Health Coverage Issues

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Health Coverage Issues
Presenter Sean Fry
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Health Coverage Issues
Categories of Coverage Recognized By
Statute www.tdi.state.tx.us/company/lhck_lst.html
ah_start Categories of Coverage Not Recognized
By Statute Mini Medical Plans Limited
Benefit Plans Under Group
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Health Coverage Issues

• Accident Health Market
• Individual
• Group
• Large Employer (including cooperatives)
• Small Employer (including cooperatives)
• Associations (including employer)
• Other Groups

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Health Coverage Issues

• Private Purchasing Cooperatives
• www.tdi.state.tx.us/company/indexlhcoop.html
• Listing of Registered Coalitions Purchasing
  Cooperatives
• HGR- Health Group Cooperatives
• HGR-P Health Group Cooperatives Section p
• PPC- Purchasing Cooperatives
• SEHC- Small Employer Coalitions

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Health Coverage Issues
Private Purchasing Cooperatives Types of
Cooperatives Forming a Cooperative Joining a
Cooperative Cooperative Feature
Comparison www.tdi.state.tx.us/company/indexlhcoop
.html
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Health Coverage Issues
Characteristics of Cooperatives Information
related to distinguishing characteristics of the
different types of cooperatives. For additional
characteristics please refer to the below
referenced link. www.tdi.state.tx.us/company/inde
xlhcoop.html
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Health Coverage Issues
Characteristics of Cooperatives Private
Purchasing Cooperative (PPC) Enacted by HB 2055,
73rd Legislative Session
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Health Coverage Issues
Characteristics of Cooperatives Private
Purchasing Cooperative (PPC) Enacted by HB 2055,
73rd Legislative Session Original Private
Purchasing Cooperative
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Health Coverage Issues
Characteristics of Cooperatives Private
Purchasing Cooperative (PPC) Enacted by HB 2055,
73rd Legislative Session Original Private
Purchasing Cooperative Small Employer for
Benefit Elections
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Health Coverage Issues
Characteristics of Cooperatives Private
Purchasing Cooperative (PPC) Enacted by HB 2055,
73rd Legislative Session Original Private
Purchasing Cooperative Small Employer for
Benefit Elections Not Guaranteed Issue
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Health Coverage Issues
Characteristics of Cooperatives Private
Purchasing Cooperative (PPC) Enacted by HB 2055,
73rd Legislative Session Original Private
Purchasing Cooperative Small Employer for
Benefit Elections Not Guaranteed Issue Rate
Employers Separately
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Health Coverage Issues
Characteristics of Cooperatives Small Employer
Health Coalition (SEHC) Enacted by HB 897, 78th
Legislative Session
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Health Coverage Issues
Characteristics of Cooperatives Small Employer
Health Coalition (SEHC) Enacted by HB 897, 78th
Legislative Session Composition of Small
Employers Only
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Health Coverage Issues
Characteristics of Cooperatives Small Employer
Health Coalition (SEHC) Enacted by HB 897, 78th
Legislative Session Composition of Small
Employers Only Considered a Small Employer
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Health Coverage Issues
Characteristics of Cooperatives Small Employer
Health Coalition (SEHC) Enacted by HB 897, 78th
Legislative Session Composition of Small
Employers Only Considered a Small
Employer Guaranteed Issuance of Coverage
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Health Coverage Issues
Characteristics of Cooperatives Small Employer
Health Coalition (SEHC) Enacted by HB 897, 78th
Legislative Session Composition of Small
Employers Only Considered a Small
Employer Guaranteed Issuance of Coverage Rated
as a Single Small Employer
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Health Coverage Issues
Characteristics of Cooperatives Health Group
Cooperatives (HGR) Enacted by SB 10, 78th
Legislative Session
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Health Coverage Issues
Characteristics of Cooperatives Health Group
Cooperatives (HGR) Enacted by SB 10, 78th
Legislative Session Composed of Small or Large
Employers
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Health Coverage Issues
Characteristics of Cooperatives Health Group
Cooperatives (HGR) Enacted by SB 10, 78th
Legislative Session Composed of Small or Large
Employers Enrollment in Small Employer
HGR
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Health Coverage Issues
Characteristics of Cooperatives Health Group
Cooperatives (HGR) Enacted by SB 10, 78th
Legislative Session Composed of Small or Large
Employers Enrollment in Small Employer
HGR Enrollment in Large Employer HGR
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Health Coverage Issues
Characteristics of Cooperatives Health Group
Cooperatives (HGR) Enacted by SB 10, 78th
Legislative Session Composed of Small or Large
Employers Enrollment in Small Employer
HGR Enrollment in Large Employer HGR Considered
a Single Large Employer
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Health Coverage Issues
Types of Cooperatives Health Group
Cooperatives-Subsection (p) (HGR) Enacted by SB
805, 79th Legislative Session
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Health Coverage Issues
Types of Cooperatives Health Group
Cooperatives-Subsection (p) (HGR) Enacted by SB
805, 79th Legislative Session Composed of Small
Employers
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Health Coverage Issues
Types of Cooperatives Health Group
Cooperatives-Subsection (p) (HGR) Enacted by SB
805, 79th Legislative Session Composed of Small
Employers Election to Restrict
Membership/Enrollment
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Health Coverage Issues
Types of Cooperatives Health Group
Cooperatives-Subsection (p) (HGR) Enacted by SB
805, 79th Legislative Session Composed of Small
Employers Election to Restrict
Membership/Enrollment Election at Time
Cooperative is Formed
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Health Coverage Issues
Health Carriers Issues
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Health Coverage Issues
Health Carriers Issues Health Group
Cooperatives (HGR) Health Carrier Designation
28 TAC 26.407
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Health Coverage Issues
Health Carrier Issues Health Group Cooperatives
(HGR) Health Carrier Designation 28 TAC
26.407 Health Benefit Plan 28 TAC 26.409

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Health Coverage Issues
Health Carrier Issues Health Group Cooperatives
(HGR) Health Carrier Designation 28 TAC
26.407 Health Benefit Plan 28 TAC
26.409 Service Areas 28 TAC 26.411
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Health Coverage Issues
Health Carrier Issues Health Group Cooperatives
(HGR) Health Carrier Designation 28 TAC
26.407 Health Benefit Plan 28 TAC
26.409 Service Areas 28 TAC 26.411 Private
Purchasing Cooperatives
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Health Coverage Issues
Health Carrier Issues Health Group Cooperatives
(HGR) Health Carrier Designation 28 TAC
26.407 Health Benefit Plan 28 TAC
26.409 Service Areas 28 TAC 26.411 Private
Purchasing Cooperatives Small Employer
Market
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Health Coverage Issues
Health Carrier Issues Health Group Cooperatives
(HGR) Health Carrier Designation 28 TAC
26.407 Health Benefit Plan 28 TAC
26.409 Service Areas 28 TAC 26.411 Private
Purchasing Cooperatives Small Employer
Market Large Employer Market
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Health Coverage Issues
Conclusion Questions Contact
Information Sean Fry Assistant
Director Accident/Health Section Life/Health
Division 512-305-7284 sean.fry_at_tdi.state.tx.us