Part I.
Texas Department of Insurance
Chapter 3.
Life, Accident, and Health Insurance and Annuities
The Texas Department of Insurance proposes amendments to §§3.3303,
3.3306, 3.3308, 3.3309, and 3.3324 and new §3.3312 under Subchapter T
and 3.3603 - 3.3609, and 3.3613 under Subchapter W, concerning minimum standards
for Medicare supplement policies and miscellaneous rules for group and individual
accident and health insurance. This proposal is necessary to bring Texas into
compliance with the federal Public Law 105-33, the Balanced Budget Act of
1997 (BBA). Failure to comply with the federal mandates in the BBA will subject
Texas to potential penalties including the loss of authority to regulate Medicare
supplement coverage. The major changes brought about by the BBA specify additional
situations in which Medicare beneficiaries, after other coverage ceases or
terminates, will be guaranteed access to certain types of Medicare supplement
policies on a guaranteed issue basis. The BBA also mandates protections for
these persons against discrimination in the sale and pricing of Medicare supplement
policies, as well as limitation of preexisting condition exclusions, and adds
two new high deductible plans. These proposals will increase awareness and
accessibility of Medicare supplement coverage, which will thus increase beneficiary
access to health care services, particularly in areas with limited availability
of Medicare+Choice plans. This proposal also provides the advantage of encouraging
participation in a Medicare+Choice plan. Medicare+Choice offers a marketplace
of options similar to those available to the non-Medicare population. Under
this proposal, under certain circumstances Medicare beneficiaries are guaranteed
the right to Medicare supplement coverage if they choose to enroll in original
Medicare coverage after leaving a Medicare+Choice plan.
Amendments to §3.3303 add definitions for bankruptcy, continuous period
of creditable coverage, creditable coverage, employee welfare benefit plan,
health maintenance organization, insolvency, Medicare+Choice organization,
Medicare+Choice plan, Medicare+Choice private fee-for-service plan, Medicare
Select policy, point-of-service, provider-sponsored organization, and Secretary.
Amendments to §3.3306 set out requirements for reduction of preexisting
condition exclusions, coinsurance and copayments under Medicare Part B, and
the composition of new high deductible plans "F" and "J," and revise the list
of provided annual preventive services. Amendments to §3.3308 require
forms to disclose the reduction of preexisting condition limitations in accordance
with the new regulations. Amendments to §3.3309 require application forms
to include questions to elicit information as to whether the applicant is
eligible for guaranteed issuance of certain Medicare supplement plans, or
reduction of any applicable preexisting condition limitation. New §3.3312
sets out requirements for guaranteed issue of certain Medicare supplement
coverage for certain eligible persons. Amendments to §3.3324 set out
requirements for reduction of preexisting condition exclusions for certain
eligible persons based on their period of creditable coverage. The amendments
to §§3.3603 through 3.3609 and 3.3613 relate to the required disclosure
statements for policies that duplicate Medicare benefits. These sections codify
notice requirements for the content and format of 7 disclosure statements
which must be provided to inform prospective buyers of health insurance policies
about the extent to which benefits under such policies duplicate Medicare
benefits, pursuant to requirements approved by the U.S. Secretary of Health
and Human Services. Proposed §3.3603 sets out the purpose and scope of
the notice and disclosure. Proposed §3.3604 sets out the content and
format of the notice for policies that provide benefits for expenses incurred
for an accidental injury only. Proposed §3.3605 sets out the content
and format of the notice for policies that provide benefits for specified
limited services. Proposed §3.3606 sets out the content and format of
the notice for policies that reimburse expenses incurred for specified disease
or other specified impairments (including cancer policies, specified disease
policies and other policies limiting reimbursement to named medical conditions).
