under a license issued under Title 13.

(2) "Dependent" means:

(A) a spouse;

(B) a child younger than 25 years of age, including a newborn

child;

(i) medically certified as disabled; and

(ii) dependent on the parent;

(D) an individual who must be covered under:

(i) Section 1251.154; or

(ii) Section 1201.062; and

(E) any other child eligible under an employer's health benefit

plan, including a child described by Section 1503.003.

(3) "Eligible employee" means an employee who works on a

full-time basis and who usually works at least 30 hours a week.

The term includes a sole proprietor, a partner, and an

independent contractor, if the individual is included as an

employee under a health benefit plan of a small or large

employer. The term does not include an employee who:

(A) works on a part-time, temporary, seasonal, or substitute

basis;

(B) is covered under:

(i) another health benefit plan; or

(ii) a self-funded or self-insured employee welfare benefit plan

that provides health benefits and is established in accordance

with the Employee Retirement Income Security Act of 1974 (29

U.S.C. Section 1001 et seq.); or

plan and is covered under:

(i) the Medicaid program;

(ii) another federal program, including the CHAMPUS program or

Medicare program; or

(iii) a benefit plan established in another country.

(4) "Employee" means an individual employed by an employer.

(5) "Health benefit plan" means a group, blanket, or franchise

insurance policy, a certificate issued under a group policy, a

group hospital service contract, or a group subscriber contract

or evidence of coverage issued by a health maintenance

organization that provides benefits for health care services. The

term does not include:

(A) accident-only or disability income insurance coverage or a

combination of accident-only and disability income insurance

coverage;

(B) credit-only insurance coverage;

(D) coverage for a specified disease or illness;

(E) Medicare services under a federal contract;

(F) Medicare supplement and Medicare Select benefit plans

regulated in accordance with federal law;

(G) long-term care coverage or benefits, nursing home care

coverage or benefits, home health care coverage or benefits,

community-based care coverage or benefits, or any combination of

those coverages or benefits;

(H) coverage that provides limited-scope dental or vision

benefits;

(I) coverage provided by a single service health maintenance

organization;

(J) workers' compensation insurance coverage or similar

insurance coverage;

(K) coverage provided through a jointly managed trust authorized

under 29 U.S.C. Section 141 et seq. that contains a plan of

benefits for employees that is negotiated in a collective

bargaining agreement governing wages, hours, and working

conditions of the employees that is authorized under 29 U.S.C.

Section 157;

(L) hospital indemnity or other fixed indemnity insurance

coverage;

(M) reinsurance contracts issued on a stop-loss, quota-share, or

similar basis;

(N) short-term major medical contracts;

(O) liability insurance coverage, including general liability

insurance coverage and automobile liability insurance coverage,

and coverage issued as a supplement to liability insurance

coverage, including automobile medical payment insurance

coverage;

(P) coverage for on-site medical clinics;

(Q) coverage that provides other limited benefits specified by

federal regulations; or

(R) other coverage that:

(i) is similar to the coverage described by this subdivision

under which benefits for medical care are secondary or incidental

to other coverage benefits; and

(ii) is specified by federal regulations.

(6) "Health benefit plan issuer" means an entity authorized

under this code or another insurance law of this state that

provides health insurance or health benefits in this state,

including:

(A) an insurance company;

(B) a group hospital service corporation operating under Chapter

842;

843; and

(D) a stipulated premium company operating under Chapter 884.

(7) "Health status related factor" means:

(A) health status;

(B) medical condition, including both physical and mental

illness;

(D) receipt of health care;

(E) medical history;

(F) genetic information;

(G) evidence of insurability, including conditions arising out

of acts of family violence; and

(H) disability.

(8) "Large employer" means a person who employed an average of

at least 51 eligible employees on business days during the

preceding calendar year and who employs at least two employees on

the first day of the plan year. The term includes a governmental

entity subject to Article 3.51-1, 3.51-4, or 3.51-5, to

Subchapter C, Chapter 1364, to Chapter 1578, or to Chapter 177,

Local Government Code, that otherwise meets the requirements of

this subdivision. For purposes of this definition, a partnership

is the employer of a partner.

(9) "Large employer health benefit plan" means a health benefit

plan offered to a large employer.

(10) "Large employer health benefit plan issuer" means a health

benefit plan issuer, to the extent that the issuer is offering,

delivering, issuing for delivery, or renewing health benefit

plans subject to Subchapters C and M.

(11) "Person" means an individual, corporation, partnership, or

other legal entity.

(12) "Preexisting condition provision" means a provision that

excludes or limits coverage as to a disease or condition for a

specified period after the effective date of coverage.

(13) "Premium" means all amounts paid by a small or large

employer and eligible employees as a condition of receiving

coverage from a small or large employer health benefit plan

issuer, including any fees or other contributions associated with

a health benefit plan.

(14) "Small employer" means a person who employed an average of

at least two employees but not more than 50 eligible employees on

business days during the preceding calendar year and who employs

at least two employees on the first day of the plan year. The

term includes a governmental entity subject to Article 3.51-1,

3.51-4, or 3.51-5, to Subchapter C, Chapter 1364, to Chapter

1578, or to Chapter 177, Local Government Code, that otherwise

meets the requirements of this subdivision. For purposes of this

definition, a partnership is the employer of a partner.

(15) "Small employer health benefit plan" means a health benefit

plan developed by the commissioner under Subchapter F or any

other health benefit plan offered to a small employer in

accordance with Section 1501.252(c) or 1501.255.

(16) "Small employer health benefit plan issuer" means a health

benefit plan issuer, to the extent that the issuer is offering,

delivering, issuing for delivery, or renewing health benefit

plans subject to Subchapters C-H.

