Texas Insurance Code 1501.104 – Affiliation Period
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(a) In this section, “affiliation period” means a period that, under a small or large employer health benefit plan offered by a health maintenance organization, must expire before the coverage becomes effective.
(b) A health maintenance organization may impose an affiliation period if the period is applied uniformly without regard to any health status related factor. The affiliation period may not exceed:
(1) two months for an enrollee, other than a late enrollee; or
(2) 90 days for a late enrollee.
Terms Used In Texas Insurance Code 1501.104
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
(c) An affiliation period under a small or large employer health benefit plan must run concurrently with any applicable waiting period under the plan. A health maintenance organization must credit an affiliation period against any preexisting condition provision period.
(d) During an affiliation period, a health maintenance organization:
(1) is not required to provide health care services or benefits to the participant or beneficiary; and
(2) may not charge a premium to the participant or beneficiary.
(e) A health maintenance organization may use an alternative method approved by the commissioner to address adverse selection.