Proposed §3.3607 sets out the content and format of the notice for policies
that pay fixed dollar amounts for specified disease or other specified impairments
(including cancer, specified disease policies, and other policies that pay
a scheduled benefit or specified payment based on diagnosis of the conditions
named in the policy). Proposed §3.3608 sets out the content and format
of the notice for indemnity or other policies (other than long-term care policies)
that pay a fixed dollar amount per day. Proposed §3.3609 sets out the
content and format of the notice for policies that provide benefits for both
expenses incurred and fixed indemnity. Proposed §3.3613 sets out the
content and format of the notice for other health insurance policies not specifically
identified in §3.3604 through §3.3609. In conjunction with these
proposed amendments and new section, the department is proposing the repeal
of existing §§3.3610 - 3.3612. Notice of the proposed repeal is
published elsewhere in this issue of the
Texas Register
.
The department will consider the adoption of amendments to §§3.3303,
3.3306, 3.3308, 3.3309, 3.3324, 3.3603 - 3.3609, and 3.3613 and new §3.3312,
in a public hearing under Docket Number 2400, scheduled for 9:00 a.m. on March
30, 1999, in Room 100 of the William P. Hobby, Jr. State Office Building,
333 Guadalupe Street, Austin, Texas.
Kim Stokes, associate commissioner for life/health and managed care, has
determined that for each year of the first five years the proposed sections
will be in effect, there will be no additional fiscal impact on state or local
government as a result of enforcing or administering the sections. There will
be no measurable effect on local employment or the local economy as a result
of the proposal.
Ms. Stokes has also determined that for each year of the first five years
the proposed sections are in effect, the public benefit anticipated as a result
of enforcing the subchapter will be facilitation of the enrollment of eligible
individuals in Medicare supplement coverage, including two new high deductible
plans, compliance with federal laws relating to Medicare supplement coverage
so that Texas will not lose its authority to regulate Medicare supplement
coverage, and increased awareness of duplication of Medicare benefits by other
types of policies.
Ms. Stokes estimates that the majority of cost to persons required to comply
with these sections is the result of the federal enactment of the BBA and
is not as a result of the adoption and implementation of these proposed sections.
Any potential costs associated with the adoption, enforcement, or administration
of the proposed amendments or new sections that do not result from the BBA
arise from (1) §3.3312(b)(1) which provides for guaranteed issuance of
coverage when an individual loses benefits in a plan that is primary to Medicare,
(2) §3.3312(b)(6) which provides for guaranteed issuance of coverage
under certain circumstances when an individual age 65 or older disenrolls
from a Medicare+Choice plan, and (3) §3.3309(b), which requires applications
to include questions to elicit information as to whether the applicant is
eligible for guaranteed issuance of Medicare supplement coverage or reduction
of any applicable preexisting condition limitation exclusion.
The department does not believe that the adoption of these three requirements
will result in cost to entities required to comply with the rule. With regard
to the first two items, while both of these measures may require an entity
to provide coverage to an eligible individual, the entity will also be able
to charge the individual an actuarially sound premium for that coverage. The
department recognizes, however, that any extension of Medicare supplement
coverage entails an assumption of risk by the entity extending coverage, so
it has undertaken to provide data regarding the number of persons who might
qualify for guaranteed issuance of coverage under §3.3312(b). The Bureau
of Census's Statistical Abstract of the U.S. shows the number of workers with
employer or union provided group health plans, for firms employing less than
25 persons, to be 28.1%. Moreover, the Texas Workforce Commission reports
that 1,613,218 persons in Texas work at firms that employ less than 20 persons.
Accordingly, the estimated number of employees with health plans in Texas
firms is 453, 314. The Bureau of Census, Statistical Abstract of the U.S.,
reports that 3.54% of the employed workforce is over the age of 65. Therefore,
the total estimated number of Texas employees over the age of 65 who are covered
by a group health plan is 16,047. Not all of these persons will qualify for
guaranteed issuance of Medicare supplement coverage under §3.3312(b),
however, and the number of potential enrollees will be further reduced as
eligible individuals enroll in alternative coverages, such as a Medicare+Choice
plan or retirement coverage offered through their employer.
