Affiliation Period

Sec. 1501.104. AFFILIATION PERIOD. (a) In this section, "affiliation period" means a period that, under a small or large employer health benefit plan offered by a health maintenance organization, must expire before the coverage becomes effective. (b) A health maintenance organization may impose an affiliation period if the period is applied uniformly without regard to any health status related factor. The affiliation period may not exceed: (1) two months for an enrollee, other than a late enrollee; or (2) 90 days for a late enrollee. (c) An affiliation period under a small or large employer health benefit plan must run concurrently with any applicable waiting period under the plan. A health maintenance organization must credit an affiliation period against any preexisting condition provision period. (d) During an affiliation period, a health maintenance organization: (1) is not required to provide health care services or benefits to the participant or beneficiary; and (2) may not charge a premium to the participant or beneficiary. (e) A health maintenance organization may use an alternative method approved by the commissioner to address adverse selection. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.