(16-a) "Small employer health coalition" means a private

purchasing cooperative composed solely of small employers that is

formed under Subchapter B.

(17) "Waiting period" means a period established by an employer

that must elapse before an individual who is a potential enrollee

in a health benefit plan is eligible to be covered for benefits.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.046(a), eff. September 1, 2005.

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

730, Sec. 2G.013, eff. April 1, 2009.

Sec. 1501.003. APPLICABILITY: SMALL EMPLOYER HEALTH BENEFIT

PLANS. An individual or group health benefit plan is a small

employer health benefit plan subject to Subchapters C-H if it

provides health care benefits covering two or more eligible

employees of a small employer and:

(1) the employer pays a portion of the premium or benefits;

(2) the employer or a covered individual treats the health

benefit plan as part of a plan or program for purposes of Section

106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section 106

or 162); or

(3) the health benefit plan is an employee welfare benefit plan

under 29 C.F.R. Section 2510.3-1(j).

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

2005.

Sec. 1501.004. APPLICABILITY: LARGE EMPLOYER HEALTH BENEFIT

PLANS. An individual or group health benefit plan is a large

employer health benefit plan subject to Subchapters C and M if

the plan provides health care benefits to eligible employees of a

large employer and:

(1) the employer pays a portion of the premium or benefits;

(2) the employer or a covered individual treats the health

benefit plan as part of a plan or program for purposes of Section

106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section 106

or 162); or

(3) the health benefit plan is an employee welfare benefit plan

under 29 C.F.R. Section 2510.3-1(j).

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

2005.

Sec. 1501.005. EXCEPTION: CERTAIN INDIVIDUALLY UNDERWRITTEN

POLICIES. Except as provided by Section 1501.003 or 1501.004,

this chapter does not apply to an individual health insurance

policy that is subject to individual underwriting, even if the

premium is paid through a payroll deduction method.

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

2005.

Sec. 1501.006. CERTIFICATION. (a) In accordance with rules

adopted by the commissioner, each health benefit plan issuer

shall certify that the issuer is offering, delivering, issuing

for delivery, or renewing, or that the issuer intends to offer,

deliver, issue for delivery, or renew:

(1) a health benefit plan to or through a small employer in this

state that is subject to this chapter; or

(2) a health benefit plan to or through a large employer in this

state that is subject to this chapter.

(b) A health benefit plan issuer must submit a revised

certification to the commissioner only if the issuer changes its

status as a small or large employer health benefit plan issuer or

changes its intent to become a small or large employer health

benefit plan issuer to the extent that its previous certification

ceases to be accurate.

benefit plan issuer is complying with this chapter to the extent

it applies to the issuer.

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

2005.

Sec. 1501.007. AFFILIATES. (a) In this section, "affiliate"

has the meaning described by Section 823.003.

(b) For purposes of this chapter, health benefit plan issuers

that are affiliates or that are eligible to file a consolidated

tax return are considered to be one issuer, and a restriction

imposed by this chapter applies as if the health benefit plans

delivered or issued for delivery to small employers in this state

by the affiliates were issued by one issuer.

organization that is an affiliate is considered to be a separate

health benefit plan issuer for purposes of this chapter.

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

2005.

Sec. 1501.008. LATE ENROLLEES. (a) For purposes of this

chapter, an employee or dependent eligible for enrollment in a

small or large employer's health benefit plan is a late enrollee

if the individual requests enrollment after the expiration of:

(1) the initial enrollment period established under the terms of

the first plan for which the individual was eligible through the

small or large employer; or

(2) an open enrollment period under Section 1501.156(a) or

1501.606(a).

(b) An employee or dependent eligible for enrollment is not a

late enrollee if the individual:

(1) was covered under another health benefit plan or self-funded

employer health benefit plan at the time the individual was

eligible to enroll;

(2) declined enrollment in writing, at the time of the initial

eligibility for enrollment, stating that coverage under another

health benefit plan or self-funded employer health benefit plan

was the reason for declining enrollment;

(3) has lost coverage under the other health benefit plan or

self-funded employer health benefit plan as a result of:

(A) the termination of employment;

(B) a reduction in the number of hours of employment;

(D) the termination of contributions toward the premium made by

the employer; or

(E) the death of a spouse or divorce; and

(4) requests enrollment not later than the 31st day after the

date coverage under the other health benefit plan or self-funded

employer health benefit plan terminates.

a late enrollee if the individual is:

(1) employed by an employer that offers multiple health benefit

plans and the individual elects a different health benefit plan

during an open enrollment period;

(2) a spouse for whom a court has ordered coverage under a

covered employee's plan and the request for enrollment of the

spouse is made not later than the 31st day after the date the

court order is issued;

(3) a child for whom a court has ordered coverage under a

covered employee's plan and the request for enrollment is made

not later than the 31st day after the date the employer receives

the court order; or

(4) a child of a covered employee who has lost coverage under

Title XIX of the Social Security Act (42 U.S.C. Section 1396 et

seq.), other than coverage consisting solely of benefits under

Section 1928 of that Act (42 U.S.C. Section 1396s), or under

Chapter 62, Health and Safety Code, and the request for

enrollment is made not later than the 31st day after the date on

which the child loses coverage.

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

2005.

Sec. 1501.009. SCHOOL DISTRICT ELECTION. (a) An independent

school district may elect to participate as a small employer

without regard to the number of eligible employees in the

district. An independent school district that makes the election

is treated as a small employer under this chapter for all

purposes.

