| (a) An issuer of a health benefit plan, or its delegated
entity, that covers prescription drugs and uses one or more drug formularies
must provide, in plain language, the disclosures required by Insurance
Code §1369.054. The plain language disclosure must be in the
coverage documentation provided to each enrollee and include the address
and telephone number where the enrollee may contact the issuer of
the health benefit plan, or its delegated entity, to determine if
a specific prescription drug is on the formulary.
(b) An issuer of an individual health benefit plan
must allow a current or prospective enrollee to obtain a paper copy
of the formulary information required under §21.3032 and §21.3033
of this title (relating to Formulary Disclosure Requirements for Individual
Health Benefit Plans and Facilitating Comparison Shopping for Individual
Health Benefit Plans) by calling the toll-free number listed on the
summary health plan document.
(c) An issuer may elect to exclude the plan-level cost-sharing
information required under §21.3031(c) of this title (relating
to Formulary Information for Individual Health Benefit Plans on Issuer's
Website) from the paper format if the document provides a toll-free
number through which a current or prospective enrollee may obtain
formulary information contained in §21.3032 and §21.3033,
including the plan-specific cost-sharing information required under §21.3032(c),
for any formulary drug.
(d) The paper copy of the formulary information must
use at least 10-point font.
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