Texas Risk Pool Insurance Rates

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Texas Health Insurance Risk Pool

BlueExtrasSM —- Use your Pool ID card to take advantage of discounts on health and wellness services, including vision, hearing, weight management and vitamins. To learn more, log on to BlueAccess for Members, click on the My Coverage tab and the BlueExtrasSM Discount Program.

The next meeting of the Board of Directors will be held on Friday, October 26, 2007 in Austin, Texas. The Agenda will be posted here as well as on the Secretary of State’s Texas Register Open Meetings website. If you need information prior to the posting, please contact [email protected].

Currently, medicine in the USA is one of the leading and most expensive in the world. Even Americans have difficulties getting medical insurance and providing medical a-sistance. Only children under 19 years old can receive free medical services. To save on health care, many Americans travel to Mexico. Tourists who come to the United States […]

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Texas High Risk Pool - Texas Health Insurance Pools - Shavi Tech

Category: Insurance Pool

The Texas Legislature created the Texas Health Insurance Pool, a good way to offer medical insurance to Texas residents that meet certain criteria. This

The Texas Legislature created the Texas Health Insurance Pool, a good way to offer medical insurance to Texas residents that meet certain criteria. This program is geared towards humans who cannot gain different medical insurance from business insurers because of existing medical conditions. The high-risk pool in Texas also guarantees coverage portability to folks who lose insurance under a corporation plan, national plan, or church plan. It is a protection net for humans with pre-existing health situations that have been denied coverage from different businesses even though they may find the money for the charges. As of August 2010, there are 26,762 human beings enrolled within the Texas High-Risk Pool.

Not most effective does the Texas High-Risk Pool provide medical health insurance to people with pre-current clinical conditions, but also to humans that lately lost their organization-sponsored insurance. If a person cannot attain conventional medical insurance, then the Texas High-Risk Pool is most in all likelihood the next most comprehensive coverage alternative. The Health Pool gives primary clinical insurance. This is very much like what is offered at the commercial stage with various specialists and services. The rates are determined via the insured’s gender, age, residential ZIP code, and tobacco use. Health repute isn’t always a subject for this program. However, the fees can be as much as double the standard charges determined within the man or woman health insurance marketplace.

To enroll within the Texas High-Risk Pool, someone has to fulfill a few necessities, including evidence of citizenship and documented evidence of preceding problems obtaining insurance. There can also be a query regarding the closing time the applicant had complete coverage medical insurance. If all necessities are met, an application can be completed. Applications can be published from a pc and mailed in, or the software can be completed online.

Read loads of records approximately the plan, eligibility necessities, rates, deductions, and all different factors of the Texas High-Risk Pool insurance software. Then decide if it is the proper plan for you. Continue to display the health care industry as various healthcare initiatives are coming down the belt, strengthening and increasing the nation’s excessive danger swimming pools and implementing a brand new Pre-Existing Condition Insurance plan that can be had in every country. This new coverage plan isn’t predicted to take the vicinity of the Texas High-Risk Pool.

Fibromyalgia is a difficult, persistent medical condition with many painful symptoms and few answers concerning its reason. Perhaps you have suffered for years with unexplainable muscle ache and discomfort, a persistent feeling of being tired, in addition to trouble sound asleep. These are the maximum not unusual signs of the ailment, but the severity and extent of the circumstance range from individual to man or woman. Finally, getting an analysis of fibromyalgia after years of those symptoms might seem like a bit of victory. However, the victory probably will be quick-lived once you discover that the condition is continual and has no recognized remedy. That is why it’s so crucial that if you are experiencing symptoms that include the ones listed above, you need to recollect your health insurance picks cautiously.

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Texas Health Insurance Pool Company - Health Insurance Providers

A review of the Texas Health Insurance Pool Company finds the Texas Health Insurance Pool, a program created by the Texas Legislature in 1989. The Pool wasn’t given funding until 1997, at which time the original program was amended and provided with startup expenses. The Texas Health Insurance Pool only covers a small percentage of […]

The Texas Health Insurance Pool only covers a small percentage of customers, so if you are looking for health insurance quotes, please type your zip code into the box on this page.

The purpose of the Pool is to help provide health insurance coverage to Texans who otherwise would not qualify for health insurance because of their medical condition. It also covers people who are eligible under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). A Board of Directors, appointed by the Texas Insurance Commissioner, manages the Texas Health Insurance Pool.

The Pool’s Board of Directors consists of nine members, representing the insurance industry, the public, and the medical community. Public members may either be those that benefit from the Pool, or their parents, or anybody else not affiliated with a medical or insurance company.

At the end of 2010, nearly half of all Pool enrollees qualified under HIPAA guidelines. The plan collected $215 million in premiums, while paying out nearly $304 million in claims. The Texas Health Insurance Pool makes up the shortfall through a-sessments to health insurance providers.

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2023 Medicare Advantage Plans Change Recap Video

1:08:26 - 2 years ago

How do the plans change across the country's? What are the new benefits companies are offering? What plan might be the best in ...

Texas Automobile Insurance Plan A-sociation (TAIPA) - ValuePenguin

Texas Automobile Insurance Plan Association (TAIPA) - ValuePenguin

The TAIPA was established to help ensure motorists in Texas is carrying auto insurance as mandated by the law. Motorists who have been rejected by multiple insurers may find their last option here.

According to the Texas Safety Responsibility Act (also known as the Financial Responsibility Law), all drivers in Texas need to be financially responsible for operating their motor vehicles, which means that they must possess the state minimum coverage of auto insurance. High-risk drivers are occasionally not eligible to purchase insurance in the standard and voluntary market. Texas drivers who can certify that they have been rejected for insurance by two companies within 60 days are eligible for coverage through TAIPA.

The Texas Automobile Insurance Plan A-sociation was established in 1952 to provide high-risk drivers, who have been deemed ineligible by companies in the voluntary auto insurance market, with insurance so that they are able to meet the state requirement.

Once a motorist’s application has been accepted by the TAIPA, they are placed into a residual pool consisting of insurance companies licensed to write automobile insurance in Texas that are members of the A-sociation. Each member company of the A-sociation has to accept a certain amount of drivers each year from the residual pool in order to meet an annual quota. A member company that has 10% of the Texas auto insurance market share will be allocated 10% of the high-risk drivers from the residual pool.

For example, State Farm Mutual Automobile Insurance had 19.2% of the Texas auto insurance market share in 2013, which means that 19.2% of the high-risk drivers in the residual pool should be a-signed to State Farm. A motorist in the pool has a good chance of being a-signed to a large, national insurance company. If a member company fails to report data to TAIPA, the consequence is a larger number of drivers a-signed to them from the residual pool.

Regardless of which carrier a motorist is a-signed to by TAIPA, the coverage that will be offered is universally the same. TAIPA offers very basic coverage, but it costs much more than identical coverage policies in the voluntary market. Thus the number of drivers in TAIPA’s residual pool has decreased over time, as motorists have been able to find cheaper auto insurance with TX companies that specialize in insuring high-risk drivers. In 2014, only 3,628 motorists applied for coverage with TAIPA, which suggests that most high-risk drivers were able to find reasonable policies within the voluntary market.

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Does homeowners insurance cover swimming pools?

Summer is the time for getting the most out of your swimming pool. Take a minute to review your homeowners insurance to make sure you're fully covered if you have a pool.

