CHAPTER 1505. GROUP HEALTH INSURANCE PLANS FOR PERSONS 65 YEARS OF AGE OR OLDER
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE G. HEALTH COVERAGE AVAILABILITY
CHAPTER 1505. GROUP HEALTH INSURANCE PLANS FOR PERSONS 65 YEARS
OF AGE OR OLDER
Sec. 1505.001. DEFINITION. In this chapter, "health insurer"
means an insurance company authorized to provide a hospital,
surgical, and medical expense insurance plan in this state,
including:
(1) a stock insurance company;
(2) a reciprocal or interinsurance exchange;
(3) a Lloyd's plan;
(4) a fraternal benefit society;
(5) a stipulated premium company; and
(6) a mutual insurance company, including a statewide mutual
assessment company or a local mutual aid association.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.002. PLANS FOR CERTAIN PERSONS 65 YEARS OF AGE OR
OLDER. (a) Two or more health insurers may provide a hospital,
surgical, and medical expense insurance plan under a group
insurance policy that covers residents of this state who are at
least 65 years of age and the spouses of those residents.
(b) The participating health insurers may enter into agreements
regarding matters within the scope of this chapter, including:
(1) premium rates;
(2) policy provisions; and
(3) sales, administrative, technical, and accounting procedures.
(c) Each participating health insurer is subject to regulation
under the laws of this state and is severally liable on a group
insurance policy issued under this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.003. APPLICATION AND OTHER EVIDENCE OF INSURANCE
FORMS. An application, policy, certificate, or other evidence of
insurance form for an insurance plan under this chapter is
subject to Chapter 1701.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.004. EXECUTION OF POLICY. An authorized person may
execute an insurance policy subject to this chapter on behalf of
the participating health insurers.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.005. USE OF UNINCORPORATED ENTITY. (a) The
participating health insurers may issue the group insurance
policy in their own names or in the name of an unincorporated
association, trust, or other organization formed for the sole
purposes of this chapter and evidenced by a written contract
executed by the insurers. An unincorporated association, trust,
or other organization formed under this subsection may sue and be
sued in the name of the association, trust, or organization.
(b) A person licensed as a general life, accident, and health
agent under Chapter 4054, as a general property and casualty
agent under Chapter 4051 authorized to write health and accident
insurance under Section 4051.053, or as a personal lines property
and casualty agent authorized to write health and accident
insurance under Section 4051.402, may act in the licensed
capacity in connection with an insurance policy or a certificate
of insurance issued by an unincorporated association, trust, or
other organization formed under Subsection (a). The agent is not
required to notify the department that the person has been
appointed to act for that purpose.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
548, Sec. 2.12, eff. September 1, 2007.
Sec. 1505.006. REQUIRED FILINGS; DEPARTMENT APPROVAL. (a) The
participating health insurers shall provide for the filing with
the department on behalf of the insurers of:
(1) a copy of any contract of association or organization or
trust agreement entered into by the insurers under this chapter;
(2) the schedule of premium rates to be charged for the
insurance coverage; and
(3) the plan for operating and marketing the insurance.
(b) Except as provided by Subsection (c), a contract, schedule,
or plan described by Subsection (a) may not be effective until
approved by the commissioner.
(c) A contract, schedule, or plan described by Subsection (a)
that is not approved or disapproved in a written order of the
commissioner on or before the 30th day after the date on which
the document is filed with the department is considered approved
on the 31st day after the date of filing.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.007. EFFECT OF COMMISSIONER DISAPPROVAL. If, after
notice and public hearing, the commissioner determines under
reasonable assumptions that a premium rate charged for the
insurance coverage offered under this chapter or the plan for
operating and marketing that insurance is excessive, inadequate,
or contrary to the public interest or that any activity or
practice performed in connection with the insurance is unfair,
unreasonable, or contrary to the public interest, the
commissioner shall:
(1) enter an order containing the commissioner's determination
and disapproving the premium rate or plan or the activity or
practice; and
(2) require the discontinuance of the premium rate, plan,
activity, or practice within a period that is not less than 30
days after the date of the commissioner's order containing the
determination.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.008. EXEMPTION FROM PREMIUM TAXES. Each premium
received for group insurance coverage authorized by this chapter
is exempt from any premium tax imposed by any other law of this
state.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1505.009. EXEMPTION FROM CERTAIN ANTITRUST REQUIREMENTS.
An association, trust, or other organization formed and operated
in accordance with this chapter or an insurance business
conducted in accordance with this chapter is not considered a
combination in restraint of trade, an illegal monopoly, or an
attempt to lessen competition or fix prices arbitrarily and does
not otherwise violate the antitrust laws of this state.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.