SECTION 21.3003. Standard Identification Cards

(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 name and identification code 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.

Source Note: The provisions of this §21.3003 adopted to be effective December 20, 2000, 25 TexReg 12441; amended to be effective August 18, 2016, 41 TexReg 6035