Current through Reg. 50, No. 13; March 28, 2025
(a) Under Insurance Code §
1352.005, health
benefit plan issuers must provide to insureds and enrollees the notification
specified in this subsection. A representation of this notification is as
follows:
Attached Graphic
(b) The notice required by Insurance Code
§
1352.005 and
subsection (a) of this section is required by Insurance Code §
1352.005 to be issued
annually to each insured or enrollee under the plan.
(c) The notice must be printed in at least
12-point type and must comply with the following requirements:
(1) The notice must be provided during the
policy term for the plan, and no later than the 60th day after enrollment and
renewal.
(2) Except as specified in
paragraph (6) of this subsection, a health benefit plan issuer must deliver the
notice to insureds or enrollees through the U.S. Postal Service.
(3) The notice may be delivered with other
health benefit plan documents that are delivered through the U.S. Postal
Service as long as the time frames set forth in paragraph (1) of this
subsection are met. For example, the notice may be delivered with the policy,
certificate, evidence of coverage, or enrollment or insurance card.
(4) If the notice is provided to the primary
insured's or enrollee's last known address, the requirements of this section
are satisfied with respect to all insureds or enrollees residing at that
address.
(5) If the last known
address of a covered spouse or dependent is different than the primary
insured's or enrollee's last known address, separate notices are required to be
provided to the spouse or the dependent at the spouse's or dependent's last
known address.
(6) For group health
benefit plans, the notice may be provided to the group master contract holder
for distribution to insureds or enrollees if the health benefit plan issuer has
an agreement with the group master contract holder that the notice will be
delivered in compliance with the timelines specified in paragraph (1) of this
subsection; however, the health benefit plan issuer must ensure that the notice
is provided to the insureds or enrollees.
(d) As provided in Insurance Code §
1352.005(a),
this section does not apply to a small employer health benefit plan
issuer.
