State RegulationsTX specificDifficulty 2/5
A Texas small employer health benefit plan imposes minimum participation and employer contribution requirements. How must those requirements be applied?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under 28 TAC 26.8, minimum participation and employer contribution requirements must be applied uniformly across eligible employees and across employers in the same class, so no individual employee can be singled out and no single group can be given a tailored deal. For the agent, this means a participation shortfall is a group-level problem to be cured by enrolling more eligible employees, not by negotiating an exception for one unhealthy member of the group.
Why the other options are wrong
- A) An insurer cannot change participation or contribution terms case by case at renewal; changes must be applied uniformly and with notice.
- B) Varying the requirement by expected claims makes it a health-status rule, which 28 TAC 26.8 forbids.
- D) Participation requirements apply to the eligible class as a whole, not only to employees new to group coverage.
Memory hook
One rule, the whole group, applied the same way.