(b) An independent school district that is participating in the

uniform group coverage program established under Chapter 1579 may

not participate in the small employer market under this section

for health insurance coverage and may not renew a health

insurance contract obtained in accordance with this section after

the date on which the program of coverages provided under Chapter

1579 is implemented. This subsection does not affect a contract

for the provision of optional coverages not included in a health

benefit plan under this chapter.

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

2005.

Amended by:

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

730, Sec. 2G.014, eff. April 1, 2009.

Sec. 1501.0095. SCHOOL DISTRICT EMPLOYEE ELECTION. (a)

Notwithstanding any other provision of this chapter, a school

district employee who is eligible for coverage under a large or

small employer health benefit plan providing coverage to the

school district's employees and who is the spouse of another

school district employee covered under the plan may elect whether

to be treated under the plan as:

(1) an employee; or

(2) the dependent of the other employee.

(b) The commissioner shall adopt rules under Section 1501.010

governing the manner in which an election under this section must

be made.

Added by Acts 2005, 79th Leg., Ch.

998, Sec. 1, eff. June 18, 2005.

Sec. 1501.010. GENERAL RULES. The commissioner shall adopt

rules necessary to:

(1) implement this chapter; and

(2) meet the minimum requirements of federal law, including

regulations.

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

2005.

Sec. 1501.011. DETERMINATION OF EMPLOYER STATUS FOR CERTAIN

EMPLOYERS. (a) For an employer that did not exist throughout

the calendar year preceding the year in which the determination

of whether the employer is a small employer is made, the

determination is based on the average number of employees and

eligible employees the employer reasonably expects to employ on

business days in the calendar year in which the determination is

made.

(b) For an employer that did not exist throughout the calendar

year preceding the year in which the determination of whether the

employer is a large employer is made, the determination is based

on the average number of eligible employees the employer

reasonably expects to employ on business days in the calendar

year in which the determination is made.

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

2005.

SUBCHAPTER B. COALITIONS AND COOPERATIVES

Sec. 1501.051. DEFINITIONS. In this subchapter:

(1) "Board of directors" means the board of directors elected by

a private purchasing cooperative or a health group cooperative.

(2) "Board of trustees" means the board of trustees of the Texas

cooperative.

(3) "Cooperative" means a private purchasing cooperative or a

health group cooperative established under this subchapter.

(3-a) "Expanded service area" means any area larger than one

county in which a health group cooperative offers coverage.

(4) "Texas cooperative" means the Texas Health Benefits

Purchasing Cooperative established under Section 1501.052.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.048(a), eff. September 1, 2005.

Sec. 1501.052. TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE;

BOARD OF TRUSTEES. (a) The Texas Health Benefits Purchasing

Cooperative is a nonprofit corporation established to make health

care coverage available to small and large employers and their

eligible employees and the eligible employees' dependents.

(b) The Texas cooperative is administered by a board of trustees

of five members appointed by the governor with the advice and

consent of the senate. Two members must represent employers, two

members must represent employees, and one member must represent

the public.

terms, with the terms of one or two members expiring February 1

of each odd-numbered year.

(d) A member of the board of trustees may not be compensated for

serving on the board but is entitled to reimbursement for actual

expenses incurred in performing functions as a member of the

board as provided by the General Appropriations Act.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.049(a), eff. September 1, 2005.

Sec. 1501.053. TEXAS HEALTH BENEFITS PURCHASING COOPERATIVE:

EXECUTIVE DIRECTOR AND OTHER EMPLOYEES. (a) The board of

trustees shall employ an executive director. The executive

director may hire other employees of the Texas cooperative as

necessary.

(b) Salaries for employees of the Texas cooperative and related

costs may be paid from administrative fees collected from

employers and participating health benefit plan issuers or other

sources of funding arranged by the Texas cooperative.

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

2005.

Sec. 1501.054. REGIONAL SUBDIVISIONS OF TEXAS HEALTH BENEFITS

PURCHASING COOPERATIVE. The board of trustees may:

(1) develop regional subdivisions of the Texas cooperative; and

(2) authorize each subdivision to separately exercise the powers

and duties of a cooperative.

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

2005.

Sec. 1501.055. APPLICABILITY OF PUBLIC INFORMATION LAW TO TEXAS

HEALTH BENEFITS PURCHASING COOPERATIVE. The Texas cooperative is

subject to the public information law, Chapter 552, Government

Code.

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

2005.

Sec. 1501.056. PRIVATE PURCHASING COOPERATIVES AND HEALTH GROUP

COOPERATIVES. (a) Two or more small or large employers may form

a private purchasing cooperative to purchase small or large

employer health benefit plans. Subject to Subsection (d), a

person may form a health group cooperative to purchase employer

health benefit plans. A cooperative must be organized as a

nonprofit corporation and has the rights and duties provided by

the Texas Non-Profit Corporation Act (Article 1396-1.01 et seq.,

Vernon's Texas Civil Statutes).

(b) On receipt of a certificate of incorporation or certificate

of authority from the secretary of state, the cooperative shall

file written notice of the receipt of the certificate and a copy

of the cooperative's organizational documents with the

commissioner.

commissioner a statement of all amounts collected and expenses

incurred for each of the preceding three years.

(d) A health benefit plan issuer may not form, or be a member

of, a health group cooperative. A health benefit plan issuer may

associate with a sponsoring entity, such as a business

association, chamber of commerce, or other organization

representing employers or serving an analogous function, to

assist the sponsoring entity in forming a health group

cooperative.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.050(a), eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

728, Sec. 11.050(b), eff. September 1, 2005.

Sec. 1501.057. IMMUNITY. (a) The Texas cooperative or a member

of the board of trustees, the executive director, or an employee

or agent of the Texas cooperative is not liable for:

(1) an act performed in good faith in the execution of duties in

connection with the cooperative; or

(2) an independent action of a small employer health benefit

plan issuer or a person who provides health care services under a

health benefit plan.

