Texas § IN.1501.108 - RENEWABILITY OF COVERAGE

§ IN.1501.108. RENEWABILITY OF COVERAGE

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. (c) A small or large employer health benefit plan issuer may not 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 in accordance with Section 1369.0541 or 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 (H.B. 2467 ), Sec. 1, eff. September 1, 2007. Acts 2011, 82nd Leg., R.S., Ch. 501 (H.B. 1405 ), Sec. 8, eff. September 1, 2011.