SECTION 21.5311. Notification Requirement of Insurers, Employer and Group Policyholders, and HMOs

(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 [phone] 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 [phone] o visite este sitio de Internet: http://www.tdi.texas.gov/pubs/consumer/cb005.html#losing. Se habla español."; and

(c) If an employee, member, dependent, or enrollee is eligible for both COBRA continuation coverage and state continuation coverage, as permitted under §21.5310(e) of this title, the carrier may send the notice for state continuation coverage with the COBRA continuation notice. If the carrier sends both notices simultaneously, the carrier must allow the employee, member, dependent, or enrollee to elect both COBRA continuation coverage and state continuation coverage, which will be effective at the expiration of COBRA continuation coverage as described in §21.5310(e) of this title. A person's election of only COBRA continuation coverage does not waive the person's right to elect or waive state continuation coverage at a later date, provided the election is made within the statutory time frame under Insurance Code §1251.253 and §1271.302.

(d) If an employee, member, dependent, or enrollee is eligible for both COBRA and state continuation coverage but only elects COBRA continuation coverage, the carrier must provide a notice of state continuation coverage eligibility at least 30 days and no more than 60 days prior to termination of COBRA continuation coverage. If the employer, group policy or contract holder, or carrier becomes aware less than 30 days before actual termination that COBRA continuation coverage will terminate, notification must be given to the affected employee, member, dependent, or enrollee within five business days.

(e) The written notice of state continuation coverage privileges required by this subsection must also comply with the requirements of Insurance Code Chapter 1251, Subchapter G, and Chapter 1271, Subchapter G.

(f) Except as otherwise provided by this chapter, the requirements of this section apply only on or after February 1, 2015. Before that date, §3.506 of this title as it existed immediately before the effective date of this chapter applies, and is continued in effect through January 31, 2015, for that purpose.

Source Note: The provisions of this §21.5311 adopted to be effective November 17, 2014, 39 TexReg 9036