Summer is the time for getting the most out of your swimming pool. Take a minute to review your homeowners insurance to make sure you're fully covered if you have a pool. Here are five things to think about when reviewing your insurance:

Some insurers will not renew coverage for a pool that hasn’t been properly maintained. Also, coverage for trees, shrubs, plants and lawns can be limited. If you put in decks or landscaping around the pool, consider including its value in your policy, too.

If you want to rent out your pool, but not the house, you probably need specific coverage. Work with your insurance company to find the right amount of coverage for renting out your pool.

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INSURANCE CODE CHAPTER 1510. TEMPORARY HEALTH INSURANCE RISK POOL

Category: INSURANCE RISK POOL

Sec. 1510.003. PURPOSE OF POOL. (a) The exclusive purpose of the pool is to provide a temporary mechanism to a-sist residents of this state in obtaining access to quality, guaranteed issue health coverage at minimum cost to the public.

(b) The pool may not be used to expand the Medicaid program, including the program administered under Chapter 32, Human Resources Code, and the program administered under Chapter 533, Government Code.

(c) The pool may not be used in a manner that requires this state to a-sume functions currently performed by the United States Department of Health and Human Services or the United States Internal Revenue Service under the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), including establishing an exchange or administering premium tax credits.

(b) If necessary to ensure access to quality individual health insurance coverage for individuals with preexisting conditions, the commissioner may take actions necessary to establish a temporary high risk pool substantially similar to the risk pool authorized by former Chapter 1506, Insurance Code, repealed by Chapter 615 (S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013, including:

(c) Any rule or plan of operation adopted under Subsection (b) remains in effect only until 30 days following the end of the next regular session of the legislature unless a law is enacted that authorizes coverage to be issued by the temporary risk pool and provides for funding for coverage under the temporary risk pool.

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TAIPA | – Texas Auto Insurance Plan A-socation

TAIPA | – Texas Auto Insurance Plan Assocation

A person may not serve as a public member if that person, an individual related to that person within the second degree of consanguinity or affinity, or an individual residing in the same household with that person is:

Only minimum limits are available through TAIPA, which are currently 30/60/25 ($30,000 for each injured person, up to a total of $60,000 per accident, and $25,000 for property damage per accident). Physical damage coverage is not available.

Certified agents (producers) submit Private Passenger or Commercial/Public applications for their applicants using the EASi website. The producer then mails the completed, signed application to TAIPA within one business day, along with the down payment. TAIPA processes the application, then a-signs it to a company. TAIPA mails the application and down payment to the a-signed company. The company will handle everything related to the policy from that point, including policy issuance, billing and payments, renewals, commissions, etc.

The A-sociation was created by statute and is subject to regulatory supervision of the Department of Insurance. The purpose of the A-sociation is to make automobile bodily injury and property damage liability insurance required by the Texas Motor Vehicle Safety Responsibility Act available to eligible applicants, subject to the rules of the A-sociation.

The A-sociation has established procedures for the equitable distribution of applications for insurance to be a-signed to insurance companies. All insurance companies authorized to write motor vehicle liability policies in the State of Texas must be members of the A-sociation and participate in its operation.

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TML – TML

Demonstrated rate stability; Property valuations at no cost to Member; ... Risk Pool board members are made up of your leaders. ... Partnering with Texas …

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Texas High Risk Pool - Texas Health Insurance Pools

The Texas Legislature created the Texas Health Insurance Pool in order to offer health insurance to Texas residents that meet a certain criteria. This program is geared towards people that are not able to attain other health insurance from commercial insurers due to existing medical conditions. The high risk pool in Texas also guarantees portability of coverage to those who lose coverage under an employer plan, state plan, or church plan. It is a safety net for people with pre-existing health conditions that have been denied coverage from other companies even though they could afford the premiums. As of August 2010, there are 26,762 people enrolled in the Texas High Risk Pool.

Not only does the Texas High Risk Pool offer health insurance to those with pre-existing medical conditions, but also to people that recently lost their employer-sponsored coverage. If a person cannot obtain traditional health insurance coverage, than the Texas High Risk Pool is most likely the next most comprehensive insurance option. The Health Pool provides major medical coverage that is very similar to what is offered at the commercial level with a wide range of specialists and services. The rates are determined by the insured's gender, age, residential ZIP code, and tobacco use. Health status is not a concern for this program, but the rates can be as much as double the standard rates found in the individual health insurance market.

To enroll in the Texas High Risk Pool, a person has to meet a few requirements such as proof of citizenship and documented proof of previous problems obtaining insurance. There will also be a question regarding the last time the applicant had full coverage health insurance. If all requirements are met, an application can be completed. Applications can be printed from a computer and mailed in or the application can be completed online.

Read a lot of information about the plan, eligibility requirements, rates, deductions, and all other aspects of the Texas High Risk Pool insurance program. Then decide if it is the right plan for you. Continue to monitor the heath care industry as there are a lot of healthcare initiatives coming down the belt, such as strengthening and expanding state's high risk pools and the implementation of a new Pre-Existing Condition Insurance plan that may be available in every state. This new insurance plan is not expected to take the place of the Texas High Risk Pool.

Sean L Johnson is a journalist for Health Insurance Buyer a referral service that refers consumers to the insurance carriers that can best fit their wants and needs. Get a free reduce quote today at www.health-insurance-buyer.com [http://www.health-insurance-buyer.com].

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Risk Pools and Texas School Districts - Robert V. Reim …

Largest Texas School Risk Pools Risk Pool Name Known As Member Equity Audit Year Notes. Texas A-sociation of School Boards Risk Management Fund TASB $212,736,226 2016 From …

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High Risk Auto Insurance Texas 🟢 Oct 2022

Category: Insurance Texas

High Risk Auto Insurance Texas - If you are looking for an easy way to get quotes then our online services are the way to go.

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INSURANCE CODE CHAPTER 2206. RISK MANAGEMENT POOLS FOR CERTAIN EDUCATIONAL ENTITIES

Sec. 2206.002. APPLICABILITY OF OTHER LAWS. (a) Except as provided by Subsection (b), a pool is not considered insurance under this code or other laws of this state, and the department does not have jurisdiction over the pool.

Sec. 2206.051. CREATION OF SCHOOL DISTRICT RISK MANAGEMENT POOL. (a) The boards of trustees of five or more school districts may create the school district risk management pool by adopting a resolution to create the pool.

Sec. 2206.053. ORGANIZATIONAL MEETING; SELECTION OF TEMPORARY BOARD. (a) On authorization to create the school district risk management pool as provided by Section 2206.051, the board of trustees of each school district adopting a resolution to create the pool shall select one representative to meet with representatives of the other school districts adopting the resolution.

Sec. 2206.101. CREATION OF JUNIOR COLLEGE DISTRICT RISK MANAGEMENT POOL. (a) The board of trustees of five or more junior college districts may create the junior college district risk management pool by adopting a resolution to create the pool.

Sec. 2206.103. ORGANIZATIONAL MEETING; SELECTION OF TEMPORARY BOARD. (a) On authorization to create the junior college district risk management pool as provided by Section 2206.101, the board of trustees of each junior college district adopting a resolution to create the pool shall select one representative to meet with representatives of the other junior college districts adopting the resolution.

