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.