A cooperative must arrange and manage health benefit plan coverage, premium collection, procedures, compliance, and public awareness efforts, and it may also contract for marketing, administration, premium negotiation, and ancillary services.
Sec. 1501.058. POWERS AND DUTIES OF COOPERATIVES. (a) A cooperative shall: (1) arrange for small or large employer health benefit plan coverage for small employer groups, large employer groups, and, subject to Section 1501.0581, eligible single-employee businesses that participate in the cooperative by contracting with small or large employer health benefit plan issuers that meet the requirements established by Section 1501.061; (2) collect premiums to cover the cost of: (A) small or large employer health benefit plan coverage purchased through the cooperative; and (B) the cooperative's administrative expenses; (3) establish administrative and accounting procedures for the operation of the cooperative; (4) establish procedures under which an applicant for or participant in coverage issued through the cooperative may have a grievance reviewed by an impartial person; (5) contract with small or large employer health benefit plan issuers to provide services to small or large employers covered through the cooperative; and (6) develop and implement a plan to maintain public awareness of the cooperative and publicize the eligibility requirements for, and the procedures for enrollment in, coverage through the cooperative. (b) A cooperative may: (1) contract with agents to market coverage issued through the cooperative; (2) contract with a small or large employer health benefit plan issuer or third-party administrator to provide administrative services to the cooperative; (3) negotiate the premiums paid by its members; and (4) offer other ancillary products and services to its members that are customarily offered in conjunction with health benefit plans. (c) A cooperative shall comply with: (1) federal laws applicable to cooperatives and health benefit plans issued through cooperatives, to the extent required by state law or rules adopted by the commissioner; and (2) state laws applicable to cooperatives and health benefit plans issued through cooperatives. (d) To be eligible to exercise the authority granted under Subsection (a)(1), a health group cooperative must have at least 10 participating employers. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.053(a), eff. September 1, 2005. Acts 2011, 82nd Leg., R.S., Ch. 1067 (S.B. 859), Sec. 2, eff. June 17, 2011.