Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter SS - CONTINUATION AND CONVERSION PROVISIONS › Division 2 - GROUP CONTINUATION PROVISIONS › Section 21.5311 - Notification Requirement of Insurers, Employer and Group Policyholders, and HMOs

Current through Reg. 49, No. 28; July 12, 2024
(a) Each carrier to
					 which this subchapter applies is responsible for the timely offer of state
					 continuation coverage options and must provide the notice for that coverage
					 described in subsections (b) - (e) of this section. If the carrier delegates
					 the responsibility of providing continuation notices to an employer or other
					 group policyholder, the carrier remains responsible if the employer or other
					 group policy or contract holder does not provide notice in compliance with this
					 section. The carrier must provide timely notice of continuation privileges
					 available to each employee, member, dependent, or enrollee whose coverage is
					 terminating.
(b) For purposes of
					 this section, notice is presumed timely if it is given at least 30 days and no
					 more than 60 days prior to the scheduled termination of coverage.
(1) If the employer, group policy or contract
					 holder, or carrier becomes aware, less than 30 days before actual termination,
					 that coverage will terminate, notification must be given to the affected
					 employee, member, dependent, or enrollee within five business days.
(2) The time limits required by this
					 subsection in no way affect or limit notice requirements specified in Insurance
					 Code §
												1251.307
					 and §
												1251.308.
					 When a group policyholder must give notice of continuation under Insurance Code
					 Chapter 1251, Subchapter G, on receipt of written notification of an event
					 triggering the election of a continuation option, the statutory time limits
					 referenced in subsection (e) of this section prevail.
(3) The notice must include:
(A) the time period allocated for making the
					 election to continue coverage prescribed in Insurance Code §§
													1251.253,
					 1251.254,
					 and
					 1271.302;
(B) the premium amount that an employee,
					 member, dependent, or enrollee electing continuation of coverage must pay to
					 the employer or other group policy or contract holder on a monthly
					 basis;
(C) the date on which the
					 employer or other group policy or contract holder must receive the employee's,
					 member's, dependent's, or enrollee's written election to continue coverage and
					 the first premium contribution;
(D)
					 the length of time the eligible employee, member, dependent, or enrollee may
					 continue coverage;
(E) notice of a
					 conversion option, if offered, as required under §
													21.5321
					 of this title;
(F) an
					 enrollment/election form and signature line;
(G) the following English and Spanish
					 statement at the end of the notice: "If you have questions regarding your
					 rights for continuation of your health insurance, contact (insert name of
					 insurance company) at (insert company toll-free telephone number, or other
					 telephone number if no toll-free number is available). If you have additional
					 questions about continuation or other coverage options that might be available
					 to you, you may contact the Texas Department of Insurance, toll-free, at (800)
					 252-3439 or visit this Internet site:
					 http://www.tdi.texas.gov/pubs/consumer/cb005.html#losing." "Si usted tiene
					 preguntas sobre sus derechos para continuar con su seguro de salud,
					 comuníquese con (insert name of insurance company) al (insert company
					 toll-free telephone number, or other telephone number if no toll-free number is
					 available). Si usted tiene preguntas adicionales sobre la continuación
					 del seguro u otras opciones de cobertura que podrían estar disponibles
					 para usted, puede comunicarse con el Departamento de Seguros de Texas al
					 número de teléfono gratuito (800) 252-3439 o visite este sitio de
					 Internet: http://www.tdi.texas.gov/pubs/consumer/cb005.html#losing. Se habla
					 espanol."; and