Texas Register, Volume 32, Number 3, Pages 215-274, January 19, 2007 Page: 242
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The Department did not receive any comments on the proposed
amendments.
The amendments are adopted under the Insurance Code,
521.005, 521.103, 521.101, 1271.054, 1271.101, 843.151,
and 36.001. Under 521.005(a), each insurance policy deliv-
ered or issued for delivery in this state must include with the
policy a brief written notice that includes a suggested policy-
holder dispute procedure, the Department's name and address,
and the Department's toll-free number. Under 521.005(b),
the Commissioner is specifically charged with adopting the
appropriate wording for the notice. The Commissioner is also
authorized by 521.103(b) to adopt rules governing the manner
in which an insurer's or HMO's toll-free telephone number ap-
pears on the insurance policy or evidence of coverage. Section
521.101 provides that the Insurance Code, Chapter 521, Sub-
chapter C (Health Maintenance Organization or Insurer Toll-free
Number for Information and Complaints) applies to a health
maintenance organization authorized to engage in the business
of a health maintenance organization in this state or an insurer
organized to engage in the business of insurance in this state.
Section 1271.054 requires that an evidence of coverage contain
a clear and understandable description of the HMO's methods
for resolving enrollee complaints. Section 1271.101(a) provides
that an evidence of coverage or an amendment of an evidence
of coverage may not be issued or delivered to a person in this
state until the form of the evidence of coverage or amendment
has been filed with and approved by the Commissioner. Section
843.151 authorizes the Commissioner to adopt reasonable rules
as necessary and proper to implement Chapter 843 (Health
Maintenance Organizations). Section 36.001 provides that the
Commissioner of Insurance may adopt any rules necessary and
appropriate to implement the powers and duties of the Texas
Department of Insurance under the Insurance Code and other
laws of this state.
1.601. Notice of Toll-Free Telephone Numbers and Information and
Complaint Procedures.
(a) Purpose and applicability.
(1) The purpose of this section is to provide the means
by which insurers and health maintenance organizations (HMOs)
may comply with the notice requirements of the Insurance Code
521.103, and the means by which insurers may comply with the
notice requirements of the Insurance Code 521.005 and 521.056.
Compliance with this section is deemed compliance with these notice
requirements.
(2) Except as provided by subsection (b)(3), this section
applies to any new or renewal insurance policy, bond, annuity con-
tract, subscriber contract, health care plan, certificate, and evidence of
coverage issued for delivery in this state on or after May 1, 1992.
(3) All policies, certificates, or evidences of coverage
which are delivered, issued for delivery, or renewed in the State of
Texas on or after May 1, 1992, by insurers or HMOs shall have the
notice included as the first, second, or third page of the policy, certifi-
cate, evidence of coverage, or first written communication indicating
renewal of coverage, pursuant to the provisions of subsection (b) of
this section. The notice must appear on a full, separate page with
no text other than that provided in this section. The form of the
notice shall be as provided by subsection (b) of this section. The item
numbers 1 - 8 in the left-hand column of this form correspond to the
respective paragraphs of subsection (b) of this section, and the item
numbers may be omitted from the notice.
Figure: 28 TAC 1.601(a)(3)(b) Notice requirements. Each respectively numbered item in
the notice provided in subsection (a)(3) of this section must be set out
as provided in this subsection. There must be at least one blank line
between each item, but the text within each item may be single-spaced.
The Spanish portion of each item included in a company's notice is
required only for personal automobile, homeowners, and life, accident
and health policies, certificates, and evidences of coverage. Text shall
be in at least 10-point type. The letterhead of the insurer or HMO
and any automated form identification numbers may be included on
the notice.
(1) Item 1 must be included in all notices. "Important No-
tice" and "Aviso Importante" must be in all capital letters and in at least
10-point boldface type. There must be at least one blank line below
"Important Notice" and "Aviso Importante."
(2) Item 2 is optional. The title for the English portion
may be either "agent," "third party administrator," "managing general
agent," or "employee benefits coordinator." The title for the Spanish
portion may be either "agente," "administrador tercero," "agente gen-
eral," or "administrador de beneficios para empleados." In lieu of a spe-
cific telephone number, the insurer or HMO may refer to the applicable
telephone number and where it can be found.
(3) Item 3 is required unless one of the exemptions pro-
vided in this subsection applies. For purposes of this section a toll-free
telephone number is one which can be used by any covered person
to obtain information or make a complaint without incurring long-dis-
tance calling expenses. The insurer's or HMO's toll-free number must
appear in at least 10-point boldface type and must be preceded and fol-
lowed by one blank line. Item 3 is not required for an insurer or HMO:
(A) whose gross initial premium receipts collected in
this state are less than $2 million a year;
(B) with respect to fidelity, surety, or guaranty bonds;
(C) that is a surplus lines insurer; or
(D) with respect to certificates of insurance issued un-
der a group policy:
(i) if the insurer does not administer the group policy
or determine questions of coverage; or
(ii) if the policyholder to whom the policy is issued
is an employer or a labor union.
(4) Item 4 is optional. If used, the insurer's or HMO's name
and address must be inserted.
(5) Item 5 is required on all notices. The toll-free number
must be in at least 10-point boldface type and must be preceded and
followed by one blank line.
(6) Item 6 is required on all notices.
(7) Item 7 is required on all notices except those notices
provided by HMOs with evidences of coverage. "Premium or claim
disputes" and "Disputas sobre primas o reclamos" must be in all cap-
ital letters and 10-point boldface type. The insurer may insert either
"agent," "company," or "agent or company" and may insert either "el
agente," "la compania," or "el agente o la compania."
(8) Item 8 is required on all notices. "Attach this notice to
your policy" and "Una este aviso a su poliza" must be in all capital
letters and 10-point boldface type.
(c) Exceptions to notice requirements for insurer's toll-free
number.32 TexReg 242 January 19, 2007 Texas Register
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Texas. Secretary of State. Texas Register, Volume 32, Number 3, Pages 215-274, January 19, 2007, periodical, January 19, 2007; Austin, Texas. (https://texashistory.unt.edu/ark:/67531/metapth97380/m1/26/: accessed May 4, 2024), University of North Texas Libraries, The Portal to Texas History, https://texashistory.unt.edu; crediting UNT Libraries Government Documents Department.