Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter K - CERTIFICATION OF CREDITABLE COVERAGE
Section 21.1103 - Timing of Issuance of a Written Certificate of Creditable Coverage to an Individual

Universal Citation: 28 TX Admin Code § 21.1103

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

(a) Each issuer of a health benefit plan shall comply with the following:

(1) For an individual who is a qualified beneficiary entitled to elect COBRA continuation coverage, a certificate of creditable coverage shall be provided at the time the individual would lose coverage under the plan in the absence of COBRA continuation coverage or alternative coverage elected, instead of COBRA continuation coverage. The certificate of creditable coverage shall be provided within 30 days of the date the individual would lose coverage under the plan, in the absence of COBRA continuation coverage.

(2) For an individual who is not a qualified beneficiary entitled to elect COBRA continuation coverage, a certificate of creditable coverage shall be provided within 30 days after the date the individual ceases to be covered under the health benefit plan.

(3) For an individual who is a qualified beneficiary and has elected COBRA continuation coverage, a certificate of creditable coverage shall be provided within 30 days after coverage under COBRA ceases or within 30 days after the expiration of any grace period for nonpayment of premium. A certificate of creditable coverage is required to be provided regardless of whether the individual has previously received a certificate of creditable coverage under paragraph (1) of this subsection.

(b) Requests for certificates are permitted to be made by, or on behalf of, an individual within 24 months after coverage ceases. For example, the issuer of a health benefit plan in which an individual enrolls may, if authorized by the individual, request a certificate of the individual's creditable coverage from an issuer of a health benefit plan in which the individual was formerly covered. After the request is received, the issuer of the health benefit plan in which the individual was formerly covered shall provide the certificate within 30 days of receipt of the request. A certificate is required to be provided under this subsection even if the individual has previously received a certificate under this subsection or under subsection (a)(1) or (2) of this section. An issuer of a health benefit plan shall establish a procedure for individuals to request and receive certificates under this subsection.

(c) An issuer of a health benefit plan is not required to issue a certificate of creditable coverage for coverage excluded as creditable coverage under the definition of creditable coverage in § 21.1101 of this title (relating to Definitions).

(d) A certificate of creditable coverage shall be provided under this section without charge.

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