Moreover, the rule does not require the extension of coverage to an individual
who would not otherwise be entitled to coverage; it merely allows an individual
participating in either a Medicare+Choice plan or an employee welfare benefit
plan to take advantage of guaranteed issuance of coverage at later time. Accordingly,
the rule may actually reduce costs for affected entities, since it may delay
the requirement that the entity extend coverage to an individual.
Similarly, the department does not believe that the third requirement,
concerning the application, will result in additional costs beyond that required
by federal law. The BBA requires that entities providing Medicare supplement
coverage ascertain whether applicants are eligible for guaranteed issuance
of coverage or reduction of any applicable preexisting condition limitation.
The department believes application questions are the most efficient method
of obtaining the data necessary to make this determination. Application questions
will also minimize the likelihood of disputes regarding the entity's attempt
to obtain this information and corresponding enforcement action by regulatory
authorities. The department recognizes that this change may add to the cost
of the application and estimates that the cost of amending or supplementing
applications to add additional appropriate questions will be no greater than
$0.25 per applicant. The actual total cost to each affected entity will vary
depending on the number of persons applying for Medicare supplement coverage
with the entity.
Ms. Stokes has determined that, except as enumerated specifically below,
any economic costs to any entity qualifying as a small business under Government
Code §2006.001 that complies with the proposed requirements for each
year of the first five years the proposed requirements will be in effect are
the result of the federal enactment of the BBA and not as a result of the
adoption, enforcement, or administration of the proposed requirements. With
regard to the requirements not mandated by the BBA, as expressed above, the
department does not believe the expansion of the guaranteed issue provisions
of §3.3312(b)(1) and (6) will result in cost to entities required to
provide Medicare supplement coverage. With regard to the requirement in §3.3309(b)
to include questions to elicit information as to whether the applicant is
eligible for guaranteed issuance of Medicare supplement coverage or reduction
of any applicable preexisting condition limitation exclusion, the total cost
to entities is not dependent upon the size of the business, but rather is
dependent upon how the addition of these questions will change the application
as well as how many applications the business produces. The cost per each
$100 of sales would not vary between the smallest and largest businesses,
assuming that small businesses and the largest businesses spend proportional
amounts on producing applications. Therefore, it is the department's position
that the adoption of this proposal will have no adverse economic effect on
small businesses.
Comments on the proposal must be submitted within 30 days after publication
of the proposed sections in the Texas Register to Lynda H. Nesenholtz, General
Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance,
P.O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comment
must be submitted to Linda von Quintus, Deputy Commissioner, Regulation and
Safety Division, Mail Code 107-2A, Texas Department of Insurance, P.O. Box
149104, Austin, Texas 78714-9104.
Subchapter T. Minimum Standards for Medicare Supplement Policies
28 TAC §§3.3303, 3.3306, 3.3308, 3.3309, 3.3312, 3.3324
The amendments and new section are proposed under the Insurance
Code Articles 3.74, 3.70-3 and 1.03A. Article 3.74, §5(d) provides that
the department may promulgate reasonable rules for captions or notice requirements
determined to be in the public interest and designed to inform prospective
insureds, subscribers, or enrollees that particular coverages are not Medicare
supplement coverages. Article 3.74, §10 provides that the department
shall adopt rules in accordance with federal law necessary for the state to
retain certification under 42 U.S.C. Section 1395ss, as well as any other
reasonable rules necessary and proper to enforce Texas' minimum statutory
standards for Medicare supplement policies. Article 3.70-3 authorizes the
department to adopt rules and regulations for the filing and submission of
health insurance policies as are necessary, proper or advisable. Article 1.03A
authorizes the commissioner to adopt rules and regulations for the conduct
and execution of the duties and functions of the department as authorized
by statute.
The following articles are affected by this proposal: Insurance Code Articles
3.70-3, 3.74, 21.21.
§3.3303.Definitions.
The following words and terms, when used in this subchapter, shall
have the following meanings, unless the context clearly indicates otherwise.
(1)
Applicant--
(A)
In the case of an individual Medicare supplement policy,
the person who seeks to contract for insurance or other health benefits.
(B)
In the case of a group Medicare supplement policy, the
proposed certificate holder.