(b) A private purchasing cooperative, a health group

cooperative, or a member of the board of directors, the executive

director, or an employee or agent of the private purchasing or

health group cooperative is not liable for:

(1) an act performed in good faith in the execution of duties in

connection with the private purchasing or health group

cooperative; or

(2) an independent action of a small or large employer health

benefit plan issuer or a person who provides health care services

under a health benefit plan.

directors, the executive director, or an employee or agent of the

health group cooperative is not liable for failure to arrange for

coverage of any particular illness, disease, or health condition.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.050(c), eff. September 1, 2005.

Sec. 1501.0575. VOLUNTARY PARTICIPATION BY ISSUER IN

COOPERATIVE. A health benefit plan issuer may elect not to

participate in a health group cooperative. The health benefit

plan issuer may elect to participate in one or more health group

cooperatives and may select the cooperatives in which the issuer

will participate.

Added by Acts 2005, 79th Leg., Ch.

823, Sec. 1, eff. September 1, 2005.

Sec. 1501.058. POWERS AND DUTIES OF COOPERATIVES. (a) A

cooperative shall:

(1) arrange for small or large employer health benefit plan

coverage for small or large employer groups that participate in

the cooperative by contracting with small or large employer

health benefit plan issuers that meet the requirements

established by Section 1501.061;

(2) collect premiums to cover the cost of:

(A) small or large employer health benefit plan coverage

purchased through the cooperative; and

(B) the cooperative's administrative expenses;

(3) establish administrative and accounting procedures for the

operation of the cooperative;

(4) establish procedures under which an applicant for or

participant in coverage issued through the cooperative may have a

grievance reviewed by an impartial person;

(5) contract with small or large employer health benefit plan

issuers to provide services to small or large employers covered

through the cooperative; and

(6) develop and implement a plan to maintain public awareness of

the cooperative and publicize the eligibility requirements for,

and the procedures for enrollment in, coverage through the

cooperative.

(b) A cooperative may:

(1) contract with agents to market coverage issued through the

cooperative;

(2) contract with a small or large employer health benefit plan

issuer or third-party administrator to provide administrative

services to the cooperative;

(3) negotiate the premiums paid by its members; and

(4) offer other ancillary products and services to its members

that are customarily offered in conjunction with health benefit

plans.

(1) federal laws applicable to cooperatives and health benefit

plans issued through cooperatives, to the extent required by

state law or rules adopted by the commissioner; and

(2) state laws applicable to cooperatives and health benefit

plans issued through cooperatives.

(d) To be eligible to exercise the authority granted under

Subsection (a)(1), a health group cooperative must have at least

10 participating employers.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.053(a), eff. September 1, 2005.

Sec. 1501.0581. SPECIAL PROVISIONS RELATING TO HEALTH GROUP

COOPERATIVES. (a) The membership of a health group cooperative

may consist of only small employers, only large employers, or

both small and large employers. To participate as a member of a

health group cooperative, an employer must be a small or large

employer as described by this chapter.

(a-1) Notwithstanding Subsections (b) and (c), membership in a

health group cooperative may be restricted to small and large

employers within a single industry grouping as defined by the

most recent edition of the United States Census Bureau's North

American Industry Classification System.

(b) Subject to the requirements imposed on small employer health

benefit plan issuers under Section 1501.101 and subject to

Subsections (a-1) and (o), a health group cooperative:

(1) shall allow a small employer to join a health group

cooperative consisting of only small employers or both small and

large employers and enroll in health benefit plan coverage; and

(2) may allow a large employer to join the health group

cooperative and enroll in health benefit plan coverage.

cooperative consisting of only small employers or both small and

large employers shall allow any small employer to join the health

group cooperative and enroll in the cooperative's health benefit

plan coverage during the initial enrollment and annual open

enrollment periods.

(d) A sponsoring entity of a health group cooperative may inform

the members of the entity about the cooperative and the health

benefit plans offered by the cooperative. Coverage issued

through the cooperative must be issued through a licensed agent

marketing the coverage in accordance with Section 1501.058(b)(1).

(e) The commissioner shall adopt rules that govern the manner in

which an employer may terminate, because of a financial hardship

affecting the employer, participation in a health group

cooperative.

(f) An employer's participation in a health group cooperative is

voluntary, but an employer electing to participate in a health

group cooperative must commit to purchasing coverage through the

health group cooperative for two years, except as provided by

Subsection (e).

(g) A health benefit plan issuer issuing coverage to a health

group cooperative:

(1) shall use a standard presentation form, prescribed by the

commissioner by rule, to market health benefit plan coverage

through the health group cooperative;

(2) may contract to provide health benefit plan coverage with

only one health group cooperative in any county, except that a

health benefit plan issuer may contract with additional health

group cooperatives if it is providing health benefit plan

coverage in an expanded service area in accordance with

Subsection (l);

(3) shall allow enrollment in health benefit plan coverage in

compliance with Subsection (c) and with the health benefit plan

issuer's agreement with the health group cooperative;

(4) is exempt from the premium tax or tax on revenues imposed by

Chapter 222, and the retaliatory tax under Chapter 281 for two

years, with respect to the premiums or revenues received for

coverage provided to each uninsured employee or dependent as

defined by the commissioner in accordance with Subsection (h);

and

(5) shall maintain documentation to be provided by health group

cooperatives to ensure compliance with the rules adopted by the

commissioner under Subsection (h) with respect to uninsured

employees or dependents.

(h) The commissioner by rule shall determine who constitutes an

uninsured employee or dependent for purposes of Subsection

(g)(4).

