CHAPTER 1207. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE A. HEALTH COVERAGE IN GENERAL
CHAPTER 1207. ENROLLMENT OF MEDICAL ASSISTANCE RECIPIENTS AND
CHILDREN ELIGIBLE FOR STATE CHILD HEALTH PLAN
Sec. 1207.001. APPLICABILITY OF CHAPTER. This chapter applies
only to a group health benefit plan, including a small employer
health benefit plan written under Chapter 1501, a plan provided
under Chapter 1551, 1575, or 1601, or a successor to a plan
provided under one of those chapters, or a medical savings
account plan or other health reimbursement arrangement authorized
by law, that provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or
sickness, including a group, blanket, or franchise insurance
policy or insurance agreement, a group hospital service contract,
or a group evidence of coverage or similar group coverage
document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating under Chapter
842;
(3) a fraternal benefit society operating under Chapter 885;
(4) a stipulated premium company operating under Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a health maintenance organization operating under Chapter
843;
(7) a multiple employer welfare arrangement that holds a
certificate of authority under Chapter 846; or
(8) an approved nonprofit health corporation that holds a
certificate of authority under Chapter 844.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.025(a), eff. September 1, 2005.
Sec. 1207.002. ENROLLMENT REQUIRED. (a) A group health benefit
plan issuer shall permit an individual who is otherwise eligible
for enrollment in the plan to enroll in the plan, without regard
to any enrollment period restriction, on receipt of written
notice from the Health and Human Services Commission that the
individual is:
(1) a recipient of medical assistance under the state Medicaid
program and is a participant in the health insurance premium
payment reimbursement program under Section 32.0422, Human
Resources Code; or
(2) a child eligible for the state child health plan under
Chapter 62, Health and Safety Code, and eligible to participate
in the health insurance premium assistance program under Section
62.059, Health and Safety Code.
(b) A group health benefit plan issuer shall permit an
individual who is otherwise eligible for enrollment in the plan
to enroll in the plan, without regard to any enrollment period
restriction, if the individual:
(1) becomes ineligible for medical assistance under the state
Medicaid program or enrollment in the state child health plan
under Chapter 62, Health and Safety Code, after initially
establishing eligibility; and
(2) provides a written request for enrollment in the group
health benefit plan not later than the 30th day after the date
the individual's eligibility for the state Medicaid program or
the state child health plan terminated.
(c) If an individual described by Subsection (a)(1) or (2) or
Subsection (b) is not eligible to enroll in the group health
benefit plan unless a family member of the individual is also
enrolled in the plan, the plan issuer, on receipt of written
notice under Subsection (a) or a written request under Subsection
(b), shall enroll both the individual and the family member in
the plan.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.026(a), eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
268, Sec. 24(a), eff. September 1, 2007.
Sec. 1207.003. EFFECTIVE DATE OF ENROLLMENT. (a) Unless
enrollment occurs during an established enrollment period,
enrollment in a group health benefit plan under Section 1207.002
takes effect on:
(1) the eligibility enrollment date specified in the written
notice from the Health and Human Services Commission under
Section 1207.002(a); or
(2) the first day of the first calendar month that begins at
least 30 days after the date written notice or a written request
is received by the plan issuer under Section 1207.002(a) or (b),
as applicable.
(b) Notwithstanding Subsection (a), the individual must comply
with a waiting period required under the state child health plan
under Chapter 62, Health and Safety Code, or under the health
insurance premium assistance program under Section 62.059, Health
and Safety Code, as applicable.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.026(a), eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
268, Sec. 24(b), eff. September 1, 2007.
Sec. 1207.004. TERMINATION OF ENROLLMENT. (a) Notwithstanding
any other requirement of a group health benefit plan, the plan
issuer shall permit an individual who is enrolled in the plan
under Section 1207.002(a)(1), and any family member of the
individual enrolled under Section 1207.002(c), to terminate
enrollment in the plan not later than the 60th day after the date
on which the individual provides satisfactory proof to the issuer
that the individual is no longer:
(1) a recipient of medical assistance under the state Medicaid
program; or
(2) a participant in the health insurance premium payment
reimbursement program under Section 32.0422, Human Resources
Code.
(b) Notwithstanding any other requirement of a group health
benefit plan, the plan issuer shall permit an individual who is
enrolled in the plan under Section 1207.002(a)(2), and any family
member of the individual enrolled under Section 1207.002(c), to
terminate enrollment in the plan not later than the 60th day
after the date on which the individual provides a written request
to disenroll from the plan because the individual no longer
wishes to participate in the health insurance premium assistance
program under Section 62.059, Health and Safety Code.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.026(a), eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch.
268, Sec. 24(c), eff. September 1, 2007.