• Increase Text Icon
  • Decrease Text Icon
  • Email Icon
  • Print this page
You are here: Home . rules . 2002 . trade
Archived File – for Reference Use.
Links and contact information may be outdated.

SUBCHAPTER M. MANDATORY BENEFIT NOTICE REQUIREMENTS

28 TAC §21.2107

The Commissioner of Insurance adopts amendments to §21.2107 concerning the rights of eligible beneficiaries to notice under §3.3312. The amended sections are adopted without changes to the proposed text as published in the January 25, 2002 issue of the Texas Register (27 TexReg 570) and will not be republished.

The amendments are necessary to implement changes made to the Social Security Act (Act) by Medicare, Medicaid, and State Children´s Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA) and subsequent changes made to the National Association of Insurance Commissioners (NAIC) Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act. The Model Regulation was accepted by the Centers for Medicare and Medicaid Services (CMS), the agency which administers Medicare programs.

The amendments to §21.2107 are necessary to notify entities described in §3.3312 of the requirement to disclose to individuals their right to extended Medicare supplement access if their enrollment is interrupted within their trial period due to involuntary termination.

No comments were received regarding adoption of these amendments.

The amendments are adopted under the Insurance Code Articles 3.74, 20A.22, and §36.001. Article 3.74 provides that the Texas Department of Insurance shall adopt rules in accordance with federal law applicable to the regulation of Medicare supplement insurance coverage that are necessary for the state to obtain or retain certification as a state with approved regulatory program under §1882 of the Social Security Act (42 U.S.C. 1395ss). Article 20A.22 provides that the Commissioner is specifically authorized to promulgate rules to meet the requirements of federal laws and regulations. Section 36.001 provides that the Commissioner of Insurance may adopt rules to execute the duties and functions of the Texas Department of Insurance as authorized by statute.

§21.2107. Right To Medicare Supplement Coverage Notice.

(a) At the time of an event described in §3.3312(b) of this title (relating to Guaranteed Issue for Eligible Persons) because of which an individual loses coverage or benefits due to the termination of a contract, agreement, policy, or plan, the entity, as defined in and pursuant to §3.3312 of this title, shall notify the individual of his or her rights under §3.3312(a), (c), (d), and (e) of this title, and of the obligations of issuers of Medicare supplement policies under §3.3312(a) of this title. The entity shall communicate such notice contemporaneously with the notification of termination.

(b) At the time of an event described in §3.3312(b) of this title because of which an individual ceases enrollment under a contract, agreement, policy, or plan, the entity, as defined in §3.3312 of this title, which offers the contract or agreement, regardless of the basis for the cessation of enrollment, the entity offering the plan, or the licensed third party administrator of the plan, respectively, shall notify the individual of his or her rights under §3.3312(a), (c), (d), and (e) of this title, and of the obligations of issuers of Medicare supplement policies under §3.3312(a) of this title. The entity shall communicate such notice within ten working days of the entity's receipt of notification of disenrollment.



For more information, contact:

Contact Information and Other Helpful Links