(i) Notwithstanding any other law, and except as provided by

Subsection (n), a health benefit plan issued by a health benefit

plan issuer to provide coverage with a health group cooperative

is not subject to a state law, including a rule, that:

(1) relates to a particular illness, disease, or treatment; or

(2) regulates the differences in rates applicable to services

provided within a health benefit plan network or outside the

network.

(j) The commissioner by rule shall implement the exemption

authorized by Subsection (i).

(k) A health group cooperative may offer more than one health

benefit plan, but each plan offered must be made available to all

employees covered by the cooperative.

(l) A health benefit plan issuer may, with notice to the

commissioner, provide health benefit plan coverage to an expanded

service area that includes the entire state. A health benefit

plan issuer may apply for approval of an expanded service area

that comprises less than the entire state by filing with the

commissioner an application, in a form and manner prescribed by

the commissioner, at least 60 days before the date the health

benefit plan issuer issues coverage to the health group

cooperative in the expanded service area. At the expiration of

60 days after the date of receipt by the department of a filed

application, the application is considered approved by the

department unless, before that date, the application was either

affirmatively approved or disapproved by written order of the

commissioner. The commissioner, after notice and opportunity for

hearing, may rescind an approval granted to a health benefit plan

issuer under this subsection if the commissioner finds that the

health benefit plan issuer has failed to market fairly to all

eligible employers in the state or the expanded service area.

(m) The provisions of this section do not limit or restrict a

small or large employer's access to health benefit plans under

this chapter.

(n) A health benefit plan provided through a health group

cooperative must provide coverage for diabetes equipment,

supplies, and services as required by Subchapter B, Chapter 1358.

(o) A health group cooperative consisting only of small

employers is not required to allow a small employer to join the

health group cooperative under Subsection (c) if:

(1) the cooperative has elected to restrict membership in the

cooperative in accordance with this subsection and Subsection

(p); and

(2) after the small employer has joined the cooperative, the

total number of eligible employees employed on business days

during the preceding calendar year by all small employers

participating in the cooperative would exceed 50.

(p) A health group cooperative must make the election described

by Subsection (o) at the time the cooperative is initially

formed. Evidence of the election must be filed in writing with

the commissioner in the form and at the time prescribed by the

commissioner by rule.

Added by Acts 2005, 79th Leg., Ch.

728, Sec. 11.051(a), eff. September 1, 2005.

Amended by:

Acts 2005, 79th Leg., Ch.

823, Sec. 2, eff. September 1, 2005.

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

547, Sec. 1, eff. September 1, 2007.

Sec. 1501.0582. HEALTH GROUP COOPERATIVE: EXPEDITED APPROVAL

PROCESS. The department shall develop an expedited approval

process for health benefit plan coverage arranged by a health

group cooperative.

Added by Acts 2005, 79th Leg., Ch.

728, Sec. 11.052(a), eff. September 1, 2005.

Sec. 1501.059. SELF-INSURED OR SELF-FUNDED PLAN PROHIBITED. A

cooperative may not self-insure or self-fund any health benefit

plan or portion of a plan.

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

2005.

Sec. 1501.060. SCOPE OF GROUP COVERAGE. Subchapter B, Chapter

1251, does not limit the type of group that may be covered by a

group health benefit plan issued through a cooperative.

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

2005.

Sec. 1501.061. REQUIREMENTS APPLICABLE TO HEALTH BENEFIT PLAN

ISSUERS WITH WHICH COOPERATIVE MAY CONTRACT. A cooperative may

contract only with a small or large employer health benefit plan

issuer that demonstrates that the issuer:

(1) is in good standing with the department;

(2) has the capacity to administer health benefit plans;

(3) is able to monitor and evaluate the quality and

cost-effectiveness of care and applicable procedures;

(4) is able to conduct utilization management and establish

applicable procedures and policies;

(5) is able to ensure that enrollees have adequate access to

health care providers, including adequate numbers and types of

providers;

(6) has a satisfactory grievance procedure and is able to

respond to enrollees' calls, questions, and complaints; and

(7) has financial capacity, either through satisfying financial

solvency standards, as applied by the commissioner, or through

appropriate reinsurance or other risk-sharing mechanisms.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.053(b), eff. September 1, 2005.

Sec. 1501.062. COOPERATIVE NOT INSURER; AGENTS AND

ADMINISTRATORS. (a) A cooperative is not an insurer and the

employees of the cooperative are not required to be licensed

under Title 13. This exemption from licensure includes a health

group cooperative that acts to provide information about and to

solicit membership in the cooperative, subject to Section

1501.0581(d).

(b) An agent or third-party administrator used and compensated

by a cooperative must be licensed as required by Title 13.

the products and services sponsored by the cooperative without

being appointed by each small or large employer health benefit

plan issuer participating in the cooperative. The agent may not

market any other product or service of a participating small or

large employer health benefit plan issuer that is not sponsored

by the cooperative unless the agent has been appointed by that

issuer.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.052(b), eff. September 1, 2005.

Sec. 1501.063. STATUS AS EMPLOYER. (a) A small employer health

coalition that otherwise meets the description of a small

employer is considered a single small employer for all purposes

under this chapter.

(b) A health group cooperative that is composed of only small

employers, only large employers, or both small and large

employers is considered a single employer under this code.

(b-1) A health group cooperative that is composed only of small

employers and that has made the election described by Section

1501.0581(o)(1) in accordance with Subsection (p) of that section

shall be treated in the same manner as a small employer for the

purposes of this chapter, including for the purposes of any

provision relating to premium rates and issuance and renewal of

coverage.

