SECTION 21.3030. Availability of Formulary Information

(a) An issuer of a health benefit plan, or its delegated entity, that covers prescription drugs and uses one or more drug formularies must provide, in plain language, the disclosures required by Insurance Code §1369.054. The plain language disclosure must be in the coverage documentation provided to each enrollee and include the address and telephone number where the enrollee may contact the issuer of the health benefit plan, or its delegated entity, to determine if a specific prescription drug is on the formulary.

(b) An issuer of an individual health benefit plan must allow a current or prospective enrollee to obtain a paper copy of the formulary information required under §21.3032 and §21.3033 of this title (relating to Formulary Disclosure Requirements for Individual Health Benefit Plans and Facilitating Comparison Shopping for Individual Health Benefit Plans) by calling the toll-free number listed on the summary health plan document.

(c) An issuer may elect to exclude the plan-level cost-sharing information required under §21.3031(c) of this title (relating to Formulary Information for Individual Health Benefit Plans on Issuer's Website) from the paper format if the document provides a toll-free number through which a current or prospective enrollee may obtain formulary information contained in §21.3032 and §21.3033, including the plan-specific cost-sharing information required under §21.3032(c), for any formulary drug.

(d) The paper copy of the formulary information must use at least 10-point font.

Source Note: The provisions of this §21.3030 adopted to be effective August 18, 2016, 41 TexReg 6035; amended to be effective May 21, 2018, 43 TexReg 3243