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SUBCHAPTER O. Notice of Availability of Coverage Under the Texas Health Insurance Risk Pool

Category: Texas Department Of Insurance

Notice of Availability of Coverage Under the Texas Health Insurance Risk Pool Division

1. INTRODUCTION. The Commissioner of Insurance adopts amendments to §§21.2302 - 21.2306, concerning notice of availability of coverage under the Texas Health Insurance Risk Pool (Health Pool). Sections 21.2304 and 21.2306 are adopted with nonsubstantive changes to the proposed text published in the May 5, 2006 issue of the Texas Register (31 TexReg 3656). Sections 21.2302, 21.2303, and 21.2305, are adopted without changes.

2. REASONED JUSTIFICATION. The adopted amendments are necessary to implement SB 809, enacted by the 79th Legislature, Regular Session, effective January 1, 2006, which, in part, amends the Insurance Code §1506.152 to address eligibility for pool coverage. The primary purpose of SB 809 is to amend Chapter 1506 to make risk pool operations more cost-effective, efficient, and equitable. The amendments to the rules modify the definitions, notice requirements, and form used for notification of an individual's eligibility for coverage under the Health Pool.

The Department made one nonsubstantive change to the published proposed amendment to §21.2304(b) by conforming §21.2304(b)(5) to reflect that the amendments to §21.2305 as adopted delete subsection (b) and its reference to Figure 1, since the amended notice will not be filed with the Secretary of State's Office and is not adopted by reference in the text of the rule. The change conforms the cross reference in §21.2304(b)(5) to the Form Health Pool Notice as referenced in §21.2305 and as subsequently updated. The change does not introduce new subject matter or affect additional persons other than those subject to the proposal as published.

The Department made one nonsubstantive change to the published proposed amendment to §21.2306 by eliminating the reference to subsection (D) of §21.2304(b)(3) in the §21.2306 reference to amendments to §21.2304(b)(3). The change does not introduce new subject matter or affect additional persons other than those subject to the proposal as published.

3. HOW THE SECTIONS WILL FUNCTION. The adopted amendments to §21.2302 make necessary conforming changes to the definitions of "covered individual," "health carrier," and "health coverage and substantially similar health coverage," by substituting the term "benefit plan issuer" for the term "carrier." These changes are needed as a result of the enactment of the nonsubstantive Insurance Code revision by the 78th Legislature, Regular Session, effective April 1, 2005 (78th Legislature code revision).

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CHAPTER 1506. TEXAS HEALTH INSURANCE RISK POOL :: Texas Insurance Code :: 2005 Texas Code :: Texas Code :: US Codes and Statutes :: US Law :: Justia