(2)
Bankruptcy--The situation that
occurs when a Medicare+Choice organization that is not an issuer has filed,
or has had filed against it, a petition for declaration of bankruptcy and
has ceased doing business in this state.
(3)
Certificate--Any certificate issued under
a group Medicare supplement policy, which certificate has been delivered or
issued for delivery in this state regardless of the place where the policy
was delivered or issued for delivery.
(4)
Continuous period of creditable coverage--The
period during which an individual was covered by creditable coverage, if,
during the period of the coverage, the individual had no breaks in coverage
greater than 63 days.
(5)
Creditable coverage--Any coverage
of an individual as defined in (§21.1101 of this title (relating to Definitions).
(6)
Employee welfare benefit plan--A
plan, fund or program of employee benefits as defined in 29 U.S.C. Section
1002 (Employee Retirement Income Security Act).
(7)
Health Maintenance Organization (HMO)--An
entity as defined in 42 U.S.C. 300e(a).
(8)
Insolvency--The situation which occurs
when an issuer has had an order of liquidation entered against it with a finding
of insolvency by a court of competent jurisdiction in the issuer's state of
domicile.
(9)
Issuer--An insurance company, fraternal
benefit society, health care service plan, health maintenance organization,
or any other entity delivering or issuing for delivery in this state Medicare
supplement policies or certificates.
(10)
Medicare--The Health Insurance for the
Aged Act, Title XVIII of the Social Security Act Amendments of 1965 as Then
Constituted or Later Amended.
(11)
Medicare+Choice organization--An
entity as defined in 42 U.S.C. ( 1395w-28(a)(1).
(12)
Medicare+Choice plan--A plan of
coverage for health benefits under Medicare Part C as defined in 42 U.S.C.
( 1395w-28(b)(1), and includes:
(A)
coordinated care plans which provide health
services, including but not limited to health maintenance organization plans
(with or without a point-of-service option), plans offered by provider-sponsored
organizations, and preferred provider organization plans;
(B)
medical savings account plans coupled
with a contribution into a Medicare+Choice medical savings account; and
(C)
Medicare+Choice private fee-for-service
plans.
(13)
Medicare+Choice private fee-for-service
plan--An entity as defined in 42 U.S.C. (1395w-28(b)(2).
(14)
Medicare Select policy or Medicare
Select certificate -- A Medicare supplement policy or certificate, respectively,
that contains restricted network provisions.
(15)
Medicare supplement policy--A group or
individual policy of accident and sickness insurance or a subscriber contract
of a hospital service corporation subject to the Insurance Code, Chapter 20,
or, to the extent [
(A)
a policy, contract, subscriber contract, or evidence of
coverage of one or more employers or labor organizations, or of the trustees
of a fund established by one or more employers or labor organizations, or
combination thereof, for employees or former employees, or combination thereof,
or for members or former members, or combination thereof, of the labor organizations;
(B)
a policy or health care benefit plan including a policy
or contract of group insurance or group contract of a hospital service corporation
subject to the Insurance Code, Chapter 20, or group evidence of coverage issued
by a health maintenance organization subject to the Texas Health Maintenance
Organization Act, when such policy or plan is not marketed or held to be a
Medicare supplement policy or benefit plan; or
(C)
an individual or group evidence of coverage issued pursuant
to a contract under the Federal Social Security Act, §1876 (42 United
States Code §§1395, et seq) by a health maintenance organization
subject to the Texas Health Maintenance Organization Act (Texas Insurance
Code, Chapter 20A).
(16)
Point-of-service--A benefit
option as defined in 42 C.F.R. ( 422.2.
(17)
Provider-Sponsored organization--An
entity as defined in 42 U.S.C. ( 1395w-25(d)(1).
(18)
Qualified actuary--An actuary who is
a member of either the Society of Actuaries or the American Academy of Actuaries.
(19)
Secretary--The Secretary of the
United States Department of Health and Human Services.
§3.3306.Minimum Benefit Standards.
