Tex. Ins. Code Section 1252.003
Coverage Issued on Group-type Basis

(a)

For purposes of this chapter, health benefit plan coverage is provided on a group-type basis if:

(1)

the plan provides coverage under an insurance policy or subscriber contract to a class of employees or a class of members of a labor union or members of an association and the class is determined by conditions relating to their employment or to their membership in the union or association;

(2)

coverage under the plan is not available to the general public and can be obtained and maintained only because of the covered individual’s employment status or membership in a labor union or an association;

(3)

premiums or subscription charges for the plan are paid to the carrier on an aggregate or bulk-payment basis; and

(4)

the plan is sponsored by:

(A)

the employer of the class of employees covered by the plan; or

(B)

the labor union or an association to which the class of members covered by the plan belongs.

(b)

Health benefit plan coverage is not provided on a group-type basis if it is a salary-budget plan using individual insurance policies or subscriber contracts that do not meet the conditions for group-type coverage specified by Subsection (a).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1252.003 — Coverage Issued on Group-type Basis, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1252.­htm#1252.­003 (accessed May 26, 2025).

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May 26, 2025

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