Category: INSURANCE RISK POOL INSURANCE INSURANCE RISK POOL

INSURANCE CODE CHAPTER 1506. TEXAS HEALTH INSURANCE RISK POOL SUBCHAPTER A. GENERAL PROVISIONS § 1506.001. DEFINITIONS. In this chapter: (1) "Board" means the board of directors of the pool. (2) "Health benefit arrangement" means a plan, program, contract, or other arrangement through which an employer provides health care services, other than health care services covered through a health benefit plan issuer, to the employer's officers, employees, or other personnel. (3) "Health benefit plan issuer" means an entity that provides health benefit plan coverage in this state, including stop-loss or excess loss insurance. The term includes: (A) an insurance company; (B) a group hospital service corporation operating under Chapter 842; (C) a fraternal benefit society operating under Chapter 885; (D) a stipulated premium company operating under Chapter 884; (E) a health maintenance organization; (F) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; (G) an eligible surplus lines insurer operating under Chapter 981; (H) an insurer providing stop-loss or excess loss insurance to physicians, health care providers, or hospitals or to any benefit arrangements to the extent permitted by Section 3, Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002); and (I) any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. (4) "Health maintenance organization" means an entity that holds a certificate of authority to operate under Chapter 843. (5) "Hospital" means a hospital for which a license is issued under Chapter 241, Health and Safety Code, or that is owned or operated by the federal or state government. (6) "Physician" means a person licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code. (7) "Pool" means the Texas Health Insurance Risk Pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.002. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this chapter, "health benefit plan" means an individual or group health benefit plan and includes: (1) a hospital or medical expense incurred policy; (2) coverage of medical or health care services offered by: (A) a group hospital service corporation operating under Chapter 842; (B) a fraternal benefit society operating under Chapter 885; (C) a stipulated premium company operating under Chapter 884; (D) a health maintenance organization; (E) a multiple employer welfare arrangement subject to Chapter 846; or (F) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; and (3) any other health care plan or arrangement that pays for or furnishes medical or health care services by insurance or otherwise, including stop-loss insurance or excess loss insurance or reinsurance for individual or group health insurance or for any other health care plan or arrangement. (b) In this chapter, "health benefit plan" does not include: (1) accident insurance; (2) a plan providing coverage only for dental or vision care; (3) fixed indemnity insurance, including hospital indemnity insurance; (4) credit insurance; (5) long-term care insurance; (6) disability income insurance; (7) other limited benefit coverage, including specified disease coverage; (8) coverage issued as a supplement to liability insurance; (9) insurance arising out of a workers' compensation law or similar law; (10) automobile medical payment insurance; or (11) insurance coverage under which benefits are payable with or without regard to fault and that is statutorily required to be contained in a liability insurance policy or equivalent self-insurance. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.064(a), eff. Sept. 1, 2005; Acts 2005, 79th Leg., ch. 824, § 1, eff. Jan. 1, 2006. § 1506.003. DEFINITION OF DEPENDENT. In this chapter, "dependent" means: (1) a resident spouse or unmarried child younger than 25 years of age; or (2) a child who is: (A) a full-time student younger than 25 years of age who is financially dependent on the parent; (B) 18 years of age or older and is an individual for whom a person may be obligated to pay child support; or (C) disabled and dependent on the parent regardless of the age of the child. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.004. AUDIT OF POOL. (a) Annually, the state auditor may conduct a special audit of the pool under Chapter 321, Government Code. The special audit may include a financial audit and an economy and efficiency audit. (b) The state auditor shall report the cost of each audit conducted under this section to the board and the comptroller. The board shall remit that amount to the comptroller. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.065(a), eff. Sept. 1, 2005. § 1506.005. RULES. The commissioner may adopt rules necessary and proper to implement this chapter. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.006. COMPLAINT PROCEDURES. (a) An applicant for or participant in coverage from the pool is entitled to have complaints against the pool reviewed by a grievance committee appointed by the board. (b) The grievance committee shall report to the board after completion of the review of each complaint. (c) The board shall retain each written complaint concerning the pool at least until the third anniversary of the date the pool received the complaint. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.007. PROVISION OF INFORMATION ABOUT POOL. (a) A health benefit plan issuer may provide to its insureds and enrollees a notice relating to the existence of the pool that contains the address from which an insured or enrollee may obtain information about the coverage offered by the pool, the eligibility for and cost of the coverage, and other information that allows an insured or enrollee to compare the issuer's health benefit plan coverage provided to the insured or enrollee with the coverage offered by the pool. (b) A health benefit plan issuer providing notice under this section shall provide the notice as prescribed by the commissioner. (c) A health benefit plan issuer does not incur any liability solely for providing notice under this section. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. SUBCHAPTER B. BOARD OF DIRECTORS § 1506.051. GOVERNANCE OF POOL; BOARD MEMBERSHIP. (a) The pool is governed by a board of directors. (b) The board consists of nine members appointed by the commissioner as follows: (1) at least two, but not more than four, members must be individuals who are affiliated with a health benefit plan issuer authorized to write health benefit plans in this state; (2) at least two of the members must be individuals or the parents of individuals who are covered by the pool or are reasonably expected to qualify for coverage by the pool; and (3) the other members of the board may be selected from individuals such as: (A) a physician licensed to practice in this state by the Texas State Board of Medical Examiners; (B) a hospital administrator; (C) an advanced nurse practitioner; or (D) a representative of the public who is not employed by or affiliated with an insurance company or insurance plan, group hospital service corporation, or health maintenance organization. (c) For purposes of Subsection (b), an individual who is required to register under Chapter 305, Government Code, because of the individual's activities with respect to health benefit plan-related matters is affiliated with a health benefit plan issuer. (d) An individual is not disqualified under Subsection (b)(3)(D) from representing the public if the individual's only affiliation with an insurance company or insurance plan, group hospital service corporation, or health maintenance organization is as an insured or as an individual who has coverage through a plan provided by the corporation or organization. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.066(a), eff. Sept. 1, 2005. § 1506.052. PRESIDING OFFICER. The commissioner shall designate one member of the board to serve as presiding officer at the pleasure of the commissioner. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.053. TERMS; VACANCY. (a) Members of the board serve staggered six-year terms. (b) The commissioner shall fill a vacancy on the board by appointing, for the unexpired term, an individual who has the appropriate qualifications to fill that position. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.054. PER DIEM; REIMBURSEMENT. A member of the board is entitled to: (1) a per diem in the amount provided by the General Appropriations Act for state officials for each day the member performs duties as a board member; and (2) reimbursement of expenses incurred while performing duties as a board member in the amount provided by the General Appropriations Act for state officials. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.055. MEMBER'S IMMUNITY. (a) A member of the board is not liable for an act or omission made in good faith in the performance of powers and duties under this chapter. (b) A cause of action does not arise against a member of the board for an act or omission described by Subsection (a). Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.056. ADJUSTMENTS. (a) The board may adjust deductibles, the amounts of stop-loss coverage, and the periods governing preexisting conditions under Section 1506.155 to preserve the financial integrity of the pool. (b) Not later than the 30th day after the date the board makes an adjustment under this section, the board shall submit to the commissioner a written report containing a description of and the reasons for the adjustment. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.057. ANNUAL REPORT OF POOL'S ACTIVITIES. (a) Not later than June 1 of each year, the board shall submit a report to the governor, the lieutenant governor, the speaker of the house of representatives, and the commissioner. (b) The report must summarize the activities of the pool in the calendar year preceding the year in which the report is submitted and must include information relating to net written and earned premiums, plan enrollment, administration expenses, and paid and incurred losses. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.058. ADDITIONAL POWERS AND DUTIES. The commissioner by rule may establish powers and duties of the board in addition to those provided by this chapter. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. SUBCHAPTER C. POWERS AND DUTIES OF POOL § 1506.101. PURPOSES OF POOL. (a) The purposes of the pool are to: (1) provide for access to quality health care at minimum cost to the public; (2) relieve the insurable population of the disruptive cost of sharing coverage; and (3) maximize reliance on strategies of managed care proven by the private sector. (b) The pool is not intended to diminish the availability of traditional health care coverage to consumers who are eligible for that coverage. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.102. EMPLOYEES; COMMITTEES. (a) The pool may employ and set the compensation of any persons necessary to a-sist the pool in carrying out its responsibilities and functions. (b) The pool may appoint appropriate legal, actuarial, and other committees necessary to provide technical a-sistance in operating the pool and performing any of the functions of the pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.103. PROVIDING COVERAGE. (a) The pool may provide health benefit coverage to an individual who is eligible for that coverage under this chapter. (b) The pool may issue health benefit coverage subject to this chapter and the pool's plan of operation under Section 1506.201. (c) The pool may issue additional types of health benefit coverage to provide optional coverages that comply with applicable provisions of state and federal law, including a Medicare supplement benefit plan for individuals 65 years of age or older who are eligible for Medicare. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.067(a), eff. Sept. 1, 2005. § 1506.104. CHARGES, FORMULAS, AND FORMS. (a) The pool may establish appropriate rates, rate schedules, rate adjustments, expense allowances, agents' referral fees, and claim reserve formulas and perform actuarial functions appropriate to the operation of the pool. (b) The pool may adopt policy forms, endorsements, and riders and applications for coverage. