Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 21 - TRADE PRACTICES
Subchapter M - MANDATORY BENEFIT NOTICE REQUIREMENTS
Section 21.2105 - Delivery of Mandatory Benefit Notices
Universal Citation: 28 TX Admin Code § 21.2105
Current through Reg. 50, No. 13; March 28, 2025
(a) The notices required by § 21.2103(a)(1), (3), and (4) of this title (relating to Mandatory Benefit Notices) must be issued to enrollees of a health benefit plan within 60 days of the plan's issuance or renewal.
(1)
Except as specified in paragraph (5) of this subsection, a carrier must deliver
the notices to enrollees through the U.S. Postal Service or, as permitted by
state law, electronically.
(2) The
notice may be delivered with other health benefit plan documents within 60 days
of the plan's issuance or renewal. For example, the notice may be delivered
with the policy, certificate, evidence of coverage, or the enrollment or
insurance card.
(3) If the notices
are provided to the primary enrollee's last known address, the requirements of
this section are satisfied with respect to all enrollees residing at that
address.
(4) If a covered spouse or
dependent's last known address is different than the primary enrollee, separate
notices are required to be provided to the spouse or the dependent at the
spouse's or dependent's last known address.
(5) For group health benefit plans, the
notice may be provided to the group master contract holder for distribution to
enrollees if the carrier has an agreement with the group master contract holder
that the notice will be delivered within 60 days of the plan's issuance or
renewal; however, TDI will hold the carrier responsible for ensuring that
notice is provided to the enrollees.
(b) The notices required by § 21.2103(a)(2) of this title must be issued to enrollees of a health benefit plan and be provided according to the following paragraphs:
(1)
the enrollment notice required by §
21.2103(a)(2)(A)
of this title must be issued to each enrollee upon enrollment in the health
benefit plan;
(2) the annual notice
required by §
21.2103(a)(2)(B)
of this title must be issued to each enrollee annually; and
(3) notwithstanding §
21.2103(a)(2) of
this title, a carrier may elect to issue the enrollment notice required by
§
21.2103(a)(2)(A)
of this title to satisfy the annual notice requirements set forth in §
21.2103(a)(2)(B)
of this title.
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