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You are here: Home . rules . 2003 . 0112-059
Archived File – for Reference Use.
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Subchapter T. Submission of Clean Claims

§21.2820

The Commissioner of Insurance adopts new §21.2820 concerning identification (ID) cards issued by insurers who issue preferred provider benefit plans and health maintenance organizations (HMOs) (hereinafter "carriers"). The section is adopted with changes to the proposed text as published in the October 31, 2003 issue of the Texas Register (28 TexReg 9398).

The new section is necessary to implement certain provisions of Senate Bill (SB) 418, 78 th Regular Legislative Session, concerning the content of ID cards issued by carriers. Among other things, SB 418 added new Texas Insurance Code Art. 3.70-3C, Sec. 11, and §843.209. These sections contain provisions concerning ID cards issued by carriers regulated under the Insurance Code and subject to the provisions of SB 418, that basically require carriers that issue ID cards to display certain information on the cards. In developing this rule, the department discussed the provisions with the Technical Advisory Committee on Claims Processing (TACCP) appointed by the commissioner of insurance pursuant to SB 418, and drafted the proposal after receiving comments from members of the TACCP.

Pursuant to the emergency adoption provisions of Senate Bill (SB) 418, 78 th Regular Session, the department adopted §21.2820 on an emergency basis effective August 16, 2003, which was the date that certain provisions of SB 418 went into effect. The emergency section will be withdrawn at the time this adoption becomes effective.

In response to a comment, §21.2820(b)(2) was changed to eliminate the requirement that the ID card contain both a toll-free number and a statement or other indication that a preferred provider may use the number to obtain the enrollee´s first date of eligibility. The adopted section´s language conforms more closely to the language of the statute. In addition, a change was made to §21.2820(b)(3) for purposes of consistency, and the effective date was modified to accommodate the transition from the application of the emergency rule to the final adopted rule.

The adopted section requires carriers that are subject to the applicable subchapter and that issue ID cards to display the first date of coverage or, in the alternative, to give a toll-free number by which a physician or provider may obtain this information. Because these provisions only apply to carriers and health plans subject to SB 418, they also contemplate that such cards identify applicability of the statute. Therefore, the adopted section also requires that the letters "TDI" or "DOI" be prominently displayed on the front of the card or document. As noted in the proposal, because a slightly different emergency rule has been in effect since August 16, 2003 (requiring that ID cards contain a symbol consisting of a star containing the letters "TDI"), any plans that have already printed cards containing the symbol as required by the emergency rule will be deemed to be in compliance with this adopted rule.

Finally, the adoption states that the requirements of the section apply to any HMO evidence of coverage or preferred provider benefit plan issued or renewed on or after February 1, 2004 . The department believes that the adoption implements the ID card provisions of SB 418 consistent with the law´s intent that the cards be as uniform and useful as possible for enrollees, insureds, carriers, and physicians and providers. The emergency rule relating to identification cards in effect prior to this adoption functioned similarly to this adopted rule and applied to any HMO evidence of coverage or preferred provider benefit plan issued or renewed on or after February 1, 2004 . As noted earlier, the emergency rule will be withdrawn at the time this adoption becomes effective. The adoption of this permanent rule does not relieve a carrier´s obligation to comply with the emergency rule nor does the adoption provide a delay or break in a carrier´s requirement to comply with the identification card requirements.

Comment: Two commenters requested that the proposed effective date of January 1, 2004, be delayed by either one or two months to give plans more time to comply. One commenter urged that the department retain the January 1 date, as many health plans begin or renew their plan year on that date, and a later compliance date would defer the issuance of compliant ID cards for up to 11 months for such plans.

Agency Response:Because January 1, 2004 was the date contained in emergency rules that went into effect on August 16, 2003, carriers have had several months´ notice and opportunity to prepare for the changes. The effective date has been changed in this adopted rule from the date included in the proposal, but only to accommodate the transition from the application of the emergency rule to the final adopted rule. Due to the substantially similar requirements in the emergency and adopted rules, the department expects that identification cards relating to plans issued or renewed on or after January 1, 2004 pursuant to the provisions of the emergency rule will effectively be in compliance with the requirements of this rule. Identification cards for plans issued or renewed on and after February 1, 2004 must be in compliance with this rule.

Comment: A commenter disagrees with the rule´s requirement that the front of ID cards contain the words "TDI" or "DOI." The carrier contends that this will be costly and will have no measurable impact on two of the most critical health care issues: improving the quality of health care and making coverage more affordable.

Agency Response: The department disagrees, as inclusion of information identifying regulated plans was a provision of SB 418. Nevertheless, the department has been sensitive to costs of implementation. As a result of discussions with the TACCP, the proposed rule eliminated the emergency rule´s requirement of a symbol in order to make compliance as simple as possible. The proposed rule also stated that carriers that had already printed cards containing the symbol would be deemed to be in compliance with the adopted final rule.

Comment: A commenter complains that the proposed rules on elements of a dental claim (§21.2803) make the subscriber ID number (Social Security Number or unique number) a required element if included on the ID card, yet this rule does not require inclusion of that number.

Agency Response: The department disagrees that this rule should mandate inclusion of a subscriber ID number, as SB 418 does not contain such a requirement. However, carriers are free to include that number on the ID cards.

Comment: One commenter urged removing the requirement that the card contain both a toll-free number and a statement or other indication that a preferred provider may use the number to obtain the enrollee´s first date of eligibility for benefits. The commenter claimed a statement would further clutter up the card, and said the rule should track the statutory language requiring that the card contain the first date on which the enrollee or insured became eligible for benefits under the plan or a toll-free number a physician or provider may use to obtain that date. Another commenter supported the rule as proposed, stating that general statements like "For customer service" or "For member information" would not be sufficiently explicit to meet the statutory requirement.

Agency Response: The department believes that the first commenter´s suggested change more closely complies with the statute, and has changed this part of the rule accordingly. The department is mindful of the limited space on ID cards, and believes that a more abbreviated notation, such as "Member information" is sufficiently explanatory.

style="text-align:justify;line-height:200%"> For: Texas Medical Association.

For, with changes: PacifiCare of Texas and PacifiCare Life Assurance Company; UNICARE Life & Health Insurance Company; Humana, Inc.; National Association of Dental Plans.

The new section is adopted under the Texas Insurance Code Article 3.70-3C, Sec. 11, and §§36.001 and 843.209. Article 3.70-3C, Sec. 11, and §843.209 contain provisions concerning ID cards issued by carriers regulated under the Insurance Code and subject to the provisions of SB 418. Section 36.001 of the Insurance Code provides that the commissioner of insurance may adopt any rules necessary and appropriate to implement the powers and duties of the Texas Department of Insurance under the Insurance Code and other laws of this state.

§21.2820. Identification Cards.

(a) An identification card, or other similar document that includes information necessary to allow enrollees and insureds to access services or coverage under an HMO evidence of coverage or a preferred provider benefit plan, that is issued by an HMO or preferred provider carrier subject to this subchapter pursuant to §21.2801 of this title (relating to Scope) shall comply with the requirements of this section.

(b) An identification card or other similar document issued to enrollees or insureds shall include the following information:

(1) the name of the enrollee or insured;

(2) the first date on which the enrollee or insured became eligible for benefits under the plan or a toll-free number that a preferred provider may use to obtain such information; and

(3) the letters "TDI" or "DOI" prominently displayed on the front of the card or document.

(c) The requirements of this section apply to an HMO evidence of coverage or a preferred provider benefit plan issued or renewed on or after February 1, 2004 .



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