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.105. PREMIUM RATES. (a) The pool may not charge premium rates that are unreasonable in relation to the benefits provided, the risk experience, and the reasonable expenses of providing the coverage. (b) Separate schedules of premium rates based on age, s-x, and geographic location may apply for individual risks. (c) Premium rates and premium rate schedules may be adjusted for appropriate risk factors, including age and variation in claim costs. The pool may consider appropriate risk factors in accordance with established actuarial and underwriting practices. (d) The pool shall establish the standard risk rate. In establishing the rate, the pool shall use reasonable actuarial techniques and consider the premium rates charged by other health benefit plan issuers offering health benefit coverage to individuals. The rate must reflect anticipated experience and expenses for health benefit coverage. (e) Premium rates shall be established to provide fully for all of the expected costs of claims, including recovery of prior losses, expenses of operation, investment income from claim reserves, and any other cost factors, subject to the limitation described in this subsection. In no event may pool premium rates exceed 200 percent of rates applicable to individual standard risks. (f) The pool shall submit each rate and rate schedule to the commissioner for approval. The pool may not use a rate or rate schedule before the rate or schedule is approved by the commissioner. In evaluating a rate or rate schedule of the pool, the commissioner shall consider the factors provided by this section. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.068(a), eff. Sept. 1, 2005. § 1506.106. REINSURANCE. The pool may provide for reinsurance on a facultative or treaty basis or on both facultative and treaty bases. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.107. CONTRACTS. (a) The pool may enter into a contract that is necessary to carry out this chapter, including, with the approval of the commissioner, a contract with: (1) a similar pool in another state for the joint performance of common administrative functions; or (2) another organization for the performance of administrative functions. (b) The pool may contract for stop-loss insurance for risks incurred by the pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.108. LEGAL ACTION. (a) The pool may sue or be sued. (b) The pool may take any legal action necessary to: (1) avoid payment of improper claims against the pool or the coverage provided by or through the pool; or (2) recover or collect amounts due the pool, including: (A) a-sessments due the pool; (B) amounts erroneously or improperly paid by the pool; and (C) amounts paid by the pool as a mistake of fact or law. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.109. COST CONTAINMENT. (a) The pool shall provide for and use cost containment measures and requirements to make the coverage offered by the pool more cost-effective. To the extent the board determines it is cost-effective, the cost containment measures must include individual case management and disease management. The cost containment measures may include preadmission screening, the requirement of a second surgical opinion, and concurrent utilization review subject to Article 21.58A. (b) The pool may design, use, contract for, or otherwise arrange for the delivery of cost-effective health care services, including establishing or contracting with preferred provider organizations and health maintenance organizations. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 824, § 2, eff. Jan. 1, 2006. § 1506.110. BORROWING. The pool may borrow money as necessary to implement the purposes of the pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.111. ADDITIONAL AUTHORITY. In addition to the other powers granted to the pool under this chapter, the pool may exercise any of the authority that a health benefit plan issuer authorized to write health benefit plans in this state may exercise under the law of this state. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. SUBCHAPTER D. POOL COVERAGE AND BENEFITS § 1506.151. MINIMUM POOL COVERAGE. (a) The pool shall offer coverage consistent with major medical expense coverage to each eligible individual who is under the age of 65. (b) The board, with the approval of the commissioner, shall establish: (1) the coverages to be provided by the pool; (2) the applicable schedules of benefits; and (3) any exclusions to coverage and other limitations. (c) The benefits provisions of the pool's coverage must include: (1) all required or applicable definitions; (2) a description of covered services required under the pool; (3) a list of any exclusions or limitations to coverage; and (4) the deductibles, coinsurance options, and copayment options that are required or permitted. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.069(a), eff. Sept. 1, 2005. § 1506.152. ELIGIBILITY FOR COVERAGE. (a) An individual who is a legally domiciled resident of this state is eligible for coverage from the pool if the individual: (1) provides to the pool evidence that the individual maintained health benefit plan coverage for the preceding 18 months with no gap in coverage longer than 63 days and with the most recent coverage being provided through an employer-sponsored plan, church plan, or government plan; (2) provides to the pool evidence that the individual maintained health benefit plan coverage under another state's qualified Health Insurance Portability and Accountability Act health program that was terminated because the individual did not reside in that state and submits an application for pool coverage not later than the 63rd day after the date the coverage described by this subdivision was terminated; (3) has been a legally domiciled resident of this state for the preceding 30 days, is a citizen of the United States or has been a permanent resident of the United States for at least three continuous years, and provides to the pool: (A) a notice of rejection of, or refusal to issue, substantially similar individual health benefit plan coverage from a health benefit plan issuer, other than an insurer that offers only stop-loss, excess loss, or reinsurance coverage, if the rejection or refusal was for health reasons; (B) certification from an agent or salaried representative of a health benefit plan issuer that states that the agent or salaried representative cannot obtain substantially similar individual coverage for the individual from any health benefit plan issuer that the agent or salaried representative represents because, under the underwriting guidelines of the health benefit plan issuer, the individual will be denied coverage as a result of a medical condition of the individual; (C) an offer to issue substantially similar individual coverage only with conditional riders; (D) a diagnosis of the individual with one of the medical or health conditions on the list adopted under Section 1506.154; or (E) evidence that the individual is covered by substantially similar individual coverage that excludes one or more conditions by rider; or (4) provides to the pool evidence that, on the date of application to the pool, the individual is certified as eligible for trade adjustment a-sistance or for pension benefit guaranty corporation a-sistance, as provided by the Trade Adjustment A-sistance Reform Act of 2002 (Pub. L. No. 107-210). (b) Each dependent of an individual who is eligible for coverage from the pool is also eligible for coverage from the pool. (c) If an individual who obtains coverage from the pool under Subsection (a) is a child, each parent, grandparent, brother, sister, or child of that individual who resides with that individual is also eligible for coverage from the pool. (d) The board shall develop a form to be used for certification under Subsection (a)(3)(B). Before it may be used, the form must be approved by the commissioner. (e) Notwithstanding Sections 1506.153(1)-(6), an individual who is certified as eligible for trade adjustment a-sistance or for pension benefit guaranty corporation a-sistance, as provided by the Trade Adjustment A-sistance Reform Act of 2002 (Pub. L. No. 107-210), and who has at least three months of prior health benefit plan coverage, as described by Section 1506.155(d), is not required to exhaust any benefits from the continuation of coverage under Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.), as amended (COBRA), or state continuation benefits to be eligible for coverage from the pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.070(a), eff. Sept. 1, 2005; Acts 2005, 79th Leg., ch. 824, § 3, eff. Jan. 1, 2006. § 1506.153. INELIGIBILITY FOR COVERAGE. Text of section as amended by Acts 2005, 79th Leg., ch. 728, § 11.071(a) Notwithstanding Sections 1506.152(a)-(d), an individual is not eligible for coverage from the pool if: (1) on the date pool coverage is to take effect, the individual has health benefit plan coverage from a health benefit plan issuer or health benefit arrangement in effect; (2) at the time the individual applies to the pool, the individual is eligible for other health care benefits, including benefits from the continuation of coverage under Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.), as amended (COBRA), other than: (A) coverage, including COBRA or other continuation coverage or conversion coverage, maintained for any preexisting condition waiting period under a pool policy; (B) employer group coverage conditioned by a limitation of the kind described by Section 1506.152(a)(3)(A) or (C); or (C) individual coverage conditioned by a limitation described by Section 1506.152(a)(3)(C) or (D); (3) within 12 months before the date the individual applies to the pool, the individual terminated coverage in the pool, unless the individual demonstrates a good faith reason for the termination; (4) the individual is confined in a county jail or imprisoned in a state or federal prison; (5) any of the individual's premiums are paid for or reimbursed under a government-sponsored program or by a government agency or health care provider, other than as an otherwise qualifying full-time employee of a government agency or health care provider or as a dependent of such an employee; (6) the individual's prior coverage with the pool was terminated: (A) during the 12-month period preceding the date of application for nonpayment of premiums; or (B) for fraud; or (7) the individual is eligible for health benefit plan coverage provided in connection with a policy, plan, or program paid for or sponsored by an employer, even though the employer coverage is declined. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.071(a), eff. Sept. 1, 2005. For text of section as amended by Acts 2005, 79th Leg., ch. 824, § 4, effective January 1, 2006, see § 1506.153, post § 1506.153. INELIGIBILITY FOR COVERAGE. Text of section as amended by Acts 2005, 79th Leg., ch. 824, § 4 Notwithstanding Section 1506.152, an individual is not eligible for coverage from the pool if: (1) on the date pool coverage is to take effect, the individual has health benefit plan coverage from a health benefit plan issuer or health benefit arrangement in effect, except as provided by Section 1506.152(a)(3)(E); (2) at the time the individual applies to the pool, the individual is eligible for other health care benefits, including benefits from the continuation of coverage under Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.), as amended (COBRA), other than: (A) coverage, including COBRA or other continuation coverage or conversion coverage, maintained for any preexisting condition waiting period under a pool policy; (B) employer group coverage conditioned by a limitation of the kind described by Section 1506.152(a)(3)(A) or (C); or (C) individual coverage conditioned by a limitation described by Section 1506.152(a)(3)(C) or (D); (3) within 12 months before the date the individual applies to the pool, the individual terminated coverage in the pool, unless the individual demonstrates a good faith reason for the termination; (4) the individual is confined in a county jail or imprisoned in a state prison; (5) any of the individual's premiums are paid for or reimbursed under a government-sponsored program or by a government agency or health care provider, other than as an otherwise qualifying full-time employee of a government agency or health care provider or as a dependent of such an employee; (6) the individual's prior coverage with the pool was terminated: (A) during the 12-month period preceding the date of application for nonpayment of premiums; or (B) for fraud; or (7) the individual is eligible for health benefit plan coverage provided in connection with a policy, plan, or program paid for or sponsored by an employer, even though the employer coverage is declined. