Section 26.512 - Application, Initial Certification of Eligibility, and Enrollment(a) Applications from employers applying for qualifying group health benefit plans must be made directly to a participating health benefit plan issuer. For purposes of submission acknowledgment, a participating health benefit plan issuer shall maintain a record of the date and time it receives an employer application for coverage under a qualifying group health benefit plan.(b) A participating health benefit plan issuer shall provide all necessary information, including application and enrollment forms to applicants on request.(c) A participating health benefit plan issuer:(1) Shall collect the initial employer eligibility certifications required by the Insurance Code § 1508.151;(2) May collect appropriate documentation in support of a certification as provided in the Insurance Code § 1508.151(c);(3) Shall be responsible for examination of such employer eligibility certifications and any supporting documentation to verify that applicants meet applicable eligibility requirements; and(4) Shall base verification upon review of the employer certification and any supporting documentation requested and received.(d) The commissioner may prescribe a standardized health benefit plan application form that includes an employer eligibility certification section. (1) The commissioner may, as part of such standardized application form process, prescribe a standardized notification form to be utilized by a participating health benefit plan issuer to inform a small employer applicant about submission of an incomplete application, and actions necessary to complete the application.(2) A participating health benefit plan issuer must use any standardized application form that may be prescribed by the commissioner.(e) A qualified group health benefit plan must provide employees with an initial enrollment period that is at least 31 days in length, and at least one open enrollment period annually that is at least 31 days in length.(f) Unless the commissioner suspends enrollment in the Healthy Texas Program pursuant to the Insurance Code § 1508.258, or limits the dates on which a health benefit plan issuer must accept employer applications pursuant to the Insurance Code § 1508.152, all applicants meeting eligibility criteria shall be accepted and coverage must be issued on the first day of the month following the month in which a complete application has been submitted if such completed application has been submitted on or prior to the 20th day of the month of application. For complete applications submitted after the 20th day of a month, coverage shall be issued no later than the first day of the second month following the date of complete submission.(g) A participating health benefit plan issuer shall provide to applicants who have failed to demonstrate eligibility a written notice of denial which clearly states the basis for the denial within two weeks of receipt of the completed initial employer eligibility certification or renewal certification and supporting documentation.(h) A participating health benefit plan issuer must submit, monthly or at other intervals as determined reasonable and necessary by the commissioner, enrollment reports in the format specified by the commissioner. Pursuant to the Insurance Code § 1508.154, such reports shall be submitted to the commissioner within a reasonable time frame as set by the commissioner.(i) In the event that the enrollment in the small employer Healthy Texas Program is suspended by the commissioner pursuant to the Insurance Code § 1508.258, a participating health benefit plan issuer shall: (1) notify applicants that enrollment has been suspended; and(2) maintain a waiting list to be filled in the order of receipt of application in the event that enrollment is reactivated.(j) An enrollment suspension pursuant to the Insurance Code § 1508.258 shall not preclude the addition of dependents or new employees to existing qualifying group health benefit plans.28 Tex. Admin. Code § 26.512
The provisions of this §26.512 adopted to be effective March 16, 2010, 35 TexReg 2174