(b-2) A health group cooperative that is composed only of small

employers and that has not made the election described by Section

1501.0581(o)(1) in accordance with Subsection (p) of that

section, or a health group cooperative that is composed of both

small and large employers, may be treated in the same manner as a

large employer for the purposes of this chapter, including for

the purposes of any provision relating to premium rates and

issuance and renewal of coverage.

(b-3) A health group cooperative shall have sole authority to

make benefit elections and perform other administrative functions

under this code for the cooperative's participating employers.

considered an employer solely for the purposes of benefit

elections under this code.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.052(c), eff. September 1, 2005.

Acts 2005, 79th Leg., Ch.

823, Sec. 3, eff. September 1, 2005.

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

547, Sec. 2, eff. September 1, 2007.

Sec. 1501.064. CERTAIN USE OF APPROPRIATED MONEY PROHIBITED.

The Texas cooperative may not use money appropriated by the state

to pay or otherwise subsidize any portion of the premium for a

small employer covered through the cooperative.

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

2005.

Sec. 1501.065. CERTAIN ACTIONS BASED ON RISK CHARACTERISTICS OR

HEALTH STATUS PROHIBITED. A cooperative may not limit, restrict,

or condition an employer's or employee's membership in a

cooperative or choice among benefit plans based on:

(1) risk characteristics of a group or of any member of a group;

(2) health status related factors, duration of coverage, or any

similar characteristic related to the health status or experience

of a group or of any member of a group.

Added by Acts 2005, 79th Leg., Ch.

728, Sec. 11.053(c), eff. September 1, 2005.

SUBCHAPTER C. PROVISION OF COVERAGE

Sec. 1501.101. GEOGRAPHIC SERVICE AREAS. (a) A small or large

employer health benefit plan issuer must file each of the

issuer's geographic service areas with the commissioner. The

commissioner may disapprove the use of a geographic service area

by a small or large employer health benefit plan issuer.

(b) A small employer health benefit plan issuer that refuses to

issue a small employer health benefit plan in a geographic

service area may not offer a health benefit plan to a small

employer in the applicable service area before the fifth

anniversary of the date of the refusal.

required to offer or issue a small or large employer health

benefit plan to:

(1) a small or large employer that is not located within a

geographic service area of the issuer;

(2) an employee of a small or large employer who neither resides

nor works in the geographic service area of the issuer; or

(3) a small or large employer located within a geographic

service area of the issuer with respect to which area the issuer

demonstrates to the commissioner's satisfaction that the issuer:

(A) reasonably anticipates that it will not have the capacity to

deliver services adequately because of obligations to existing

covered individuals; and

(B) is acting uniformly without regard to the claims experience

of the employer or any health status related factor of employees,

employees' dependents, or new employees or dependents who may

become eligible for the coverage.

(d) A small or large employer health benefit plan issuer that is

unable to offer coverage in a geographic service area in

accordance with a determination made by the commissioner under

Subsection (c)(3) may not offer a small or large employer benefit

plan, as applicable, in that service area before the 180th day

after the later of:

(1) the date the issuer refuses to offer coverage; or

(2) the date the issuer demonstrates to the satisfaction of the

commissioner that it has regained the capacity to deliver

services to small or large employers in the geographic service

area.

(e) If the commissioner determines that requiring the acceptance

of small or large employers under this chapter would place a

small or large employer health benefit plan issuer in a

financially impaired condition and that the issuer is acting

uniformly without regard to the claims experience of the small or

large employer or any health status related factors of eligible

employees, eligible employees' dependents, or new employees or

dependents who may become eligible for the coverage, the issuer

may not offer coverage to small or large employers until the

later of:

(1) the 180th day after the date the commissioner makes the

determination; or

(2) the date the commissioner determines that accepting small or

large employers would not place the issuer in a financially

impaired condition.

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

2005.

Sec. 1501.102. PREEXISTING CONDITION PROVISION. (a) In this

section, "creditable coverage" has the meaning assigned by

Section 1205.004 and includes coverage provided under:

(1) a political subdivision health benefits risk pool; and

(2) a short-term limited duration coverage plan.

(b) A preexisting condition provision in a small or large

employer health benefit plan may apply only to coverage for a

disease or condition for which medical advice, diagnosis, care,

or treatment was recommended or received during the six months

before the earlier of:

(1) the effective date of coverage; or

(2) the first day of the waiting period.

employer health benefit plan may not apply to expenses incurred

on or after the first anniversary of the initial effective date

of coverage of the enrollee, including a late enrollee.

(d) A preexisting condition provision in a small or large

employer health benefit plan may not apply to an individual who

was continuously covered for an aggregate period of 12 months

under creditable coverage that was in effect until a date not

more than 63 days before the effective date of coverage under the

plan, excluding any waiting period.

(e) In determining whether a preexisting condition provision

applies to an individual covered by a small or large employer

health benefit plan, the plan issuer shall credit the time the

individual was covered under previous creditable coverage if the

previous coverage was in effect at any time during the 12 months

preceding the effective date of coverage under the plan. If the

previous coverage was issued under a health benefit plan, any

waiting period that applied before that coverage became effective

must also be credited against the preexisting condition provision

period.

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

2005.

Sec. 1501.103. TREATMENT OF CERTAIN CONDITIONS AS PREEXISTING

PROHIBITED. (a) A small or large employer health benefit plan

issuer may not treat genetic information as a preexisting

condition described by Section 1501.102(b) in the absence of a

diagnosis of the condition related to the information.

(b) A small or large employer health benefit plan issuer may not

treat pregnancy as a preexisting condition described by Section

1501.102(b).

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

2005.