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.071(a), eff. Sept. 1, 2005; Acts 2005, 79th Leg., ch. 824, § 4, eff. Jan. 1, 2006. For text of section as amended by Acts 2005, 79th Leg., ch. 728, § 11.071(a), effective September 1, 2005, see § 1506.153, ante § 1506.154. LIST OF COVERED CONDITIONS. (a) The board shall adopt a list of medical or health conditions for which an individual is eligible for pool coverage under Section 1506.152(a)(3)(E) without applying for health benefit plan coverage. (b) The board may amend the list as appropriate. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.155. PREEXISTING CONDITIONS. (a) Except as provided by this section and Section 1506.056, pool coverage excludes charges or expenses incurred before the first anniversary of the effective date of coverage with regard to any condition for which: (1) the existence of symptoms would cause an ordinarily prudent person to seek diagnosis, care, or treatment within the six-month period preceding the effective date of coverage; or (2) medical advice, care, or treatment was recommended or received during the six-month period preceding the effective date of coverage. (b) The exclusion provided by Subsection (a) does not apply to an individual who: (1) was continuously covered for a period of at least 12 months, excluding any waiting period, by health benefit plan coverage that terminated not earlier than the 63rd day before the effective date of coverage under the pool; and (2) applied for pool coverage not later than the 63rd day after the date the health benefit plan coverage described by Subdivision (1) terminated. (c) If an individual was covered by health benefit plan coverage that was in effect at any time during the 12-month period preceding the effective date of the individual's coverage under the pool, the pool shall subtract from the exclusion period required under Subsection (a) the period that the individual was covered under that health benefit plan and any waiting period that applied before that health benefit plan coverage became effective. (d) A preexisting condition provision may not be applied to an individual who has been certified as eligible for trade adjustment a-sistance or for pension benefit guaranty corporation a-sistance, as provided by the Trade Adjustment A-sistance Reform Act of 2002 (Pub. L. No. 107-210), if the individual: (1) was continuously covered by a health benefit plan for a period of three months before the individual's separation from employment; and (2) applies for coverage from the pool not later than the 63rd day after the date on which the prior coverage was terminated. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.071(b), eff. Jan. 1, 2006; Acts 2005, 79th Leg., ch. 824, § 5, eff. Jan. 1, 2006. § 1506.156. BENEFIT REDUCTION; CERTAIN COVERAGES SECONDARY. (a) The pool shall reduce benefits otherwise payable under pool coverage by: (1) the total amount paid or payable through any other health benefit plan or health benefit arrangement; and (2) the total amount of hospital or medical expense benefits paid or payable under: (A) workers' compensation coverage; (B) automobile insurance, regardless of whether provided on the basis of fault or no fault; or (C) a state or federal law or program. (b) Pool coverage provided under Section 1506.152(a)(3)(E) is secondary to the individual coverage described by that paragraph for any period during which that individual coverage is in effect. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 824, § 6, eff. Jan. 1, 2006. § 1506.157. RECOVERY OF CERTAIN AMOUNTS. (a) The pool has a cause of action against an eligible individual for the recovery of the amount of benefits paid that are not for covered expenses. (b) Benefits due from the pool may be reduced or refused as an offset against an amount recoverable under this section. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.158. TERMINATION OF POOL COVERAGE. (a) An individual's pool coverage ends: (1) on the date the individual ceases to be a legally domiciled resident of this state, unless the individual: (A) is a student younger than 25 years of age and is financially dependent on a parent covered by the pool; (B) is a child for whom an individual covered by the pool may be obligated to pay child support; or (C) is a child who is disabled and dependent on a parent covered by the pool, regardless of the age of the child; (2) on the first day of the month following the date the individual requests coverage to end; (3) on the date the individual covered by the pool dies; (4) on the date state law requires cancellation of the coverage; (5) at the option of the pool, on the 31st day after the date the pool sends to the individual any inquiry concerning the individual's eligibility, including an inquiry concerning the individual's residence, to which the individual does not reply; (6) on the 31st day after the date a premium payment for pool coverage becomes due if the payment is not made before that day; (7) on the date the individual is 65 years of age and eligible for coverage under Medicare, unless the coverage received from the pool is Medicare supplement coverage issued by the pool; or (8) at the time the individual ceases to meet the eligibility requirements for coverage. (b) Notwithstanding Subsection (a), the coverage of an individual who ceases to meet the eligibility requirements for coverage terminates on the earlier of: (1) the first premium due date after the date the pool determines the individual does not meet the eligibility requirements; or (2) the first day of the first month after the month in which the pool determines the individual does not meet the eligibility requirements. (c) The pool has the sole discretion to determine that an individual does not meet the eligibility requirements for coverage. (d) An individual may maintain pool coverage for the period the individual is satisfying a preexisting waiting period under another health benefit plan or health benefit arrangement intended to replace the pool coverage. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.071(c), eff. Sept. 1, 2005. § 1506.159. PROHIBITION ON ARRANGEMENT OR ATTEMPTED ARRANGEMENT OF CERTAIN POOL COVERAGE; PENALTY. (a) A health benefit plan issuer, agent, third-party administrator, or other person authorized or licensed under this code may not arrange or a-sist in, or attempt to arrange or a-sist in, the application for coverage from or placement in the pool of an individual who is not eligible under Section 1506.153(7) for coverage from the pool for the purpose of separating the person from health benefit plan coverage offered or provided in connection with employment that would be available to the person as an employee or a dependent of an employee. (b) A violation of this section is an unfair method of competition and an unfair or deceptive act or practice under Chapter 541. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. SUBCHAPTER E. OPERATION OF POOL § 1506.201. PLAN OF OPERATION. (a) Operation and management of the pool is governed by a plan of operation. The plan of operation includes the articles, bylaws, and operating rules of the pool that are adopted by the board. (b) The plan of operation must ensure the fair, reasonable, and equitable administration of the pool. (c) In addition to complying with the other requirements of this chapter, the plan of operation must include procedures for: (1) operation of the pool; (2) selection of an administrator as provided by Section 1506.202; (3) creation of a fund, under management of the board, for administrative expenses; (4) handling, accounting, and auditing of money and other a-sets of the pool; (5) development and implementation of a program to: (A) publicize the existence of the pool, the eligibility requirements for coverage under the pool, and enrollment procedures; and (B) foster public awareness of the pool; (6) creation of a grievance committee to review complaints presented by applicants for coverage from the pool and individuals who are covered by the pool; and (7) other matters as may be necessary and proper for the execution of the board's powers, duties, and obligations under this chapter. (d) The board shall amend the plan of operation as necessary to carry out this chapter. An amendment to the plan of operation must be approved by the commissioner before it becomes a part of the plan. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.202. POOL ADMINISTRATOR. (a) The board may select one or more health benefit plan issuers or a third-party administrator authorized by the department to administer the pool. The selection must be made under a competitive bidding process in accordance with the plan of operation. (b) The board shall establish criteria for evaluating the bids submitted under this section. The criteria must include: (1) the bidder's proven ability to handle individual health benefit plans; (2) the bidder's efficiency of claims paying procedures; (3) an estimate of total charges for administering the pool; (4) the bidder's ability to administer the pool in a cost-efficient manner; and (5) the bidder's financial condition and stability. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.203. ADMINISTRATOR'S TERM; SUCCEEDING TERM. (a) A person selected as a pool administrator serves in that capacity for a three-year term beginning on the date the board issues its order making the selection. (b) Not later than one year before the expiration of a pool administrator's term, the board shall invite all health benefit plan issuers, including the pool administrator, to submit bids to serve as a pool administrator for the succeeding administration period. The selection of the succeeding pool administrator must be made not later than the sixth calendar month preceding the month in which the pool administrator's term expires. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.204. ADMINISTRATOR'S FUNCTIONS. (a) A pool administrator shall perform the functions relating to the pool that are a-signed to the administrator. (b) The a-signed functions may include: (1) performing eligibility and administrative claims payment functions for the pool; (2) establishing a billing procedure for collection of premiums from individuals covered by the pool; (3) performing functions necessary to ensure timely payment of benefits to individuals covered by the pool, including: (A) providing information relating to the proper manner of submitting a claim for benefits to the pool and distributing claim forms; and (B) evaluating the eligibility of each claim for payment by the pool; (4) submitting regular reports to the board relating to the operation of the pool; and (5) determining after each calendar year the net written and earned premiums, expenses of administration, and paid and incurred losses of the pool for that calendar year and reporting that information to the board and the commissioner. (c) The board shall determine the form, content, and time of submission of the reports required under Subsection (b)(4). (d) The commissioner shall prescribe the forms to be used to report the information under Subsection (b)(5). (e) The board shall determine the times at which a pool administrator is to perform the billing functions for the pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.205. PAYMENTS TO ADMINISTRATOR. (a) The pool shall pay a pool administrator for the administrator's expenses incurred in performing duties and functions as provided by the plan of operation. (b) Except as provided by Subsection (c), the total amount of administrative costs and fees paid in a calendar year to all pool administrators may not exceed 12.5 percent of the gross premium receipts of the pool for the calendar year. (c) The commissioner may approve payment of a higher amount, not to exceed 15 percent of the gross premium receipts of the pool for the calendar year, if the commissioner determines that the higher amount is necessary to pay the administrative costs and fees of the pool. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. SUBCHAPTER F. A-SESSMENTS FOR OPERATION OF POOL § 1506.251. INTERIM A-SESSMENTS. (a) The board may a-sess health benefit plan issuers, including making advance interim a-sessments, as reasonable and necessary for the pool's organizational and interim operating expenses. (b) The board shall credit an interim a-sessment as an offset against any regular a-sessment that is due after the end of the fiscal year. