| (a) The filing and formatting requirements of §11.301
of this title (relating to Filing Requirements) apply to an evidence
of coverage.
(b) The style, arrangement, and overall appearance
of documents must give no undue prominence to any portion of the text.
The text of the group, individual, and conversion agreements, the
certificate, and all amendments include all printed matter except:
(1) the HMO's name, address, website address, and phone
number;
(2) the name or title of the form;
(3) the captions and subcaptions; and
(4) any brief introduction to or description of the
evidence of coverage.
(c) Each evidence of coverage must indicate by example
information that will appear in any blanks with the exception of single-case
forms, which must be filed complete and ready for use.
(d) An HMO must identify each form by a unique form
number in compliance with §11.301(2) of this title. Any change
in form number is considered a change in the form and requires approval
as a new form.
(e) Certain language must not be varied or changed
without resubmitting a form for the commissioner's approval. Changeable
language must be enclosed in brackets, include the range of variable
information or amounts, and include an explanation of how and under
what circumstances the information will vary.
(f) Each evidence of coverage must meet the readability
standards of §3.601 of this title (relating to Purpose and Scope,
Applicability, and Definitions Used in This Subchapter) and §3.602
of this title (relating to Plain Language Requirements).
(g) A matrix filing must comply with the filing requirements
in this section and §11.301 of this title. In addition, an HMO
submitting a matrix filing:
(1) must identify each provision with a unique form
number that is sufficient to distinguish it as a matrix filing; and
(2) may use the same provision filed under one form
number for all HMO products, provided that the language is applicable
to each HMO product; however, any changes in the language to comply
with the requirements for each HMO product will require a unique form
number.
(h) Evidences of coverage, agreements, and contracts
may be submitted with insert pages, or an insert page may be filed
subsequent to the approval of an evidence of coverage, agreement,
or contract.
(i) Any HMO submitting an insert page filing:
(1) must identify each insert page with a unique form
number located on the lower left hand corner of the page;
(2) may use the same insert page filed under one form
number for all plans, provided the language is applicable to each
plan type; however, any changes in the language to comply with the
requirements for each plan type will require a unique form number;
(3) may use the same insert page to replace an existing
page of a previously approved or reviewed evidence of coverage, agreement,
or contract. However, if used in this manner, the replaced page, as
originally filed, must reflect a unique form number that distinguishes
it from the other pages of the form or contract; and
(4) must list the form number for each insert page
on the transmittal checklist and provide a statement indicating how
the insert page will be used and the type of plan for which the insert
page will be used.
(j) In addition to providing the appropriate certification
on the transmittal checklist, an HMO submitting a filing as a matrix
filing or as an insert page must provide certifications certifying
that, when issued, the evidences of coverage, certificates, contracts,
riders, or applications created from the forms comply in all respects
with all applicable statutes and regulations with regard to the final
plan document that will be issued.
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