Tex. Ins. Code Section 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 (H.B. 2018), Sec. 11.053(b), eff. September 1, 2005.

Source: Section 1501.061 — Requirements Applicable to Health Benefit Plan Issuers with Which Cooperative May Contract, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1501.htm#1501.061 (accessed Jun. 5, 2024).

1501.001
Short Title 1501.002
Definitions 1501.003
Applicability: Small Employer Health Benefit Plans 1501.004
Applicability: Large Employer Health Benefit Plans 1501.005
Exception: Certain Individually Underwritten Policies 1501.006
Certification 1501.007
Affiliates 1501.008
Late Enrollees 1501.009
School District Election 1501.010
General Rules 1501.011
Determination of Employer Status for Certain Employers 1501.051
Definitions 1501.052
Texas Health Benefits Purchasing Cooperative 1501.053
Texas Health Benefits Purchasing Cooperative: Executive Director and Other Employees 1501.054
Regional Subdivisions of Texas Health Benefits Purchasing Cooperative 1501.055
Applicability of Public Information Law to Texas Health Benefits Purchasing Cooperative 1501.056
Private Purchasing Cooperatives and Health Group Cooperatives 1501.057
Immunity 1501.058
Powers and Duties of Cooperatives 1501.059
Self-insured or Self-funded Plan Prohibited 1501.060
Scope of Group Coverage 1501.061
Requirements Applicable to Health Benefit Plan Issuers with Which Cooperative May Contract 1501.062
Cooperative Not Insurer 1501.063
Status as Employer 1501.064
Certain Use of Appropriated Money Prohibited 1501.065
Certain Actions Based on Risk Characteristics or Health Status Prohibited 1501.066
Election to Treat Participating Employers Separately for Rating Purposes 1501.067
Eligible Single-employee Business 1501.0095
School District Employee Election 1501.101
Geographic Service Areas 1501.102
Preexisting Condition Provision 1501.103
Treatment of Certain Conditions as Preexisting Prohibited 1501.104
Affiliation Period 1501.105
Waiting Period Permitted 1501.106
Certain Limitations or Exclusions of Coverage Prohibited 1501.107
Discounts, Rebates, and Reductions 1501.108
Renewability of Coverage 1501.109
Refusal to Renew 1501.110
Notice to Covered Persons 1501.111
Written Statement of Denial, Cancellation, or Refusal to Renew Required 1501.151
Guaranteed Issue 1501.152
Exclusion of Eligible Employee or Dependent Prohibited 1501.153
Employer Contribution 1501.154
Minimum Participation Requirement 1501.155
Exception to Minimum Participation Requirement 1501.156
Employee Enrollment 1501.157
Coverage for Newborn Children 1501.158
Coverage for Adopted Children 1501.159
Continuation of Coverage for Certain Dependents 1501.201
Definitions 1501.202
Establishment of Classes of Business 1501.203
Establishment of Classes of Business on Certain Bases Prohibited 1501.204
Index Rates 1501.205
Premium Rates: Establishment 1501.206
Premium Rates: Adjustments 1501.207
Premium Rate Adjustment in Closed Plan 1501.208
Premium Rates: Industry Classification 1501.209
Premium Rates: Number of Employees 1501.210
Premium Rates: Nondiscrimination 1501.211
Rules Concerning Premium Rates 1501.212
Restricted Provider Network 1501.213
Premium Rates: Health Maintenance Organization Health Benefit Plan 1501.214
Enforcement 1501.215
Reporting Requirements 1501.216
Premium Rates: Notice of Increase 1501.251
Exception from Certain Mandated Benefit Requirements 1501.252
Health Benefit Plans 1501.254
Alcohol and Substance Abuse Benefits 1501.255
Health Maintenance Organization Plans 1501.256
Coordination with Federal Law 1501.257
Cost Containment 1501.258
Forms 1501.259
Riders 1501.260
Plain Language Required 1501.301
Definitions 1501.302
Texas Health Reinsurance System 1501.303
System Board of Directors 1501.304
Open Meetings 1501.305
Board Member Immunity 1501.306
System Plan of Operation 1501.307
System Powers 1501.308
System Notes as Legal Investment for Small Employer Health Benefit Plan Issuer 1501.309
System Audit 1501.310
Election of Status 1501.311
Change in Status 1501.312
Application to Operate as Risk-assuming Health Benefit Plan Issuer 1501.313
Rescission of Approval to Operate as Risk-assuming Health Benefit Plan Issuer 1501.314
Reinsurance 1501.315
Limits on Reinsurance 1501.316
Termination of Reinsurance 1501.317
Application of Managed Care Procedures 1501.318
Premium Rates for Reinsurance 1501.319
Determination of Net Loss 1501.320
Assessments to Recover Net Losses 1501.321
Limits on Assessments 1501.322
Adjustment to Assessments on Federally Qualified Health Maintenance Organizations 1501.323
Advance Interim Assessments 1501.324
Limit on Total Assessments 1501.325
Estimate of Assessments 1501.326
Deferment of Assessment 1501.351
Marketing Requirements 1501.352
Health Status and Claims Experience 1501.353
Agent Compensation 1501.354
Required Disclosures 1501.355
Rules Concerning Marketing and Availability 1501.356
Reporting Requirements 1501.357
Violations 1501.358
Applicability to Third-party Administrator 1501.0575
Voluntary Participation by Issuer in Cooperative 1501.0581
Special Provisions Relating to Health Group Cooperatives 1501.0582
Health Group Cooperative: Expedited Approval Process 1501.601
Participation Criteria 1501.602
Coverage Requirements 1501.603
Exclusion of Eligible Employee or Dependent Prohibited 1501.604
Declining Coverage 1501.605
Minimum Contribution or Participation Requirements 1501.606
Employee Enrollment 1501.607
Coverage for Newborn Children 1501.608
Coverage for Adopted Children 1501.609
Coverage for Unmarried Children 1501.610
Premium Rates 1501.611
Marketing Requirements 1501.612
Encouraging Exclusion of Employee Prohibited 1501.613
Agents 1501.615
Additional Reporting Requirements 1501.616
Applicability to Third-party Administrator 1501.2561
Waiver of Certain Federal Requirements 1501.3021
Authorization of Operation 1501.3022
Suspension of Operation

Accessed:
Jun. 5, 2024

§ 1501.061’s source at texas.gov

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Location: https://texas.public.law/statutes/tex._ins._code_section_1501.061

Original Source: Section 1501.061 — Requirements Applicable to Health Benefit Plan Issuers with Which Cooperative May Contract, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1501.htm#1501.061 (last accessed Jun. 5, 2024).