Texas Insurance Code 1508.252 – Operation of Fund; Claim Eligibility
Current as of: 2024 | Check for updates
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(a) A health benefit plan issuer is eligible to receive reimbursement in an amount that is equal to 80 percent of the dollar amount of claims paid between $5,000 and $75,000 in a calendar year for an enrollee in a qualifying health benefit plan.
(b) A health benefit plan issuer is eligible for reimbursement from the fund only for the calendar year in which claims are paid.
Terms Used In Texas Insurance Code 1508.252
- Year: means 12 consecutive months. See Texas Government Code 311.005
(c) Once the dollar amount of claims paid on behalf of a covered individual reaches or exceeds $75,000 in a given calendar year, a health benefit plan issuer may not receive reimbursement for any other claims paid on behalf of the individual in that calendar year.
