Key Takeaways
- Texas does not have a mini-COBRA law for small employers
- Federal COBRA applies only to employers with 20+ employees in Texas
- Small group health plans (1-50 employees) have guaranteed issue protections
- Texas requires mental health parity in group health plans
- HIPAA portability applies to group health coverage in Texas
Texas Group Health Insurance & COBRA
Texas has specific regulations for group health insurance. Unlike some states, Texas does not have a mini-COBRA law for small employers.
Federal COBRA in Texas
Federal COBRA applies to employers with 20+ employees:
| COBRA Element | Federal Requirement |
|---|---|
| Employer Size | 20 or more employees |
| Duration | 18-36 months |
| Premium | Up to 102% of total premium |
| Qualifying Events | Termination, reduction in hours, divorce, death |
No Texas Mini-COBRA
Important Distinction
| State | Mini-COBRA |
|---|---|
| Texas | No state mini-COBRA law |
| Other States | Many have mini-COBRA |
Implications for Small Employers
Employees of small Texas employers (fewer than 20):
- Not covered by federal COBRA
- No state continuation requirement
- May purchase individual coverage
- May qualify for marketplace coverage
- May be eligible for CHIP or Medicaid
Exam Tip: Texas does NOT have mini-COBRA. This is frequently tested. Small employer workers must seek other coverage options.
Small Group Health Insurance
Texas regulates small group health insurance (1-50 employees):
Guaranteed Issue
| Requirement | Description |
|---|---|
| Acceptance | Must accept all small employers |
| Pre-existing Conditions | Cannot exclude (ACA requirement) |
| Rating | Community rating with limited variations |
Guaranteed Renewal
Small group plans must renew unless:
- Non-payment of premium
- Fraud or misrepresentation
- Failure to comply with plan provisions
- Insurer exits market (with notice)
Mental Health Parity
Texas requires mental health parity in applicable group health plans:
Parity Requirements
| Element | Must Equal Medical/Surgical |
|---|---|
| Deductibles | Same or integrated |
| Copayments | Equal cost-sharing |
| Day Limits | No more restrictive |
| Visit Limits | No more restrictive |
| Preauthorization | No more burdensome |
Covered Conditions
- Mental health disorders
- Substance use disorders
- Behavioral health conditions
- Serious mental illness
HIPAA Portability
Texas enforces HIPAA requirements:
Certificate of Creditable Coverage
| Element | Requirement |
|---|---|
| Timing | Upon loss of coverage |
| Content | Dates of coverage, type |
| Purpose | Reduce waiting periods |
Portability Benefits
- Credit for prior continuous coverage
- Reduces new plan exclusion periods
- 63-day break rule applies
Options for Small Employer Workers
When federal COBRA doesn't apply:
| Option | Description |
|---|---|
| Marketplace | Individual coverage through HealthCare.gov |
| Medicaid | If income-eligible (Texas did not expand) |
| CHIP | For children in eligible families |
| Short-term | Temporary coverage options |
| Spouse Coverage | If available |
Note: Texas did not expand Medicaid under ACA, so options may be more limited for some individuals.
Does Texas have a mini-COBRA law for small employers?
Which employers are subject to federal COBRA requirements in Texas?
Under Texas small group health insurance rules, insurers must:
What does Texas's mental health parity law require for group health plans?
What options do workers at small Texas employers have when they lose group health coverage?