| (a) A health carrier offering or providing a consumer
choice health benefit plan must provide each prospective or current
policyholder or contract holder with a written disclosure statement
in the manner prescribed in Form CCP 1 provided by the department
for that purpose. The information provided in Form CCP 1 must provide
a sufficient description of the reduced benefit or the state-mandated
health benefits not included in the plan to enable the consumer to
make an informed decision about whether the consumer choice plan being
offered or purchased provides sufficient coverage for the consumer's
needs. Form CCP 1:
(1) acknowledges that the consumer choice health benefit
plan being offered or purchased does not provide some or all state-mandated
health benefits;
(2) lists those state-mandated health benefits not
included under the consumer choice health benefit plan;
(3) provides a notice that purchase of the plan may
limit future coverage options in the event the policyholder's, contract
holder's, or certificate holder's health changes and needed benefits
are not covered under the consumer choice health benefit plan;
(4) requires the prospective or current policyholder
or contract holder to sign an acknowledgement that the prospective
or current policyholder or contract holder has received the written
disclosure statement; and
(5) informs the prospective or current policyholder
or contract holder that the prospective or current policyholder or
contract holder has the right to a copy of the written disclosure
statement free of charge.
(b) A health carrier may obtain Form CCP 1 by making
a request to the Life and Health Lines Office Intake, Mail Code 106-1E,
Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104
or 333 Guadalupe, Austin, Texas 78701, or by accessing the department's
website at www.tdi.texas.gov.
(c) A health carrier must provide the written disclosure
statement described in subsection (a) of this section:
(1) to a prospective policyholder or contract holder,
not later than the time of the offer of a consumer choice health benefit
plan, except as provided by subsection (d) of this section;
(2) to a current policyholder or contract holder, along
with any offer to renew the contract or policy.
(d) A health carrier must provide the written disclosure
statement described in subsection (a) of this section to a prospective
or current policyholder or contract holder applying for coverage through
the federal health benefit exchange as follows:
(1) at the time of application, if the federal health
benefit exchange provides a mechanism for a health carrier to provide
the written disclosure statement and obtain a signature at the time
of application; or
(2) if the health carrier is unable to provide the
written disclosure and obtain a signature at the time of application,
the health carrier must:
(A) mail the written disclosure statement to the prospective
or current policyholder or contract holder no later than three business
days from the date the health carrier receives the application from
the federal health benefit exchange; and
(B) provide either a link to the written disclosure
statement directly on the healthcare.gov website, or a reference and
link to the written disclosure statement in the summary of benefits
and coverage or the plan brochure provided on the healthcare.gov website.
(e) Except as provided by subsection (g) of this section,
when a health carrier provides the written disclosure statement referenced
in subsection (a) of this section to a prospective or current policyholder
or contract holder:
(1) through an agent, the agent may not transmit the
application to the health carrier for consideration until the agent
has secured the signed written disclosure statement from the applicant;
and
(2) directly to the applicant, the health carrier may
not process the application until the health carrier has secured the
signed written disclosure statement from the applicant.
(f) When a health carrier provides the written disclosure
statement described in subsection (a) of this section in the manner
described by subsection (d)(2) of this section, the health carrier
must:
(1) request that the prospective or current policyholder
or contract holder sign and return the written disclosure statement
described in subsection (a) of this section, and
(2) provide a method for the prospective or current
policyholder or contract holder to return the signed written disclosure
statement to the health carrier at no cost to the prospective or current
policyholder or contract holder.
(g) The health carrier must, on request, provide the
prospective or current policyholder or contract holder with a copy
of the written disclosure statement.
(h) When a health carrier is offering or issuing a
consumer choice health benefit plan to an association, the health
carrier must satisfy the requirements of subsection (d) of this section
by providing the written disclosure statement to prospective or existing
certificate holders.
(i) A health carrier offering or issuing a consumer
choice health benefit plan to a prospective or current policyholder,
contract holder, or an association must update and file with the commissioner,
for approval, its written disclosure statement that conforms with
Form CCP 1 no later than one year from the effective date of this
rule.
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