AI-assisted research summary: The board must file an annual assessment estimate with the commissioner by March 1, and must report and evaluate the system by April 1 if assessments exceed a 5% threshold. If the board misses the report deadline, the commissioner may step in. Reinsured health benefit plan issuers may not cede additional eligible lives when the stated 5% conditions are met.
Sec. 1501.325. ESTIMATE OF ASSESSMENTS; EVALUATION AND PROTECTION OF SYSTEM. (a) Not later than March 1 of each year, the board shall file with the commissioner an estimate of the assessments necessary to fund the losses for small employer groups incurred by the system during the preceding calendar year. (b) If the board determines that the necessary assessments exceed five percent of the total premiums earned in the preceding calendar year from small employer health benefit plans delivered or issued for delivery by reinsured health benefit plan issuers to small employer groups in this state, the board shall evaluate the operation of the system and shall report its findings, including any recommendations for changes to the plan of operation, to the commissioner not later than April 1 of the year following the calendar year in which the losses were incurred. The evaluation must: (1) include an estimate of future assessments; and (2) consider: (A) the administrative costs of the system; (B) the appropriateness of the premiums charged; (C) the level of health benefit plan issuer retention under the system; and (D) the costs of coverage for small employer groups. (c) If the board fails to timely file a report required by Subsection (b), the commissioner may: (1) evaluate the operations of the system; and (2) implement amendments to the plan of operation that the commissioner considers necessary to reduce future losses and assessments. (d) A reinsured health benefit plan issuer may not cede additional eligible lives to the system during a calendar year if the assessment amount payable for the preceding calendar year is at least five percent of the total premiums earned in that calendar year from small employer health benefit plans delivered or issued for delivery by reinsured health benefit plan issuers in this state. (d-1) Expired. (e) A reinsured health benefit plan issuer may not cede additional eligible lives to the system after the board determines that the expected loss from the reinsurance system for a year will exceed the total amount of assessments payable at a rate of five percent of the total premiums earned for the preceding calendar year. A reinsured health benefit plan issuer may not resume ceding additional eligible lives to the system until the board determines that the expected loss will be less than the maximum established by this subsection. (e-1) Expired. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 823 (S.B. 805), Sec. 5, eff. September 1, 2005.