1. (a) Small employer health carriers offering a small employer health benefit plan shall file annually, not later than March 1 of each year, an actuarial certification provided at Figure 47 of §26.27(b)(47) of this title (relating to Forms) (Form Number 1212 CERT ACTUARIAL) stating that the underwriting and rating methods of the small employer carrier:

   1. (1) comply with accepted actuarial practices;
   2. (2) are uniformly applied to each small employer health benefit plan covering a small employer; and
   3. (3) comply with the provisions of the Insurance Code, Chapter 26, Subchapters A-G, and this chapter.

2. (b) Not later than March 1 of each calendar year, each health carrier shall file a certification provided at Figure 43 of §26.27(b)(43) of this title (relating to Forms) (Form Number 1212 CERT ANN LIST-OTHER/SEHBP) with the commissioner, stating whether the health carrier is offering any health benefit plan to small employers that is subject to the Insurance Code, Article 26.06(a). The certification shall:

   1. (1) list each other health insurance coverage (including the form number, approval date, and a very brief description of the type of coverage) that the health carrier is offering, delivering, issuing for delivery, or renewing to or through small employers in this state; and is not subject to this chapter because it is listed as excluded from the definition of a health benefit plan under the Insurance Code, Article 26.02, and §26.4 of this title (relating to Definitions);
   2. (2) include a statement that the health carrier is not offering or marketing to small employers as a health benefit plan the coverage listed under the Insurance Code, Article 26.07(b), and paragraph (1) of this subsection, and the health carrier is complying with the provisions of the Insurance Code, Chapter 26, Subchapters A-G, and this subchapter to the extent it is applicable to the health carrier;
   3. (3) list each health benefit plan along with riders (including the form number and approval date) previously filed with the department (or filed through the certification process) which the health carrier is no longer marketing to small employers in the state. If the health carrier no longer wishes to offer the plan, a formal withdrawal of the plan shall be filed and can be accomplished by marking the appropriate blank on the certification provided at Figure 43 of §26.27(b)(43) of this title (relating to Forms) (Form Number 1212 CERT ANN LIST-OTHER/SEHBP); and
   4. (4) list each health benefit plan and rider (including the form number and approval date) previously filed with the department which the health carrier plans to continue marketing to small employers in the state.

3. (c) Not later than March 1 of each calendar year, a small employer carrier shall file with the commissioner Form Number1212 CERT DATA provided at Figure 48 of §26.27(b)(48) of this title (relating to Forms), the following information related to health benefit plans issued by the small employer carrier to small employers in this state:

   1. (1) the number of small employers that were issued and the number of lives that were covered under health benefit plans in the previous calendar year (separated as to newly issued plans and renewals);
   2. (2) the number of small employers that were issued and the number of lives that were covered under the preventive and primary care benefit plan, the in-hospital benefit plan, the standard health benefit plan, basic coverage benefit plan, catastrophic care benefit plan, optional catastrophic care medical savings account plan, HMO preventive and primary care benefit plan, HMO group standard benefit plan and HMO small employer group health benefit plan in the previous calendar year (separated as to newly issued plans and renewals and to class of business);
   3. (3) the number of small employers that were issued and the number of lives that were covered under a prescription drug rider with the preventive and primary care benefit plan, a preventive and primary care benefit rider with the in-hospital benefit plan, an alcohol and drug abuse rider with the basic coverage and catastrophic benefit plans, a mental health benefit rider with the basic coverage and catastrophic care benefit plans, a prescription drug rider with the basic coverage and catastrophic care benefit plans, and a preventive care rider with the basic coverage benefit plan (separately listed as to newly issued plans and renewals, type of rider and type of benefit plan);
   4. (4) the number of small employer health benefit plans in force and the number of lives covered under those plans. This information should be broken down by the zip code of the small employers' principal place of business in the state of Texas;
   5. (5) the number of small employer health benefit plans that were voluntarily not renewed by small employers in the previous calendar year;
   6. (6) the number of small employer health benefit plans that were terminated or nonrenewed (for reasons other than nonpayment of premium) by the health carrier in the previous calendar year;
   7. (7) the number of small employer health benefit plans that were issued to small employers that were uninsured for at least the two months prior to issue; and
   8. (8) the health carrier's gross premiums derived from health benefit plans delivered, issued for delivery, or renewed to small employers in the previous calendar year. For purposes of this subsection, gross premiums shall be the total amount of monies collected by the health carrier for health benefit plans during the applicable calendar year or the applicable calendar quarter. Gross premiums shall include premiums collected for individual and group health benefit plans issued to small employers or their employees. Gross premiums shall also include premiums collected under certificates issued or delivered to employees (in this state) of small employers, regardless of where the policy is issued or delivered.

Source Note:The provisions of this §26.20 adopted to be effective December 30, 1993, 18 TexReg 9375; amended to be effective April 9, 1996, 21 TexReg 2648; amended to be effective March 5, 1998, 23 TexReg 2297.