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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 21TRADE PRACTICES
SUBCHAPTER AACONSUMER CHOICE HEALTH BENEFIT PLANS
DIVISION 4ADDITIONAL REQUIREMENTS
RULE §21.3542Offer of State-Mandated Plan

(a) A health carrier that offers the opportunity to apply for one or more consumer choice health benefit plans under this section must also, no later than at the time of application, offer the opportunity to apply for an accident and sickness insurance policy or evidence of coverage in the same category that reasonably approximates the consumer choice health benefit plan offered, that includes state-mandated health benefits, and that is otherwise authorized by the Insurance Code.

(b) With regard to health plans required by subsection (a) of this section, a health carrier must:

  (1) use the same sources and methods of distribution to market both consumer choice health benefit plans and health benefit plans required by this subsection, and a health carrier that markets consumer choice health benefit plans through online marketplaces, other than the federal health exchange, must use the same sources and methods of distribution to market both consumer choice health benefit plans and state-mandated health benefit plans required by this subsection;

  (2) make the offer of the health plans, the premium cost of the plans, as well as any additional details regarding them, contemporaneously with and in the same manner as the offer and premium cost of, and other details regarding, the consumer choice health benefit plan policy or evidence of coverage; and

  (3) provide at least the following information:

    (A) a description of how the person or entity may apply for or enroll in each offered policy or evidence of coverage; and

    (B) the benefits or services available, or both, and the premium cost under each offered policy or evidence of coverage.

(c) A health carrier may not apply more stringent or detailed requirements related to the application process for a consumer choice health benefit plan, or for a policy or evidence of coverage offered in accordance with subsection (a) of this section, than it applies for other health benefit plans offered by the health carrier.


Source Note: The provisions of this §21.3542 adopted to be effective June 2, 2004, 29 TexReg 5101; amended to be effective May 28, 2017, 42 TexReg 2730; amended to be effective June 7, 2021, 46 TexReg 3538

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