1. (a) Not later than March 1 annually, each health carrier providing health benefit plans in this state shall make a filing with the commissioner indicating whether the health carrier will or will not offer, renew, issue, or issue for delivery health benefit plans to large employers in this state as defined in the Insurance Code, Chapter 26, Subchapters A and H, and this subchapter. The required filing shall include the certification form Form Number 1212 CERT LEHC STATUS, completed according to the carrier's status, and shall at least provide a statement to the effect of one of the following:

   1. (1) the health carrier intends to offer, renew, issue, and issue for delivery health benefit plans to large employers and their employees and therefore will operate in accordance with the Insurance Code, Chapter 26, Subchapters A and H and this subchapter;
   2. (2) the health carrier does not intend to offer, issue, or issue for delivery health benefit plans to large employers and their employees; however, the health carrier intends to renew health benefit plans issued prior to July 1, 1997 and comply with the Insurance Code, Chapter 26, Subchapters A and H, and this subchapter;
   3. (3) the health carrier does not intend to offer, issue, or issue for delivery health benefit plans to large employers and their employees in the State of Texas and intends to nonrenew all health benefit plans issued to large employers in Texas and will provide notice to the commissioner and employers in accordance with §26.309 of this title (relating to Refusal to Renew and Application to Reenter Large Employer Market); or
   4. (4) the health carrier has no health benefit plans issued to large employers or to employees of a large employer which are in force on or after July 1, 1997, and the health carrier does not intend to offer, issue, or issue for delivery health benefit plans to large employers.
2. (b) If a health carrier chooses to change its election or the date of implementing its election under subsection (a)(1), (2), or (4) of this section, the health carrier shall notify the commissioner of its new election at least 30 days prior to the date the health carrier intends to begin operations under the new election. This notification shall be made on Form Number 1212 CERT LEHC STATUS.

3. (c) Upon election to become a large employer carrier, the health carrier shall establish geographic service areas within which the health carrier reasonably anticipates it will have the capacity to deliver services adequately to large employers in each established geographic service area. Large employer carriers shall comply with the following:

   1. (1) The health carrier shall define and submit the geographic service areas in terms of counties or ZIP codes, to the extent possible.
   2. (2) If the health carrier cannot define the service area by counties or ZIP code, the health carrier shall submit a map which clearly shows the geographic service areas.
   3. (3) If the geographic service area of the carrier is the entire state, the carrier shall define the service area as the State of Texas and no other documentation is necessary.
   4. (4) Service areas by zip code shall be defined in a non-discriminatory manner and in compliance with the Insurance Code, Articles 21.21-6 and 21.21-8.
   5. (5) Networks of HMO large employer carriers shall be established in accordance with Chapter 20A, Insurance Code and Chapter 11 of this title (relating to Health Maintenance Organizations).
   6. (6) Large employer carriers shall, no later than the initial filing of a large employer health benefit plan, utilize Form Number 1212 LEHC GEOG to submit this information.
4. (d) If a large employer carrier elects to alter its geographic service area, the large employer carrier shall notify the department of its intent at least 30 days prior to the date the health carrier intends to effect the change. The large employer carrier shall utilize Form Number 1212 LEHC GEOG to submit this information.
5. (e) This section does not exempt a large employer carrier from any other legal requirements, such as those for withdrawal from the market under §§7.1801, et seq. of this title (relating to Withdrawal Plan Requirements and Procedures).

Source Note:The provisions of this §26.302 adopted to be effective March 5, 1998, 23 TexReg 2297; amended to be effective April 6, 2005, 30 TexReg 1931.