1. (a) Upon request, each large employer purchasing health benefit plans shall be given a summary of all plans for which the employer is eligible.
2. (b) Denial by a large employer carrier of an application for coverage or cancellation, or refusal to renew must be in writing and must state with specificity the reasons for the denial, cancellation, or refusal to renew (subject to any restrictions related to confidentiality of medical information). The large employer carrier shall notify the large employer in accordance with Insurance Code, Articles 26.87 and 26.88.
3. (c) A large employer carrier may not require, as a condition to the offer or sale of a health benefit plan to a large employer, that the large employer purchase or qualify for any other insurance product or service.
4. (d) The large employer carrier shall not require a large employer to join or contribute to any association or group as a condition of being accepted for coverage by the large employer carrier, except that, if membership in an association or other group is a requirement for accepting a large employer into a particular health benefit plan, a large employer carrier may apply such requirement, subject to the requirements of the Insurance Code, Chapter 26, Subchapters A and H.

5. (e) Health carriers offering individual and group health benefit plans in this state shall be responsible for determining whether the plans are subject to the requirements of the Insurance Code, Chapter 26, Subchapters A and H, and this subchapter. Health carriers shall elicit the following information from applicants for such plans at the time of application:

   1. (1) whether or not any portion of the premium will be paid by a large employer;
   2. (2) whether or not the prospective policyholder, certificate holder, or any prospective insured individual intends to treat the health benefit plan as part of a plan or program under §162 or §106 of the United States Internal Revenue Code of 1986 (26 United States Code §106 or §162); or
   3. (3) whether or not the applicant is a large employer.
6. (f) If a health carrier fails to comply with subsection (f) of this section, the health carrier shall be deemed to be on notice of any information that could reasonably have been attained if the health carrier had complied with subsection (f) of this section.

Source Note:The provisions of this §26.307 adopted to be effective March 5, 1998, 23 TexReg 2297.