SECTION 3.602. Plain Language Requirements

(a) All health benefit plan certificates, policies, evidences of coverage, endorsements, amendments, applications, or riders shall be written in plain language and shall comply with the requirements set forth in this subchapter.

(b) A health benefit plan certificate, policy, evidence of coverage, endorsement, amendment, rider, or application form, or a provision of such health benefit plan form shall comply with the following.

(1) The text shall achieve a minimum score of 40 on the Flesch reading ease test as provided in this subchapter. For purposes of this section, a Flesch reading ease test score shall be measured by the following method.

(A) The number of words and sentences in the test shall be counted and the total number of words divided by the total number of sentences. The figure obtained shall be multiplied by a factor of 1.015.

(B) The total number of syllables shall be counted and divided by the total number of words. The figure obtained shall be multiplied by a factor of 84.6.

(C) The sum of the figures computed under paragraphs (A) and (B) of this section, subtracted from 206.835, equals the Flesch reading ease score for the form.

(D) The entire health benefit plan, including applications, endorsements, riders, and amendments shall be analyzed in determining the Flesch reading ease test score; however:

(i) forms submitted independently of the health benefit plan shall be analyzed independently and subject to all requirements of this subchapter; and

(ii) endorsement, amendment, or rider forms submitted independently of the health benefit plan that contain fewer than 150 words are not subject to the analysis.

(2) The form, except for specification pages, schedules, and tables, shall be printed in not less than 10-point type, one-point leaded.

(3) The style, arrangement, and overall appearance of the form shall give no undue prominence to any portion of the text. The form shall be appropriately divided and captioned in meaningful sequence such that each section contains an underlined, boldfaced, or otherwise conspicuous title or caption at the beginning of the section that indicates the nature of the subject matter included in or covered by the section of the form.

(4) The health benefit plan shall contain a table of contents or an index of the principal sections of the plan, if it has more than 3,000 words printed on three or fewer pages of text, or if it has more than three pages regardless of the number of words.

(5) The form shall be written in a clear and coherent manner and wherever practical, words with common and everyday meanings shall be used to facilitate readability and to aid the insured or policyholder in understanding the coverage provided.

(6) The form shall be written on paper that does not measure more than 8 1/2 inches by 11 inches, if at all possible.

(c) For purposes of determining the Flesch readability score provided under this subchapter, the following procedures shall be used.

(1) A contraction, hyphenated word, or numbers and letters, when separated by spaces, shall be counted as one word.

(2) A unit of words ending with a period, semicolon, or colon, but excluding headings and captions, shall be counted as a sentence.

(3) A syllable means a unit of spoken language consisting of one or more letters of a word as divided by an accepted dictionary. Where the dictionary shows two or more equally acceptable pronunciations of a word, the pronunciation containing fewer syllables may be used.

(d) The term "text" as used in this section shall include all printed matter except the following:

(1) the name and address of the health carrier; the name or title of the form; the table of contents or index; captions and subcaptions; specification pages, schedules, or tables; and

(2) any language required by any federal or state law, or regulation; any medical terminology; or any words which are defined in the form; provided that the health carrier identifies the language or terminology excepted by this subsection and certifies in writing that the language or terminology is entitled to be excepted by this subsection and the grounds for such exception.

(e) Form filings subject to this subchapter shall be accompanied by a certification signed by an officer of the health carrier stating the Flesch score of the form, and stating that it meets or exceeds the minimum readability score established by the commissioner. To confirm the accuracy of any certification, the commissioner may require the submission of further information to verify the certification of compliance. Any form filing that does not meet the minimum score shall not be approved by the commissioner, and shall not be issued by the health carrier.

Source Note: The provisions of this §3.602 adopted to be effective January 5, 1994, 18 TexReg 9854.