The purposes of this subchapter are to provide for the circumstances under which, and the constraints within which, a group health benefit plan issuer or an accident and health insurance issuer may:
- (1) vary benefits, including cost-sharing mechanisms such as a deductible, copayment, or coinsurance, based on whether an individual has met the standards of a wellness program that satisfies the requirements of §21.4706 or §21.4707 of this subchapter (relating to Wellness Programs With Participation as Sole Basis for Reward Eligibility and Wellness Programs With Reward Eligibility Based on Satisfying a Health Status Related Standard); and/or
- (2) vary the amount of premium or contribution it requires similarly situated individuals to pay based on whether an individual has met the standards of a wellness program that satisfies the requirements of §21.4706 or §21.4707 of this subchapter.
Source Note:The provisions of this §21.4704 adopted to be effective March 31, 2009, 34 TexReg 2135.