Current through Reg. 50, No. 13; March 28, 2025
(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
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(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.