No insurance policy, subscriber contract, certificate, or evidence
of coverage may be advertised, solicited, or issued for delivery in this state
as a Medicare supplement policy unless the policy, contract, certificate,
or evidence of coverage meets the applicable standards in paragraphs (1)-(3)
of this section. These are minimum standards and do not preclude the inclusion
of other provisions or benefits which are not inconsistent with these standards.
(1)
General standards. The following standards apply to Medicare
supplement policies and are in addition to all other requirements of this
subchapter, the Insurance Code, Article 3.74, and any other applicable law.
(A)
A Medicare supplement policy shall not exclude or limit
benefits for losses incurred more than six months from the effective date
of coverage because they involved a pre-existing condition. The policy or
certificate may not define a pre-existing condition more restrictively than
a condition for which medical advice was given or treatment was recommended
by or received from a physician within six months before the effective date
of coverage.
(i)- (ii)
(No change.)
(iii)
If a Medicare supplement policy or certificate
is issued to an applicant who qualifies under §3.3312(b) of this title
(relating to Guaranteed Issue for Eligible Persons) or (3.3324(a) of this
title (relating to Open Enrollment), the issuer shall reduce the period of
any preexisting condition exclusion as required by §3.3312(a)(2) of this
title and §3.3324(c) and (d) of this title.
(B) - (G)
(No change.)
(2)
Standards for the basic (core) benefits common
to all benefit plans. Every issuer shall make available a policy or certificate
including only the basic "core" package of benefits described in subparagraphs
(A)-(E) of this paragraph to each prospective insured. An issuer may make
available to prospective insureds any of the other Medicare supplement insurance
benefit plans in addition to the basic core package, but not in lieu of it.
The basic core benefits shall consist of the following:
(A) - (D)
(No change.)
(E)
coverage for the coinsurance amount
(or in the case
of hospital outpatient department services, the copayment amount)
of
Medicare eligible expenses under Part B regardless of hospital confinement,
subject to the Medicare Part B deductible.
(3)
Standards for Additional Benefits. The additional
benefits as uniformly defined in subparagraphs (A)-(K) of this paragraph shall
be included in Medicare Supplement Benefit Plans "B" through "J" only as provided
in paragraph
(5)(A)-(l)
[
(A) - (H)
(No change.)
(I)
Preventive Medical Care Benefit or Services--Coverage for
the preventive health services described in clauses (i)-(iv) of this subparagraph.
Coverage for preventive medical care benefits or services shall be for the
actual charges up to 100% of the Medicare-approved amount for each service,
as if Medicare were to cover the service as identified in American Medical
Association Current Procedural Terminology (AMA CPT) codes, to a maximum of
$120 annually under this benefit. This benefit shall not include payment for
any procedure covered by Medicare:
(i)
(No change.)
(ii)
any one or a combination of the following preventive screening
tests or preventive services, the frequency of which is considered medically
appropriate:
(I)
[
(II)
[
[
dipstick urinalysis for hematuria, bacteriuria,
and proteinauria;
(III)
[
(IV)
[
(V)
[
(VI)
[
(iii)
[
(iv)
any other tests or preventive measures determined appropriate
by the attending physician.
(J) - (K)
(No change.)
(4)
Requirement of uniformity for all Medicare supplement
benefit plans. An issuer shall make available only those groups, packages
or combinations of Medicare supplement benefits as described in this section,
unless otherwise permitted by provisions of paragraph (3)(K) of this section
and in §3.3325 of this title (relating to Medicare Select Policies, Certificates
and Plans of Operation). Benefit plans shall be uniform in structure, language,
designation and format to the standard benefit plan "A," defined as the basic
core plan of benefits in paragraph (2) of this section and described in paragraph
(5)(A) of this section, and benefit plans "B" through "J", described in paragraph
(5)(B)-(L)
[
(5)
Make-up of Benefit Plans. Subparagraphs
(A)-(L)
[
(A) - (F)
(No change.)