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.252. DETERMINATION OF NET LOSS. (a) After the end of each fiscal year, the board shall determine for the preceding calendar year any net loss of the pool, including administrative expenses and incurred losses, and report the net loss to the commissioner. (b) In determining the net loss, the board shall take into account investment income and other appropriate gains and losses. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.2521. ANNUAL REPORT TO BOARD. Each health benefit plan issuer shall report to the board the information requested by the board, as of December 31 of the preceding year. Added by Acts 2005, 79th Leg., ch. 728, § 11.072(a), eff. Sept. 1, 2005. § 1506.2522. ANNUAL REPORT TO BOARD: ENROLLED INDIVIDUALS. (a) Each health benefit plan issuer shall report to the board the number of residents of this state enrolled, as of December 31 of the previous year, in the issuer's health benefit plans providing coverage for residents in this state, as: (1) an employee under a group health benefit plan; or (2) an individual policyholder or subscriber. (b) In determining the number of individuals to report under Subsection (a)(1), the health benefit plan issuer shall include each employee for whom a premium is paid and coverage is provided under an excess loss, stop-loss, or reinsurance policy issued by the issuer to an employer or group health benefit plan providing coverage for employees in this state. A health benefit plan issuer providing excess loss insurance, stop-loss insurance, or reinsurance, as described by this subsection, for a primary health benefit plan issuer may not report individuals reported by the primary health benefit plan issuer. (c) Ten employees covered by a health plan issuer under a policy of excess loss insurance, stop-loss insurance, or reinsurance count as one employee for purposes of determining that health plan issuer's a-sessment. (d) In determining the number of individuals to report under this section, the health benefit plan issuer shall exclude: (1) the dependents of the employee or an individual policyholder or subscriber; and (2) individuals who are covered by the health benefit plan issuer under a Medicare supplement benefit plan subject to Chapter 1652. (e) In determining the number of enrolled individuals to report under this section, the health benefit plan issuer shall exclude individuals who are retired employees who are 65 years of age or older. Added by Acts 2005, 79th Leg., ch. 824, § 7, eff. Jan. 1, 2006. § 1506.253. A-SESSMENTS TO COVER NET LOSSES. Text of section as amended by Acts 2005, 79th Leg., ch. 728, § 11.072(b) (a) The board shall recover any net loss of the pool by a-sessing each health benefit plan issuer an amount determined annually by the board based on information in annual statements, the health benefit plan issuer's annual report to the board under Section 1506.2521, and any other reports required by and filed with the board. (b) The amount of a health benefit plan issuer's a-sessment is computed by multiplying the total amount required to be a-sessed against all health benefit plan issuers by a number computed by dividing: (1) the gross premiums collected by the issuer for health benefit plans in this state during the preceding calendar year; by (2) the gross premiums collected by all issuers for health benefit plans in this state during the preceding calendar year. (c) For purposes of the a-sessment under this subchapter, gross health benefit plan premiums do not include premiums collected for: (1) coverage under a Medicare supplement benefit plan subject to Chapter 1652; (2) coverage under a small employer health benefit plan subject to Subchapters A-H, Chapter 1501; or (3) coverage or insurance listed in Section 1506.002(b). Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.072(b), eff. Sept. 1, 2005. For text of section as amended by Acts 2005, 79th Leg., ch. 824, § 8, effective January 1, 2006, see § 1506.253, post § 1506.253. A-SESSMENTS TO COVER NET LOSSES. Text of section as amended by Acts 2005, 79th Leg., ch. 824, § 8 (a) The board shall recover any net loss of the pool by a-sessing each health benefit plan issuer an amount determined annually by the board based on information in annual statements, the health benefit plan issuer's annual report to the board under Sections 1506.2521 and 1506.2522, and any other reports required by and filed with the board. (b) To compute the amount of a health benefit plan issuer's a-sessment, if any, the board shall: (1) divide the total amount to be a-sessed by the total number of enrolled individuals reported by all health benefit plan issuers under Section 1506.2522 as of the preceding December 31 to determine the per capita amount; and (2) multiply the number of enrolled individuals reported by the health benefit plan issuer under Section 1506.2522 as of the preceding December 31 by the per capita amount to determine the amount a-sessed to that health benefit plan issuer. (c) A small employer health benefit plan subject to Subchapters A-H, Chapter 1501, is not subject to an a-sessment under this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. Amended by Acts 2005, 79th Leg., ch. 728, § 11.072(b), eff. Sept. 1, 2005; Acts 2005, 79th Leg., ch. 824, § 8, eff. Jan. 1, 2006. For text of section as amended by Acts 2005, 79th Leg., ch. 728, § 11.072(b), effective September 1, 2005, see § 1506.253, ante § 1506.254. A-SESSMENT DUE DATE; INTEREST. (a) An a-sessment is due on the date specified by the board that is not earlier than the 30th day after the date written notice of the a-sessment is transmitted to the health benefit plan issuer. (b) Interest accrues on the unpaid amount of an a-sessment at a rate equal to the prime lending rate, as published in the most recent issue of the Wall Street Journal and determined as of the date the a-sessment becomes delinquent, plus three percent. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.255. ABATEMENT OR DEFERMENT OF A-SESSMENT. (a) A health benefit plan issuer may petition the commissioner for an abatement or deferment of all or part of an a-sessment imposed by the board. The commissioner may abate or defer all or part of the a-sessment if the commissioner determines that payment of the a-sessment would endanger the ability of the health benefit plan issuer to fulfill its contractual obligations. (b) If all or part of an a-sessment against a health benefit plan issuer is abated or deferred, the amount of the abatement or deferment shall be a-sessed against the other health benefit plan issuers in a manner consistent with the method for computing a-sessments under this subchapter. (c) A health benefit plan issuer receiving an abatement or deferment under this section remains liable to the pool for the deficiency. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.256. USE OF EXCESS FROM A-SESSMENTS. (a) In this section, "future losses" includes reserves for claims incurred but not reported. (b) If the total amount of the a-sessments exceeds the pool's actual losses and administrative expenses, the board shall deposit the excess in an interest-bearing account and shall use money in that account to offset future losses or to reduce future a-sessments. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.257. COLLECTION OF A-SESSMENTS. The pool may recover or collect a-sessments made under this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. § 1506.258. PROCEDURES, CRITERIA, AND FORMS. The commissioner by rule shall provide the procedures, criteria, and forms necessary to implement, collect, and deposit a-sessments under this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005. SUBCHAPTER G. SUBROGATION RIGHTS OF POOL § 1506.301. SUBROGATION TO RIGHTS AGAINST THIRD PARTY. The pool: (1) is subrogated to the rights of an individual covered by the pool to recover against a third party costs for an injury or illness for which the third party is liable under contract, tort law, or other law that have been paid by the pool on behalf of the covered individual; and (2) may enforce that liability on behalf of the individual. Added by Acts 2005, 79th Leg., ch. 824, § 9, eff. Jan. 1, 2006. § 1506.302. BENEFITS NOT PAYABLE; ADVANCE OF BENEFITS AUTHORIZED. (a) Under coverage provided by the pool, benefits are not payable for an injury or illness for which a third party may be liable under contract, tort law, or other law. (b) Notwithstanding Subsection (a), the pool may advance to a covered individual the benefits provided under the pool coverage for medical expenses resulting from the injury or illness, subject to the pool's right to subrogation and reimbursement under this subchapter. Added by Acts 2005, 79th Leg., ch. 824, § 9, eff. Jan. 1, 2006. § 1506.303. REIMBURSEMENT OF POOL REQUIRED. (a) Subject to Section 1506.305, the amount recovered by a covered individual in an action against a third party who is liable for the injury or illness must be used to reimburse the pool for benefits for medical expenses that have been advanced under Section 1506.302. (b) The amount of reimbursement required by this section is not reduced by the application of the doctrine established at common law relating to adequate compensation of insureds and commonly referred to as the "made whole" doctrine. (c) Subject to Section 1506.305, the pool shall treat any amount recovered by a covered individual in an action against a third party who is liable for the injury or illness that exceeds the amount of the reimbursement required under this section as an advance against future medical benefits for the injury or illness that the individual would otherwise be entitled to receive under pool coverage. Added by Acts 2005, 79th Leg., ch. 824, § 9, eff. Jan. 1, 2006. § 1506.304. RESUMPTION OF PAYMENT OF BENEFITS. If the amount treated as an advance under Section 1506.303(c) is adequate to cover all future medical costs for the covered individual's injury or illness, the pool is not required to resume the payment of benefits. If the advance is insufficient, the pool shall resume the payment of benefits when the advance is exhausted. Added by Acts 2005, 79th Leg., ch. 824, § 9, eff. Jan. 1, 2006. § 1506.305. ATTORNEY'S FEE FOR REPRESENTATION OF POOL'S INTEREST. (a) For purposes of this section, the pool's recovery includes: (1) the amount recovered by the pool in the action; and (2) the amount of the covered individual's total recovery that must be used to reimburse the pool or that is treated as an advance for future medical costs under Section 1506.303(c). (b) If the pool's interest is not actively represented by an attorney in a third-party action under this subchapter, the pool shall pay a fee to an attorney representing the claimant in the amount agreed on between the attorney and the pool. In the absence of an agreement, the court shall award to the attorney payable out of the pool's recovery: (1) a reasonable fee for recovery of the pool's interest that may not exceed one-third of the pool's recovery; and (2) a proportionate share of the reasonable expenses incurred. (c) An attorney who represents a covered individual and is also to represent the interests of the pool under this subchapter must make a full written disclosure to the covered individual before employment as an attorney by the pool. The covered individual must acknowledge the disclosure and consent to the representation. A signed copy of the disclosure shall be provided to the covered individual and the pool. A copy of the disclosure with the covered individual's consent must be filed with the pleading before a judgment is entered and approved by the court. The attorney may not receive a fee under this section to which the attorney is otherwise entitled under an agreement with the pool unless the attorney complies with the requirements of this subsection. (d) If an attorney actively representing the pool's interest actively participates in obtaining a recovery, the court shall award and apportion between the covered individual's and the pool's attorneys a fee payable out of the pool's subrogation recovery. In apportioning the award, the court shall consider the benefit accruing to the pool as a result of each attorney's service. The total attorney's fees may not exceed one-third of the pool's recovery. Added by Acts 2005, 79th Leg., ch. 824, § 9, eff. Jan. 1, 2006.

