Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter AA - CONSUMER CHOICE HEALTH BENEFIT PLANS › Division 3 - REQUIRED NOTICES › Section 21.3530 - Health Carrier Disclosure

Current through Reg. 49, No. 28; July 12, 2024
(a) A
					 health carrier offering or providing a consumer choice health benefit plan must
					 provide each prospective or current policyholder or contract holder with a
					 written or electronic disclosure statement in a manner that gives the
					 policyholder or contract holder the ability to keep a copy of the disclosure
					 statement. The disclosure statement must provide a sufficiently detailed
					 description of the state-mandated health benefits that are reduced or not
					 included in the plan to enable the prospective or current policyholder or
					 contract holder to make an informed decision.
(b) Form CCP 1 fulfills the requirements of
					 this section and is available on the department's website at
www.tdi.texas.gov
.
(c) If a health carrier chooses to generate
					 its own disclosure statement, it must comply with readability standards
					 applicable to forms reviewed under Chapter 3 of this title (relating to Life,
					 Accident, and Health Insurance and Annuities) and Chapter 11 of this title
					 (relating to Health Maintenance Organizations) and the statement must use at
					 least 12-point type. The disclosure statement also must:
(1) acknowledge that the consumer choice
					 health benefit plan being offered or purchased does not provide some or all
					 state-mandated health benefits and explain, if applicable, that the plan does
					 include all health benefits required by the Affordable Care Act;
(2) in plain language, list each health
					 benefit or coverage not provided at the state-mandated level in the consumer
					 choice health benefit plan, define the listed health benefit or coverage,
					 describe the benefit or coverage in the consumer choice plan being offered, and
					 describe the benefit or coverage that would be provided in a state-mandated
					 plan;
(3) instruct consumers to
					 refer to the Summary of Benefits and Coverage to see the specific level of
					 benefits provided by the plan;
(4)
					 when applicable because the health carrier has materially modified a consumer
					 choice plan in a way that necessitates a change to the disclosure, or when the
					 disclosure must be updated to reflect changes in state law, contain the
					 following language, in bold type, directly above the list required by paragraph
					 (2) of this subsection, as applicable:
(A)
					 "The benefits or coverages you are agreeing to on this renewal are different
					 from your current plan."; or
(B)
					 "The benefits required by state law have changed since you first received this
					 disclosure.";
(5)
					 explain that the health carrier offers one or more state-mandated plans and
					 provide:
(A) a phone number where the
					 consumer can purchase the state-mandated plan;
(B) a URL that connects the consumer to the
					 health carrier's website where the state-mandated plan is available for
					 purchase; and
(C) for individual
					 market plans, indicate whether the state-mandated plan is available on the
					 federal health benefit exchange and if it is not, explain that the plan will
					 not qualify for reduced premiums or cost-sharing;
(6) contain acknowledgments of the following:
(A) that the consumer choice health benefit
					 plan does not provide the same level of coverage required in a state-mandated
					 plan;
(B) that more information
					 about consumer choice health benefit plans is available from the department
					 either online at
www.tdi.texas.gov/consumer/consumerchoice.html
,
					 or by calling the TDI Consumer Help Line at 1-800-252-3439; and
(C) if the plan is being issued in the
					 individual market, that if the plan does not meet the consumer's needs, in most
					 cases the consumer will not be able to get a new plan until the next open
					 enrollment period;
(7)
					 inform the prospective or current policyholder or contract holder that the
					 health carrier must provide a copy of the written disclosure statement upon
					 request;
(8) for a disclosure being
					 delivered consistent with subsection (e)(2) of this section, include the
					 following language in bold type, directly above the acknowledgements in
					 paragraph (6) of this subsection: "By signing your application to enroll in
					 this plan, you acknowledge the following:"; and
(9) for initial coverage or enrollment, other
					 than for a disclosure being delivered consistent with subsection (e)(2) of this
					 section, provide space for the prospective policyholder or contract holder to
					 print and sign their name, and to sign to acknowledge receipt of the disclosure
					 statement, accompanied by the following language in bold type: "Don't sign this
					 document if you don't understand it. No firme este documento si no lo
					 comprende."