Sec. 1501.104. AFFILIATION PERIOD. (a) In this section,

"affiliation period" means a period that, under a small or large

employer health benefit plan offered by a health maintenance

organization, must expire before the coverage becomes effective.

(b) A health maintenance organization may impose an affiliation

period if the period is applied uniformly without regard to any

health status related factor. The affiliation period may not

exceed:

(1) two months for an enrollee, other than a late enrollee; or

(2) 90 days for a late enrollee.

benefit plan must run concurrently with any applicable waiting

period under the plan. A health maintenance organization must

credit an affiliation period against any preexisting condition

provision period.

(d) During an affiliation period, a health maintenance

organization:

(1) is not required to provide health care services or benefits

to the participant or beneficiary; and

(2) may not charge a premium to the participant or beneficiary.

(e) A health maintenance organization may use an alternative

method approved by the commissioner to address adverse selection.

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

2005.

Sec. 1501.105. WAITING PERIOD PERMITTED. Sections

1501.102-1501.104 do not preclude application of a waiting period

that applies to all new enrollees under a small or large employer

health benefit plan.

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

2005.

Sec. 1501.106. CERTAIN LIMITATIONS OR EXCLUSIONS OF COVERAGE

PROHIBITED. (a) A small or large employer health benefit plan

may not limit or exclude, by use of a rider or amendment

applicable to a specific individual, coverage by type of illness,

treatment, medical condition, or accident.

(b) This section does not preclude a small or large employer

health benefit plan from limiting or excluding coverage for a

preexisting condition in accordance with Section 1501.102.

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

2005.

Sec. 1501.107. DISCOUNTS, REBATES, AND REDUCTIONS. (a) A small

or large employer health benefit plan issuer may establish

premium discounts, rebates, or a reduction in otherwise

applicable copayments, coinsurance, or deductibles, or any

combination of these incentives, in return for participation in

programs promoting disease prevention, wellness, and health.

(b) A discount, rebate, or reduction established under this

section does not violate Section 541.056(a).

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

2005.

Amended by:

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

112, Sec. 3, eff. May 17, 2007.

Sec. 1501.108. RENEWABILITY OF COVERAGE; CANCELLATION. (a)

Except as provided by this section and Section 1501.109, a small

or large employer health benefit plan issuer shall renew the

small or large employer health benefit plan for any covered small

or large employer, as applicable, at the employer's option,

unless:

(1) a premium has not been paid as required by the terms of the

plan;

(2) the employer has committed fraud or has intentionally

misrepresented a material fact;

(3) the employer has not complied with the terms of the plan;

(4) no enrollee in the plan resides or works in the geographic

service area of the small or large employer health benefit plan

issuer or in the area for which the issuer is authorized to do

business; or

(5) membership of the employer in an association terminates, but

only if coverage is terminated uniformly without regard to a

health status related factor of a covered individual.

(b) A small or large employer health benefit plan issuer may

refuse to renew the coverage of a covered employee or dependent

for fraud or intentional misrepresentation of a material fact by

that individual.

cancel a small or large employer health benefit plan except for a

reason specified for refusal to renew under Subsection (a). A

small or large employer health benefit plan issuer may not cancel

the coverage of a covered employee or dependent except for a

reason specified for refusal to renew under Subsection (b).

(d) Notwithstanding Subsection (a), a small or large employer

health benefit plan issuer may modify a small or large employer

health benefit plan if:

(1) the modification occurs at the time of coverage renewal;

(2) the modification is effective uniformly among all small or

large employers covered by that health benefit plan; and

(3) the issuer notifies the commissioner and each affected

covered small or large employer of the modification not later

than the 60th day before the date the modification is effective.

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

2005.

Amended by:

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

891, Sec. 1, eff. September 1, 2007.

Sec. 1501.109. REFUSAL TO RENEW; DISCONTINUATION OF COVERAGE.

(a) A small or large employer health benefit plan issuer may

elect to refuse to renew all small or large employer health

benefit plans delivered or issued for delivery by the issuer in

this state or in a geographic service area approved under Section

1501.101. The issuer shall notify:

(1) the commissioner of the election not later than the 180th

day before the date coverage under the first plan terminates

under this subsection; and

(2) each affected covered small or large employer not later than

the 180th day before the date coverage terminates for that

employer.

(b) A small employer health benefit plan issuer that elects

under this section to refuse to renew all small employer health

benefit plans in this state or in an approved geographic service

area may not write a new small employer health benefit plan in

this state or in the geographic service area, as applicable,

before the fifth anniversary of the date notice is provided to

the commissioner under Subsection (a).

under this section to refuse to renew all large employer health

benefit plans in this state or in an approved geographic service

area may not write a new large employer health benefit plan in

this state or in the geographic service area, as applicable,

before the fifth anniversary of the date notice is provided to

the commissioner under Subsection (a).

(d) A small or large employer health benefit plan issuer may

elect to discontinue a particular type of small or large employer

coverage only if the issuer:

(1) before the 90th day preceding the date of the

discontinuation of the coverage:

(A) provides notice of the discontinuation to the employer and

the commissioner; and

(B) offers to each employer the option to purchase other small

or large employer coverage offered by the issuer at the time of

the discontinuation; and

(2) acts uniformly without regard to the claims experience of

the employer or any health status related factors of eligible

employees, eligible employees' dependents, or new employees or

dependents who may become eligible for the coverage.

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

2005.

Sec. 1501.110. NOTICE TO COVERED PERSONS. (a) A small or large

employer health benefit plan issuer that cancels or refuses to

renew coverage under a small or large employer health benefit

plan under Section 1501.108 or 1501.109 shall, not later than the

30th day before the date termination of coverage is effective,

notify the small or large employer of the cancellation of or

refusal to renew coverage. The employer is responsible for

notifying enrollees in the plan of the cancellation of or refusal

to renew coverage.

