28 Tex. Admin. Code § 21.3107 - Mandatory Annual Notice to Insureds and Enrollees

(a) Under Insurance Code § 1352.005, health benefit plan issuers must provide to insureds and enrollees the notification specified in this subsection. A representation of this notification is as follows:

Attached Graphic

(b) The notice required by Insurance Code § 1352.005 and subsection (a) of this section is required by Insurance Code § 1352.005 to be issued annually to each insured or enrollee under the plan.

(c) The notice must be printed in at least 12-point type and must comply with the following requirements:

(1) The notice must be provided during the policy term for the plan, and no later than the 60th day after enrollment and renewal.

(2) Except as specified in paragraph (6) of this subsection, a health benefit plan issuer must deliver the notice to insureds or enrollees through the U.S. Postal Service.

(3) The notice may be delivered with other health benefit plan documents that are delivered through the U.S. Postal Service as long as the time frames set forth in paragraph (1) of this subsection are met. For example, the notice may be delivered with the policy, certificate, evidence of coverage, or enrollment or insurance card.

(4) If the notice is provided to the primary insured's or enrollee's last known address, the requirements of this section are satisfied with respect to all insureds or enrollees residing at that address.

(5) If the last known address of a covered spouse or dependent is different than the primary insured's or enrollee's last known address, separate notices are required to be provided to the spouse or the dependent at the spouse's or dependent's last known address.

(6) For group health benefit plans, the notice may be provided to the group master contract holder for distribution to insureds or enrollees if the health benefit plan issuer has an agreement with the group master contract holder that the notice will be delivered in compliance with the timelines specified in paragraph (1) of this subsection; however, the health benefit plan issuer must ensure that the notice is provided to the insureds or enrollees.

(d) As provided in Insurance Code § 1352.005(a), this section does not apply to a small employer health benefit plan issuer.

Notes

28 Tex. Admin. Code § 21.3107

The provisions of this §21.3107 adopted to be effective February 23, 2009, 34 TexReg 1247; Amended by Texas Register, Volume 40, Number 22, May 29, 2015, TexReg 3179, eff. 6/7/2015