| (a) Purpose and applicability.
(1) The purpose of this section is to provide the means
for insurers and health maintenance organizations (HMOs) to comply
with the notice requirements of Insurance Code §521.103, concerning
Information Included in Evidence of Coverage or Policy; §521.005,
concerning Notice to Accompany Policy; and §521.056, concerning
Information Bulletin to Accompany Policy. Compliance with this section
is deemed compliance with these notice requirements.
(2) The notice must be provided at the time of delivery
with all policies, bonds, annuity contracts, certificates, or evidences
of coverage that are delivered, issued for delivery, or renewed in
Texas by insurers or HMOs. When insurers add a certificate holder,
annuitant, or enrollee to a group policy or group plan, insurers must
also provide the notice when the certificate, annuity contract, or
evidence of coverage is delivered.
(A) The notice must appear on a full, separate page
with no text other than that provided in this section. The notice
must be prominently placed in any package of documents it is delivered
with, and it must be the first, second, or third page of the set of
documents.
(B) The form of the notice must be consistent with
Figure: 28 TAC §1.601(a)(2)(B) and the requirements of subsection
(b) of this section. The form of notice is not required to be filed
with the department.
Attached Graphic
(C) The form of the notice for workers' compensation
must be consistent with Figure: 28 TAC §1.601(a)(2)(C) and the
requirements of subsection (b) of this section. The form of notice
is not required to be filed with the department.
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(b) Notice requirements. The text may be single spaced,
but it must include at least one blank line between each paragraph.
The Spanish portion of the notice is required for personal automobile,
homeowners, life, accident, and health policies, certificates, and
evidences of coverage. The notice may include the letterhead of the
insurer or HMO and any automated form identification numbers.
(1) The notice must include a title and telephone number
for the insurer or HMO. At its option, the insurer or HMO may provide
the name and telephone number of an agent, third-party administrator,
managing general agent, or employee benefits coordinator. The telephone
number must be in bold type and be preceded and followed by one blank
line. The insurer or HMO must provide a toll-free telephone number,
unless one of the exemptions in subparagraphs (A) - (C) of this paragraph
applies. For purposes of this section, a toll-free telephone number
is one that any covered person can use to get information or make
a complaint without incurring long-distance calling expenses. An insurer
or HMO is exempt from providing a toll-free number:
(A) when the insurer's or HMO's gross initial premium
receipts collected in Texas are less than $2 million a year;
(B) with respect to fidelity, surety, or guaranty bonds;
or
(C) if it is a surplus lines insurer.
(2) The notice must include a mailing address and email
address for the insurer or HMO. The notice may include a company's
URL address.
(3) The notice must be in a type size no smaller than
10 point.
(c) Exceptions to maintenance of toll-free number.
Any exception claimed under subsection (b)(1)(A) of this section must
be based on gross initial premium receipts collected in Texas during
the previous calendar year. This information and any other data that
the company relied on to determine if it was entitled to an exception
is subject to examination by the department. Failure by any insurer
or HMO to maintain the information required in this paragraph, or
failure to provide information to the department on request, constitutes
grounds for enforcement action that may result in the cancellation,
revocation, or suspension of the insurer's or HMO's certificate of
authority. Any insurer or HMO claiming an exception must retain and
provide to the department on request:
(1) the statutory basis for the exception; and
(2) the amount of gross initial premium receipts collected
in Texas for the calendar year immediately preceding the year for
which an exception is claimed. The gross initial premium receipts
collected may be documented either by:
(A) the annual statement submitted by the insurer or
HMO; or
(B) records maintained for each new policy written
during a calendar year that include the policy number, the effective
date of the policy, and the amount of initial premium received, including
any membership fees, assessments, dues, and any other considerations
for that insurance.
(d) Providing notice. Insurers and HMOs will not need
to refile previously approved policies, bonds, annuity contracts,
certificates, or evidences of coverage, but they must provide the
notice in the manner required by this section.
(e) Implementation date. Insurers and HMOs must begin
using the notice form described in subsection (a)(2) of this section
no later than July 1, 2023. Insurers and HMOs may continue using the
previous notice form until that time.
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| Source Note: The provisions of this §1.601 adopted to be effective August 24, 1984, 9 TexReg 4340; amended to be effective June 12, 1990, 15 TexReg 3015; amended to be effective May 1, 1992, 17 TexReg 2776; amended to be effective October 28, 1992, 17 TexReg 7230; amended to be effective January 22, 2007, 32 TexReg 241; amended to be effective June 1, 2015, 40 TexReg 3174; amended to be effective November 4, 2019, 44 TexReg 6541; amended to be effective July 1, 2021, 45 TexReg 9225; amended to be effective June 7, 2023, 48 TexReg 2854 |