Disclaimer: These codes may not be the most recent version. Texas may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.

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TASB Risk Management Fund

Educators work hard to prepare students to serve as good citizens and future leaders, but emerging risks can threaten those efforts. That’s why the mission of the TASB Risk Management Fund (Fund) is to provide comprehensive risk solutions to Texas public schools.

The Fund has been going strong since 1974. Times change, as does the way we educate students. Fund coverage responds to risks faced by public schools across Texas. No matter what happens, we’ll be there to help.

The Fund also provides solutions to help you maintain safe and secure places of learning, whether you have claims or not. Training and informational resources help you and your employees prevent and mitigate risks, gain valuable insights, and work safely and compliantly.

The Fund is a separate legal entity from the Texas A-sociation of School Boards (TASB), with oversight from a 19-member board of school administrators and board trustees and program management provided by TASB staff.

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Explaining A-signed Risk Pools for Auto Insurance

Explaining Assigned Risk Pools for Auto Insurance

High risk drivers can find insurance through risk pools. In this post find out all you need to know about risk pools for auto insurance.

High-risk drivers usually experience difficulty finding car insurance. The risk of insuring these drivers is something most insurance companies are unwilling to take. It’s understandable because they can make claims that exceed their annual premiums in the long run, as a typical high-risk driver has had too many accidents and speed tickets. Insurance providers decline them any offer for insurance.

High-risk drivers might not always be immediately turned down by an auto insurance company. However, sometimes the insurance provider requires an immensely expensive premium. The insurance provider does this to ensure they can make payment for all claims without taking a loss from covering a high-risk driver. Beyond getting insurance, all drivers must meet the minimum level of car liability insurance requirements.

All car insurance companies must belong to the state’s a-signed risk pool. In the state pool, an insurance provider can’t refuse any driver that is a-signed to their company, regardless of the risk attached to the driver. Numerous speeding tickets or frequent accidents aren’t sufficient reasons to turn down a driver in the state pool.

The rates for insurance in an auto insurance a-signed risk pool are higher than you’d get in a voluntary market. Even worse, you can expect to have very limited coverage. You can expect an exclusion of collisions and comprehensive insurance coverage in an a-signed risk pool auto insurance policy. Some states limit the amount of liability on your insurance policy and allow you to add collision and comprehensive damage within that limit. Nevertheless, when you have a-sets that are more than your limits, your insurance policy becomes inadequate. This simply means that there are no limits to what you can lose as a result of a lawsuit.

As stated above, a-signed risk pool insurance should be your last resort. Exhaust the list of insurers in the voluntary market and compare rates to choose what works for you best. If you can’t find any, check non-standard insurance companies, such as private insurers. If you are concerned you might require a-signed risk pool auto insurance, you can trust our team of experts at Massive Insurance to attend to all your insurance needs today.

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