| (a) Each carrier to which this subchapter applies is
responsible for the timely offer of state continuation coverage options
and must provide the notice for that coverage described in subsections
(b) - (e) of this section. If the carrier delegates the responsibility
of providing continuation notices to an employer or other group policyholder,
the carrier remains responsible if the employer or other group policy
or contract holder does not provide notice in compliance with this
section. The carrier must provide timely notice of continuation privileges
available to each employee, member, dependent, or enrollee whose coverage
is terminating.
(b) For purposes of this section, notice is presumed
timely if it is given at least 30 days and no more than 60 days prior
to the scheduled termination of coverage.
(1) If the employer, group policy or contract holder,
or carrier becomes aware, less than 30 days before actual termination,
that coverage will terminate, notification must be given to the affected
employee, member, dependent, or enrollee within five business days.
(2) The time limits required by this subsection in
no way affect or limit notice requirements specified in Insurance
Code §1251.307 and §1251.308. When a group policyholder
must give notice of continuation under Insurance Code Chapter 1251,
Subchapter G, on receipt of written notification of an event triggering
the election of a continuation option, the statutory time limits referenced
in subsection (e) of this section prevail.
(3) The notice must include:
(A) the time period allocated for making the election
to continue coverage prescribed in Insurance Code §§1251.253,
1251.254, and 1271.302;
(B) the premium amount that an employee, member, dependent,
or enrollee electing continuation of coverage must pay to the employer
or other group policy or contract holder on a monthly basis;
(C) the date on which the employer or other group policy
or contract holder must receive the employee's, member's, dependent's,
or enrollee's written election to continue coverage and the first
premium contribution;
(D) the length of time the eligible employee, member,
dependent, or enrollee may continue coverage;
(E) notice of a conversion option, if offered, as required
under §21.5321 of this title;
(F) an enrollment/election form and signature line;
(G) the following English and Spanish statement at
the end of the notice: "If you have questions regarding your rights
for continuation of your health insurance, contact (insert name of
insurance company) at (insert company toll-free telephone number,
or other telephone number if no toll-free number is available). If
you have additional questions about continuation or other coverage
options that might be available to you, you may contact the Texas
Department of Insurance, toll-free, at (800) 252-3439 or visit this
Internet site: http://www.tdi.texas.gov/pubs/consumer/cb005.html#losing."
"Si usted tiene preguntas sobre sus derechos para continuar con su
seguro de salud, comuníquese con (insert name of insurance
company) al (insert company toll-free telephone number, or other telephone
number if no toll-free number is available). Si usted tiene preguntas
adicionales sobre la continuación del seguro u otras opciones
de cobertura que podrían estar disponibles para usted, puede
comunicarse con el Departamento de Seguros de Texas al número
de teléfono gratuito (800) 252-3439 o visite este sitio de
Internet: http://www.tdi.texas.gov/pubs/consumer/cb005.html#losing.
Se habla español."; and
(c) If an employee, member, dependent, or enrollee
is eligible for both COBRA continuation coverage and state continuation
coverage, as permitted under §21.5310(e) of this title, the carrier
may send the notice for state continuation coverage with the COBRA
continuation notice. If the carrier sends both notices simultaneously,
the carrier must allow the employee, member, dependent, or enrollee
to elect both COBRA continuation coverage and state continuation coverage,
which will be effective at the expiration of COBRA continuation coverage
as described in §21.5310(e) of this title. A person's election
of only COBRA continuation coverage does not waive the person's right
to elect or waive state continuation coverage at a later date, provided
the election is made within the statutory time frame under Insurance
Code §1251.253 and §1271.302.
(d) If an employee, member, dependent, or enrollee
is eligible for both COBRA and state continuation coverage but only
elects COBRA continuation coverage, the carrier must provide a notice
of state continuation coverage eligibility at least 30 days and no
more than 60 days prior to termination of COBRA continuation coverage.
If the employer, group policy or contract holder, or carrier becomes
aware less than 30 days before actual termination that COBRA continuation
coverage will terminate, notification must be given to the affected
employee, member, dependent, or enrollee within five business days.
(e) The written notice of state continuation coverage
privileges required by this subsection must also comply with the requirements
of Insurance Code Chapter 1251, Subchapter G, and Chapter 1271, Subchapter
G.
(f) Except as otherwise provided by this chapter, the
requirements of this section apply only on or after February 1, 2015.
Before that date, §3.506 of this title as it existed immediately
before the effective date of this chapter applies, and is continued
in effect through January 31, 2015, for that purpose.
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