Under the Texas small employer health benefit plan eligibility rules, which factor may NOT be used to determine whether an employee is eligible to enroll in the plan?

Why D is correct

Under 28 TAC 26.8, eligibility under a small employer health benefit plan must be determined without regard to health-status-related factors, meaning health status, medical condition including physical and mental illness, claims experience, receipt of health care, medical history, genetic information, evidence of insurability and disability. An employer may still define eligibility by bona fide employment-based classifications such as job class, full-time or part-time status, or completion of a waiting period that is applied the same way to everyone in the class.

Why the other options are wrong

• A) A uniformly applied waiting period is a permissible eligibility rule, so long as it is not a proxy for health status.
• B) Distinguishing full-time from part-time employees is an employment-based classification the plan may use.
• C) Job classification is a legitimate, employment-based eligibility criterion under 28 TAC 26.8.

Memory hook

Eligibility keys off the job, never off the diagnosis.