(G)
Standardized Medicare Supplement Benefit
High Deductible Plan "F." Medicare supplement benefit high deductible Plan
"F" shall include only the following: 100% of covered expenses following the
payment of the annual high deductible Plan "F" deductible. The covered expenses
include the Core Benefit as defined in paragraph (2) of this section, plus
the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part
B Deductible, 100% of the Medicare Part B Excess Charges, and Medically Necessary
Emergency Care in a Foreign Country as defined in paragraph (3) of this section.
The annual high deductible Plan "F" deductible shall consist of out-of-pocket
expenses, other than premiums for services covered by the Medicare supplement
Plan "F" policy, and shall be in addition to any other specific benefit deductibles.
The annual high deductible Plan "F" deductible shall be $1500 for 1998 and
1999, and shall be based on the calendar year. It shall be adjusted annually
thereafter by the Secretary to reflect the change in the Consumer Price Index
for all urban consumers for the twelve-month period ending with August of
the preceding year, and rounded to the nearest multiple of $10.
(H)
[
(I)
[
(J)
[
(K)
[
(L)
Standardized Medicare Supplement Benefit
High Deductible Plan "J." Medicare supplement benefit high deductible Plan
"J" shall include only the following: 100% of covered expenses following the
payment of the annual high deductible Plan "J" deductible. The covered expenses
include the Core Benefit as defined in paragraph (2) of this section, plus
the Medicare Part A Deductible, Skilled Nursing Facility Care, Medicare Part
B Deductible, 100% of the Medicare Part B Excess Charges, Extended Outpatient
Prescription Drug Benefit, Medically Necessary Emergency Care in a Foreign
Country, Preventive Medical Care and At-Home Recovery Benefit as defined in
paragraph (3) of this section. The annual high deductible Plan "J" deductible
shall consist of out-of-pocket expenses, other than premiums for services
covered by the Medicare supplement Plan "J" policy, and shall be in addition
to any other specific benefit deductibles. The annual high deductible Plan
"J" deductible shall be $1500 for 1998 and 1999, and shall be based on the
calendar year. It shall be adjusted annually thereafter by the Secretary to
reflect the change in the Consumer Price Index for all urban consumers for
the twelve-month period ending with August of the preceding year, and rounded
to the nearest multiple of $10.
§3.3308.Required Disclosure Provisions.
(a)
General rules.
(1) - (3)
(No change.)
(4)
If a Medicare supplement policy or certificate contains
any limitations with respect to preexisting conditions
:
[
(A)
the limitations shall appear as a separate
paragraph of the policy
or certificate
and be labeled as "Preexisting
Condition Limitations
;
[
(B)
the policy or certificate shall define
the
[
(C)
the policy or certificate shall include
a provision explaining the reduction of the preexisting condition limitation
for individuals that qualify under §3.3306(1)(A) of this title (relating
to Minimum Benefit Standards), §3.3312(a)(2) of this title (relating
to Guaranteed Issue to Eligible Persons), or §3.3324(c) and (d) of this
title (relating to Open Enrollment).
(5) - (7)
(No change.)
(b)
(No change.)
(c)
Form for outline of coverage. In providing outlines of
coverage to applicants pursuant to the requirements of subsection (b)(1) of
this section, insurers shall use a form which complies with the requirements
of this subsection. The outline of coverage must contain each of the following
four parts in the following order: a cover page, premium information, disclosure
pages, and charts displaying the features of each benefit plan offered by
the issuer. The outline of coverage shall be in the language and format prescribed
in paragraphs (1) and (2) of this subsection in no less than 12-point type.
(1)
(No change.)
(2)
The items in subparagraphs (A)-(C) of this paragraph
shall be included in the outline of coverage in addition to the items specified
in the plan-specific outline-of-coverage forms.
(A) - (C)
(No change.)
(D)
The outline of coverage for Medicare Select policies or
certificates shall include information regarding grievance procedures which
meet the requirements of §3.3325(m) of this title (relating to Medicare
Select Policies, Certificates and Plans of Operation).
Figure: 28 TAC §3.3308(c)(2)(D)
(d)
(No change.)
