| (a) Under Insurance Code §1352.005, health benefit
plan issuers must provide to insureds and enrollees the notification
specified in this subsection. A representation of this notification
is as follows:
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(b) The notice required by Insurance Code §1352.005
and subsection (a) of this section is required by Insurance Code §1352.005
to be issued annually to each insured or enrollee under the plan.
(c) The notice must be printed in at least 12-point
type and must comply with the following requirements:
(1) The notice must be provided during the policy term
for the plan, and no later than the 60th day after enrollment and
renewal.
(2) Except as specified in paragraph (6) of this subsection,
a health benefit plan issuer must deliver the notice to insureds or
enrollees through the U.S. Postal Service.
(3) The notice may be delivered with other health benefit
plan documents that are delivered through the U.S. Postal Service
as long as the time frames set forth in paragraph (1) of this subsection
are met. For example, the notice may be delivered with the policy,
certificate, evidence of coverage, or enrollment or insurance card.
(4) If the notice is provided to the primary insured's
or enrollee's last known address, the requirements of this section
are satisfied with respect to all insureds or enrollees residing at
that address.
(5) If the last known address of a covered spouse or
dependent is different than the primary insured's or enrollee's last
known address, separate notices are required to be provided to the
spouse or the dependent at the spouse's or dependent's last known
address.
(6) For group health benefit plans, the notice may
be provided to the group master contract holder for distribution to
insureds or enrollees if the health benefit plan issuer has an agreement
with the group master contract holder that the notice will be delivered
in compliance with the timelines specified in paragraph (1) of this
subsection; however, the health benefit plan issuer must ensure that
the notice is provided to the insureds or enrollees.
(d) As provided in Insurance Code §1352.005(a),
this section does not apply to a small employer health benefit plan
issuer.
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