| (a) The notices required by §21.2103(a)(1), (3),
and (4) of this title (relating to Mandatory Benefit Notices) must
be issued to enrollees of a health benefit plan within 60 days of
the plan's issuance or renewal.
(1) Except as specified in paragraph (5) of this subsection,
a carrier must deliver the notices to enrollees through the U.S. Postal
Service or, as permitted by state law, electronically.
(2) The notice may be delivered with other health benefit
plan documents within 60 days of the plan's issuance or renewal. For
example, the notice may be delivered with the policy, certificate,
evidence of coverage, or the enrollment or insurance card.
(3) If the notices are provided to the primary enrollee's
last known address, the requirements of this section are satisfied
with respect to all enrollees residing at that address.
(4) If a covered spouse or dependent's last known address
is different than the primary enrollee, separate notices are required
to be provided to the spouse or the dependent at the spouse's or dependent's
last known address.
(5) For group health benefit plans, the notice may
be provided to the group master contract holder for distribution to
enrollees if the carrier has an agreement with the group master contract
holder that the notice will be delivered within 60 days of the plan's
issuance or renewal; however, TDI will hold the carrier responsible
for ensuring that notice is provided to the enrollees.
(b) The notices required by §21.2103(a)(2) of
this title must be issued to enrollees of a health benefit plan and
be provided according to the following paragraphs:
(1) the enrollment notice required by §21.2103(a)(2)(A)
of this title must be issued to each enrollee upon enrollment in the
health benefit plan;
(2) the annual notice required by §21.2103(a)(2)(B)
of this title must be issued to each enrollee annually; and
(3) notwithstanding §21.2103(a)(2) of this title,
a carrier may elect to issue the enrollment notice required by §21.2103(a)(2)(A)
of this title to satisfy the annual notice requirements set forth
in §21.2103(a)(2)(B) of this title.
|
| Source Note: The provisions of this §21.2105 adopted to be effective March 29, 1998, 23 TexReg 3009; amended to be effective April 14, 1999, 24 TexReg 3356; amended to be effective January 8, 2001, 26 TexReg 202; amended to be effective April 2, 2002, 27 TexReg 2506; amended to be effective January 19, 2006, 31 TexReg 295; amended to be effective November 2, 2016, 41 TexReg 8609 |
