- (a) Charges for any individual's coverage may not be based on the individual's health status.
- (b) The charge by an HMO for individual coverage which has been converted from group coverage shall not exceed 200% of the HMO's group community rate for comparable coverage. The phrase "group community rate" as used herein is the rate which would be charged all persons in the service area if all persons were members of one group, within the parameters set out in §11.706 of this title (relating to Factors To Be Considered in Determination of Reasonability of Rates). The conversion rate is, therefore, based on the experience of all persons in the service area and not on the converting individual's characteristics.
Source Note:The provisions of this §11.704 adopted to be effective January 1, 1980, 4 TexReg 4626; amended to be effective August 17, 1992, 17 TexReg 5359.