| (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 or electronic disclosure
statement in a manner that gives the policyholder or contract holder
the ability to keep a copy of the disclosure statement. The disclosure
statement must provide a sufficiently detailed description of the
state-mandated health benefits that are reduced or not included in
the plan to enable the prospective or current policyholder or contract
holder to make an informed decision.
(b) Form CCP 1 fulfills the requirements of this section
and is available on the department's website at www.tdi.texas.gov.
(c) If a health carrier chooses to generate its own
disclosure statement, it must comply with readability standards applicable
to forms reviewed under Chapter 3 of this title (relating to Life,
Accident, and Health Insurance and Annuities) and Chapter 11 of this
title (relating to Health Maintenance Organizations) and the statement
must use at least 12-point type. The disclosure statement also must:
(1) acknowledge that the consumer choice health benefit
plan being offered or purchased does not provide some or all state-mandated
health benefits and explain, if applicable, that the plan does include
all health benefits required by the Affordable Care Act;
(2) in plain language, list each health benefit or
coverage not provided at the state-mandated level in the consumer
choice health benefit plan, define the listed health benefit or coverage,
describe the benefit or coverage in the consumer choice plan being
offered, and describe the benefit or coverage that would be provided
in a state-mandated plan;
(3) instruct consumers to refer to the Summary of Benefits
and Coverage to see the specific level of benefits provided by the
plan;
(4) when applicable because the health carrier has
materially modified a consumer choice plan in a way that necessitates
a change to the disclosure, or when the disclosure must be updated
to reflect changes in state law, contain the following language, in
bold type, directly above the list required by paragraph (2) of this
subsection, as applicable:
(A) "The benefits or coverages you are agreeing
to on this renewal are different from your current plan."; or
(B) "The benefits required by state law have changed
since you first received this disclosure.";
(5) explain that the health carrier offers one or more
state-mandated plans and provide:
(A) a phone number where the consumer can purchase
the state-mandated plan;
(B) a URL that connects the consumer to the health
carrier's website where the state-mandated plan is available for purchase;
and
(C) for individual market plans, indicate whether the
state-mandated plan is available on the federal health benefit exchange
and if it is not, explain that the plan will not qualify for reduced
premiums or cost-sharing;
(6) contain acknowledgments of the following:
(A) that the consumer choice health benefit plan does
not provide the same level of coverage required in a state-mandated
plan;
(B) that more information about consumer choice health
benefit plans is available from the department either online at www.tdi.texas.gov/consumer/consumerchoice.html,
or by calling the TDI Consumer Help Line at 1-800-252-3439; and
(C) if the plan is being issued in the individual market,
that if the plan does not meet the consumer's needs, in most cases
the consumer will not be able to get a new plan until the next open
enrollment period;
(7) inform the prospective or current policyholder
or contract holder that the health carrier must provide a copy of
the written disclosure statement upon request;
(8) for a disclosure being delivered consistent with
subsection (e)(2) of this section, include the following language
in bold type, directly above the acknowledgements in paragraph (6)
of this subsection: "By signing your application to enroll in
this plan, you acknowledge the following:"; and
(9) for initial coverage or enrollment, other than
for a disclosure being delivered consistent with subsection (e)(2)
of this section, provide space for the prospective policyholder or
contract holder to print and sign their name, and to sign to acknowledge
receipt of the disclosure statement, accompanied by the following
language in bold type: "Don't sign this document if you don't
understand it. No firme este documento si no lo comprende."
(d) 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 (e) of this section; and
(2) to a current policyholder or contract holder, along
with any offer to renew the contract or policy.
(e) 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 include the disclosure statement as the first
page in the plan brochure provided on the healthcare.gov website.
(f) A health carrier must request a signature on the
written disclosure statement:
(1) at the time of initial coverage or enrollment;
and
(2) any time a policyholder is enrolling in coverage
under a different consumer choice plan from the plan for which the
initial disclosure statement was signed, including instances where
the health carrier discontinues a plan, consistent with Insurance
Code §1202.051, concerning Renewability and Continuation of Individual
Health Insurance Policies; Insurance Code §1271.307, concerning
Renewability of Coverage: Individual Health Care Plans and Conversion
Contracts; and Insurance Code §1501.109, concerning Refusal to
Renew; Discontinuation of Coverage.
(g) Except as provided by subsection (e) of this section,
when a health carrier provides the written disclosure statement referenced
in subsection (a) of this section to a prospective 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.
(h) The health carrier must, on request, provide the
prospective or current policyholder or contract holder with a copy
of the written disclosure statement free of charge.
(i) 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 (e) of this section
by providing the written disclosure statement to prospective or existing
certificate holders.
(j) 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
this section no later than six months from the effective date of this
section.
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