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§ 110.7. Self-Insured Political Subdivision Requirements for Notifying the Division of Election to Provide Medical Benefits

(a) A health plan, for purposes of this section, is defined as a political subdivision contracting with health care providers under Labor Code § 504.053(b)(2).

(b) A political subdivision as defined by Labor Code § 504.001(3) that self-insures either individually or collectively and that pursuant to Labor Code § 504.053(b)(2) elects to provide medical benefits to its injured employees by directly contracting with health care providers or by contracting through a health benefits pool established under Local Government Code Chapter 172 shall provide to the division notice of the method by which its employees will receive medical benefits. Political subdivisions are also subject to requirements specified in § 110.1 of this title (relating to Insurance Carrier Requirements for Notifying the Division of Insurance Coverage).

(c) The notice of the method by which its employees will receive medical benefits required by subsection (b) of this section shall be filed with the division in writing or electronically and in the form and manner prescribed by the division. The notice shall include:

(1) the name, address, and the federal employer identification number (FEIN) of the political subdivision;

(2) the political subdivision’s contact information;

(3) the name of the health plan elected under Labor Code § 504.053(b)(2) for the political subdivision;

(4) the contact information for the health plan elected under Labor Code § 504.053(b)(2); and

(5) the beginning and ending date(s) of the election under subsection (b) of this section, as applicable.

(d) A self-insured political subdivision that provides medical benefits to its injured employees in the manner described by Labor Code § 504.053(b)(2) as of the effective date of this section shall provide the notice required by this section not later than December 31, 2012.

(e) A self-insured political subdivision that begins to provide medical benefits to its injured employees in the manner described by Labor Code § 504.053(b)(2) after the effective date of this section shall provide the notice required by this section not later than the 30th day after the date the political subdivision begins to provide the medical benefits in that manner.

(f) A self-insured political subdivision shall notify the division of any change in any information required by this section not later than the 30th day after the date of the change.

The provisions of this §110.7 adopted to be effective August 2, 2012, 37 TexReg 5577.

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At a Glance:

Title:

§ 110.7. Self-Insured Political Subdivision Requirements for Notifying the Division of Election to Provide Medical Benefits

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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