(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.
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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 |