Section 7.1917 - Comprehensive Health Benefit Plans(a) This section applies only to a multiple employer welfare arrangement (MEWA) that offers or seeks to offer a comprehensive health benefit plan and that: (1) was issued an initial certificate of authority under §846.054, concerning Issuance of Initial Certificate of Authority, on or after January 1, 2024; or(2) elects to be bound by Insurance Code §846.0035, concerning Applicability of Certain Laws to Association Providing Health Benefits, under §7.1916 of this title (relating to Election for the Application of Certain Laws).(b) The MEWA must submit a form signed and dated by an authorized officer or trustee to the department that includes the following:(1) a statement that is substantially similar to the following: "This document is being submitted in accordance with 28 Texas Administrative Code §7.1917. {MEWA Name} will provide a comprehensive health benefit plan as defined by 28 Texas Administrative Code § 7.1902"; and(2) if the comprehensive health benefit plan is not structured as a preferred provider benefit plan or an exclusive provider benefit plan as defined in Insurance Code §1301.001, concerning Definitions, a description of the health care provider and benefit structure of the plan and an explanation of how it does not qualify as a preferred provider benefit plan or an exclusive provider benefit plan.(c) In addition to the form required in subsection (b) of this section, the MEWA must submit the following: (1) a detailed compliance plan addressing the following requirements:(A) Insurance Code Chapter 421, concerning Reserves in General;(B) Insurance Code Chapter 422, concerning Asset Protection Act;(C) Insurance Code Chapter 1451, Subchapter C, concerning Selection of Practitioners; Subchapter F, concerning Access to Obstetrical or Gynecological Care; and Subchapter K, concerning Health Care Provider Directories; and(D) Insurance Code Chapter 4201, concerning Utilization Review Agents;(2) if the MEWA provides a comprehensive health benefit plan that is structured in the manner of a preferred provider benefit plan or an exclusive provider benefit plan as defined in Insurance Code §1301.001, concerning Definitions, a detailed compliance plan addressing the following requirements:(A) Insurance Code Chapter 1301, concerning Preferred Provider Plans; and(B) Insurance Code Chapter 1467, concerning Out-of-Network Claim Dispute Resolution; and(3) for each comprehensive health benefit plan that will be sponsored by the MEWA, an opinion from an attorney attesting to the fact that the plan is in compliance with all applicable federal and state laws. The opinion must adequately explain how each plan complies with the Employee Retirement Income Security Act of 1974 (29 United States Code § 1001 et seq.) and the Patient Protection and Affordable Care Act (42 United States Code § 18001 et seq.), including how each plan complies with federal requirements applicable to large group, small group, or individual markets, as applicable.(d) A MEWA may use the MEWA forms accessible on the department's website at www.tdi.texas.gov/forms as a resource to comply with the requirements in subsections (b) and (c) of this section.28 Tex. Admin. Code § 7.1917
Adopted by Texas Register, Volume 49, Number 44, November 1, 2024, TexReg 8730, eff. 11/6/2024