(b) The notice provided to a small or large employer by a small

or large employer health benefit plan issuer under this section

is in addition to any other notice required by Section 1501.109.

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

2005.

Sec. 1501.111. WRITTEN STATEMENT OF DENIAL, CANCELLATION, OR

REFUSAL TO RENEW REQUIRED. Denial by a small or large employer

health benefit plan issuer of an application from a small or

large employer for coverage from the issuer or cancellation of or

refusal to renew coverage by a small or large employer health

benefit plan issuer must:

(1) be in writing; and

(2) state the reason or reasons for the denial, cancellation, or

refusal to renew.

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

2005.

SUBCHAPTER D. GUARANTEED ISSUE OF SMALL EMPLOYER HEALTH BENEFIT

PLANS; CONTINUATION OF COVERAGE

Sec. 1501.151. GUARANTEED ISSUE. (a) A small employer health

benefit plan issuer shall issue the small employer health benefit

plan chosen by the small employer to each small employer that

elects to be covered under the plan and agrees to satisfy the

other requirements of the plan.

(b) A small employer health benefit plan issuer shall provide

small employer health benefit plans without regard to health

status related factors.

health coverage for the employer's employees.

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

2005.

Sec. 1501.152. EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT

PROHIBITED. A small employer health benefit plan issuer may not

exclude an eligible employee or dependent, including a late

enrollee, who would otherwise be covered under a small employer

group.

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

2005.

Sec. 1501.153. EMPLOYER CONTRIBUTION. (a) This chapter does

not require a small employer to make an employer contribution to

the premium paid to a small employer health benefit plan issuer,

but the issuer may require an employer contribution in accordance

with the issuer's usual and customary practices applicable to the

issuer's employer group health benefit plans in this state. The

issuer shall apply the employer contribution level uniformly to

each small employer offered or issued coverage by the issuer in

this state.

(a-1) Notwithstanding Subsection (a), a small employer health

benefit plan issuer may offer a small employer the option of a

small employer health benefit plan for which the employer is

required to contribute 100 percent of the premium paid. A plan

offered under this subsection may be offered in addition to a

plan offered by the issuer in accordance with Subsection (a) that

requires a lower percentage of the premium paid to be contributed

by the employer. A plan issued under this subsection must

require the employer to contribute 100 percent of the premium

paid for each eligible participating employee.

(b) If two or more small employer health benefit plan issuers

participate in a purchasing cooperative established under Section

1501.056, each participating issuer may use the employer

contribution requirement established by the cooperative for

policies marketed by the cooperative.

contribution to the premium paid to a small employer health

benefit plan issuer is not required to pay any amount with

respect to an employee who elects not to be covered.

(d) A small employer may elect to pay the premium for additional

coverage.

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

2005.

Amended by:

Acts 2009, 81st Leg., R.S., Ch.

462, Sec. 1, eff. September 1, 2009.

Sec. 1501.154. MINIMUM PARTICIPATION REQUIREMENT. (a) Except

as provided by Section 1501.155, coverage is available under a

small employer health benefit plan if at least 75 percent of a

small employer's eligible employees elect to participate in the

plan.

(b) If a small employer offers multiple health benefit plans,

the collective participation in those plans must be at least:

(1) 75 percent of the employer's eligible employees; or

(2) if applicable, the lower participation level offered by the

small employer health benefit plan issuer under Section 1501.155.

offer a health benefit plan to a small employer that offers

multiple health benefit plans if:

(1) the plans are provided by more than one issuer; and

(2) the issuer would have less than 75 percent of the employer's

eligible employees enrolled in the issuer's plan.

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

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.054(a), eff. September 1, 2005.

Sec. 1501.155. EXCEPTION TO MINIMUM PARTICIPATION REQUIREMENT.

(a) A small employer health benefit plan issuer may offer a

small employer health benefit plan to a small employer with a

participation level of less than 75 percent of the employer's

eligible employees if the issuer permits the same qualifying

participation level for each small employer health benefit plan

offered by the issuer in this state.

(b) A small employer health benefit plan issuer may offer a

small employer health benefit plan to a small employer even if

the employer's participation level is less than the issuer's

qualifying participation level established in accordance with

Subsection (a) if:

(1) the employer obtains a written waiver from each eligible

employee who declines coverage under a health benefit plan

offered to the employer stating that the employee was not induced

or pressured to decline coverage because of the employee's risk

characteristics; and

(2) the issuer accepts or rejects the entire group of eligible

employees who choose to participate and excludes only those

employees who have declined coverage.

the group of eligible employees who do not decline coverage under

Subsection (b).

(d) A small employer health benefit plan issuer may not provide

coverage to a small employer or the employer's employees under

Subsection (b) if the issuer or an agent for the issuer knows

that the employer has induced or pressured an eligible employee

or a dependent of the employee to decline coverage because of the

individual's risk characteristics.

(e) A small employer health benefit plan issuer, a small

employer, or an agent may not use the exception provided by

Subsection (b) to circumvent the requirements of this chapter.

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

2005.

Sec. 1501.156. EMPLOYEE ENROLLMENT; WAITING PERIOD. (a) The

initial enrollment period under a small employer health benefit

plan for employees and dependents must be at least 31 days, with

a 31-day open enrollment period provided annually.

(b) A small employer may establish a waiting period not to

exceed 90 days from the first day of employment.

coverage to a new employee of a covered small employer or the

employee's dependents if the issuer receives an application for

coverage not later than the 31st day after the date employment

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

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