Texas Insurance Code 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.
Terms Used In Texas Insurance Code 1501.058
- Contract: A legal written agreement that becomes binding when signed.
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005
(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.