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COMMISSIONER'S BULLETIN # B-0051-10
December 15, 2010
TO: ALL INSURERS LICENSED TO WRITE ACCIDENT AND HEALTH INSURANCE IN TEXAS AND ALL HEALTH MAINTENANCE ORGANIZATIONS
RE: ESTABLISHMENT OF TEXAS CONSUMER HEALTH ASSISTANCE PROGRAM; REQUIREMENT TO PROVIDE INFORMATION REGARDING THE AVAILABILITY OF THE TEXAS CONSUMER HEALTH ASSISTANCE PROGRAM TO ENROLLEES
The Texas Department of Insurance (TDI) issues this bulletin regarding the establishment of the Texas Consumer Health Assistance Program (Texas CHAP) and the provisions of the Patient Protection and Affordable Care Act (PPACA) that require group health plans and health insurance issuers offering group or individual health insurance coverage to provide notice of the availability of the program to enrollees.
PPACA, the federal health care reform bill, was signed into law on March 23, 2010. PPACA required the Secretary of the U.S. Department of Health and Human Services to award grants to states to enable them to establish, expand, or provide support for offices of health insurance consumer assistance or health insurance ombudsman programs. Grants were awarded as of October 15, 2010, and the Texas Department of Insurance received $2,792,180 to assist in the establishment and operation of Texas CHAP.
Texas CHAP is now operational and is administered by TDI's Consumer Protection program. It is located at the Texas Department of Insurance, 333 Guadalupe, Austin, Texas. The program's toll-free number is 1-855-TEX-CHAP (1-855-839-2427). The e-mail address is email@example.com. The mailing address is Texas Department of Insurance, Mail Code 111-1A, PO Box 149091, Austin, Texas, 78714-9091.
Under PPACA, Texas CHAP will:
Educate consumers on their rights and responsibilities with respect to group health plans and health insurance coverage;
Assist consumers with enrollment in a group health plan or health insurance coverage by providing information, referral, and assistance;
Assist with the filing of complaints and appeals, including filing appeals with the internal appeal or grievance process of the group health plan or health insurance issuer involved and providing information about the external appeal process;
Collect, track, and quantify problems and inquiries encountered by consumers;
Resolve problems with obtaining premium tax credits under section 36B of the Internal Revenue Code of 1986.
PPACA Section 2719, which relates to "Appeals Process," requires group health plans and health insurance issuers offering group or individual health insurance coverage to provide information to enrollees in a culturally and linguistically appropriate manner of the availability of the Texas Consumer Health Assistance Program to assist enrollees with the appeals processes. Under federal regulations, this information must be included as part of each notice of adverse benefit determination given to an enrollee. Guidance from the U.S. Department of Health and Human Services (HHS) concerning the federal requirements for the notice is available on the HHS Office of Consumer Information and Insurance Oversight website at:
Please direct questions regarding the Texas Consumer Health Assistance Program to Audrey Selden, Senior Associate Commissioner, firstname.lastname@example.org.
Commissioner of Insurance
For more information contact: