Current through Reg. 50, No. 13; March 28, 2025
(a) The
issuer of a health benefit plan that provides pharmacy benefits, or a pharmacy
benefit manager or administrator issuing standard identification cards to
enrollees must issue standard identification cards as follows:
(1) For a subscriber who is an enrollee, and
who has no enrolled dependents, a single card must be issued to the subscriber,
with additional cards available on request.
(2) For a subscriber who is an enrollee, and
who has enrolled dependents, either:
(A) a
card must be issued to the subscriber and to each of the enrolled dependents,
with additional cards available on request; or
(B) two cards must be issued to the
subscriber for use by the subscriber and all enrolled dependents, with
additional cards available on request.
(3) For coverage under an individual health
benefit plan in which the subscriber is not an enrollee, or for coverage under
a health benefit plan that is continued by an enrollee under Insurance Code
Chapter 1251, Subchapter E, either:
(A) a
card must be issued to each enrollee, with additional cards available on
request; or
(B) two cards must be
issued for use by all enrollees, with additional cards available on
request.
(b)
Each standard identification card issued must, at all times the card is in
effect, include current information on the front of each identification card as
follows:
(1) the enrolled subscriber's or
enrolled dependents' names and identification codes, as follows:
(A) for cards issued under subsection (a)(1)
of this section, the enrolled subscriber's name and identification
code;
(B) for cards issued under
subsection (a)(2)(A) of this section, the enrolled subscriber's name and
identification code on the enrolled subscriber's card, and on each enrolled
dependent's card, the name and identification code of the enrolled dependent to
whom the card will be issued;
(C)
for cards issued under subsection (a)(2)(B) of this section, the names and
identification codes of the enrolled subscriber and the names and
identification codes of all the enrolled dependents;
(D) for cards issued under subsection
(a)(3)(A) of this section, on each enrolled dependent's card, the name and
identification code of the enrolled dependent to whom the card will be
issued;
(E) for cards issued under
subsection (a)(3)(B) of this section, the names and identification codes of all
enrolled dependents;
(2)
the name or logo of the issuer, or of the administrator or pharmacy benefit
manager that is administering the pharmacy benefits, if different from the
health benefit plan issuer;
(3) as
applicable, the group number applicable to the enrollee(s) covered by a group
health benefit plan or the policy number or evidence of coverage number
applicable to the enrollee(s) covered by an individual health benefit
plan;
(4) the effective date of
coverage;
(5) as applicable, the
corresponding copayment or coinsurance for generic and brand-name drugs;
provided that, if the health benefit plan uses a drug formulary with benefit
levels in addition to generic and brand-name prescription drugs, the card must
include the corresponding copayments or coinsurance for each tier level of the
drug formulary. In addition to disclosure of each benefit level, the card may
include a term such as "variable," to reflect benefit designs not fully
revealed by the drug formulary tier disclosure;
(6) as applicable, the International
Identification Number, also known as the Banking Identification Number,
assigned to the administrator or pharmacy benefit manager by the American
National Standards Institute; and
(7) for a plan issued under Insurance Code
Chapters 843 or 1301, the letters "TDI" or "DOI" prominently
displayed.
(c) In
addition to the information required under subsection (b) of this section, the
issuer of a health benefit plan must include on the identification card of each
enrollee a telephone number of an appropriate person for purposes of obtaining
information relating to the pharmacy benefits provided under the health benefit
plan.
(d) Nothing in this section
prohibits the issuer of a health benefit plan, or an administrator or pharmacy
benefit manager, from issuing a standard identification card containing a
magnetic strip or other technological component enabling the electronic
transmission of information, provided that the information required by
subsections (b) and (c) of this section is printed on the card.
