AI-assisted research summary: A small employer health benefit plan issuer must rate small-employer plans consistently, limit case characteristics used without the commissioner’s prior approval, and not move a small employer into or out of a class of business unfairly.
Sec. 1501.210. PREMIUM RATES: NONDISCRIMINATION. (a) A small employer health benefit plan issuer shall apply rating factors, including case characteristics, consistently with respect to all small employers in a class of business. Rating factors must produce premium rates for identical groups that: (1) differ only by the amounts attributable to health benefit plan design; and (2) do not reflect differences because of the nature of the groups assumed to select particular health benefit plans. (b) A small employer health benefit plan issuer shall treat each health benefit plan issued or renewed in the same calendar month as having the same rating period. (c) Without the prior approval of the commissioner, a small employer health benefit plan issuer may not use case characteristics other than: (1) the geographic area in which the small employer's employees reside; (2) the age and gender of the individual employees and their dependents; (3) the number of employees and dependents; and (4) the appropriate industry classification. (d) Premium rates for a small employer health benefit plan must comply with the requirements of this chapter, notwithstanding any assessment paid or payable by a small employer health benefit plan issuer. (e) A small employer health benefit plan issuer may not transfer a small employer involuntarily into or out of a class of business. The issuer may not offer to transfer a small employer into or out of a class of business unless the offer is made to transfer all other small employers in the employer's class of business without regard to case characteristics, claims experience, health status, or duration of coverage since the issuance of the health benefit plan. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.