Texas Healthcare Insurance laws & HR compliance analysis

Texas Healthcare Insurance: What you need to know

There is no state law requiring employers to offer group health care insurance to their employees, but most employers do offer it. However, if any health care insurance is offered, state insurance laws require policies to cover certain benefits (mandated benefits), give employees the right to continue coverage or convert to an individual policy in certain circumstances if group coverage is lost, limit the operation of certain coverage restrictions, require coverage of dependents pursuant to court orders, and provide special rules for small-employer health insurance plans. There is additional information about continuation and conversion requirements.
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States are not permitted to regulate self-insured benefit plans. Texas's mandated benefits, continuation, and conversion provisions do not apply to health plans in which the employer pays all benefits without the proceeds of any insurance policy. An employer's health plan is self-insured if the risk of paying claims is on the employer and not on an insurance company. Self-insured plans may contract with third-party administrators (TPAs), including insurance companies, to process benefit claims. The TPA pays the claims and then is reimbursed by the employer. Many self-insured plans also buy “stop-loss” insurance to cover very large claims. The purchase of stop-loss insurance does not result in the loss of self-insured status and the exemption from state insurance law regulation.
The Affordable Care Act (ACA) required the establishment of healthcare exchanges to provide individuals and small employers with access to affordable insurance coverage beginning in 2014. States had the ...

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