Free Group Health Insurance Study Guide
Texas General Lines — Life, Accident, Health & HMO exam — Group Health Insurance.
Federal COBRA, HIPAA and the ACA are covered in the national Group Health Insurance guide. Texas adds state continuation (TIC 1251, Subchapter F), small employer rules (TIC 1501) and a chemical dependency mandate. This guide covers those.
State continuation (TIC 1251.252 to 1251.256)
| Item | Texas rule |
|---|---|
| Eligibility | At least 3 consecutive months of coverage just before termination. Not available after an involuntary termination for cause. |
| Request deadline | In writing, within 60 days after the later of coverage ending or notice of the right |
| Premium | What the employer contributed, plus 2% of the group rate |
| Length | 9 months for people not eligible for COBRA. 6 additional months after COBRA ends for those who are. |
| Conversion | If offered, issued without evidence of insurability on application and payment within 31 days after termination |
Small employer health plans (TIC 1501; 28 TAC 26.8)
- Small employer: averaged 2 to 50 employees in the prior calendar year, with at least two on the first day of the plan year (1501.002).
- Eligible employee: full-time, usually at least 30 hours a week. Part-time, temporary and seasonal workers aren't eligible.
- Coverage is guaranteed issue to eligible small employers (1501.151).
- Participation: at least 75% of eligible employees must enroll, unless the issuer accepts less (1501.154). A two-employee group needs 100%.
- Waiting period: no more than 90 days from the first day of work. Open enrollment periods are at least 31 days (1501.156).
- Employer contribution: the law doesn't require one. An issuer may require one if it applies the requirement uniformly (1501.153).
Chemical dependency (TIC 1368.004, 1368.005)
A group health benefit plan must cover necessary treatment of chemical dependency on terms no less favorable than coverage for physical illness. The same limits, deductibles and coinsurance apply.
Common exam traps
- State continuation requires 3 months of prior coverage. The request is due within 60 days. The premium is the contribution plus 2%.
- Continuation lasts 9 months, or 6 months after COBRA.
- A small employer has 2–50 employees. Eligible employees work 30 hours. Participation is 75%, or 100% for a two-employee group. The waiting period is at most 90 days.
Practice Group Health Insurance questions All General Lines — Life, Accident, Health & HMO topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