§3.3309.Requirements for Application Forms and Replacement Coverage.
(a)
(No change.)
(b)
Application forms shall include questions
to elicit information as to whether the applicant is an eligible person as
defined in §3.3312(b) of this title (relating to Guaranteed Issue for
Eligible Persons), or whether the applicant is eligible for reduction of any
applicable preexisting condition limitation under §3.3324(c) and (d)
of this title (relating to Open Enrollment).
(c)
[
(1)
any other health insurance policies or coverages sold to
the applicant which are still in force; and
(2)
any other health insurance policies or coverages sold
to the applicant in the past five years which are no longer in force.
(d)
[
(e)
[
(f)
[
Figure: 28 TAC §3.3309(f)
[
(g)
[
§3.3312.Guaranteed Issue for Eligible Persons.
(a)
Guaranteed Issue.
(1)
Eligible persons are those individuals described in subsection
(b) of this section who apply to enroll under the policy not later than 63
days after the date of the termination of enrollment described in subsection
(b) of this section, and who submit evidence of the date of termination or
disenrollment with the application for a Medicare supplement policy.
(2)
With respect to eligible persons, an issuer shall
not deny or condition the issuance or effectiveness of a Medicare supplement
policy described in subsection (c) of this section that is offered and is
available for issuance to newly enrolled individuals by the issuer, and shall
not discriminate in the pricing of such a Medicare supplement policy because
of health status, claims experience, receipt of health care, or medical condition,
and shall not impose an exclusion of benefits based on a preexisting condition
under such a Medicare supplement policy.
(b)
Eligible Persons. An eligible person is an individual described
in any of the following paragraphs:
(1)
The individual is enrolled under an employee welfare benefit
plan that provides health benefits that supplement the benefits under Medicare,
and the plan terminates, or the plan ceases to provide all such supplemental
health benefits to the individual; or the individual is enrolled under an
employee welfare benefit plan that is primary to Medicare and the plan terminates
or the plan ceases to provide all health benefits to the individual because
the individual leaves the plan.
(2)
The individual is enrolled with a Medicare+Choice
organization under a Medicare+Choice plan under Part C of Medicare, and any
of the following circumstances apply:
(A)
The organization's or plan's certification (under U.S.C.
Title 42, Chapter 7, Subchapter XVIII, Part D) has been terminated or the
organization has terminated or otherwise discontinued providing the plan in
the area in which the individual resides;
(B)
The individual is no longer eligible to elect the plan
because of a change in the individual's place of residence or other change
in circumstances specified by the Secretary, but not including termination
of the individual's enrollment on the basis described in section 1851(g)(3)(B)
of the federal Social Security Act (where the individual has not paid premiums
on a timely basis or has engaged in disruptive behavior as specified in standards
under section 1856), or the plan is terminated for all individuals within
a residence area;
(C)
The individual demonstrates, in accordance with guidelines
established by the Secretary, that:
(i)
The organization offering the plan substantially violated
a material provision of the organization's contract under U.S.C. Title 42,
Chapter 7, Subchapter XVIII, Part D in relation to the individual, including
the failure to provide an individual on a timely basis medically necessary
care for which benefits are available under the plan or the failure to provide
such covered care in accordance with applicable quality standards; or
(ii)
The organization, or agent or other entity acting on the
organization's behalf, materially misrepresented the plan's provisions in
marketing the plan to the individual; or
(D)
The individual meets such other exceptional conditions
as the Secretary may provide.
(3)
The individual is enrolled with an entity listed
in subparagraphs (A) - (D) of this paragraph and enrollment ceases under the
same circumstances that would permit discontinuance of an individual's election
of coverage under §3.3312(b)(2) of this title (relating to Guaranteed
Issue for Eligible Persons):
(A)
An eligible organization under a contract under Section
1876 (Medicare risk or cost);
(B)
A similar organization operating under demonstration project
authority, effective for periods before April 1,1999;
(C)
An organization under an agreement under Section 1833(a)(1)(A)
(health care prepayment plan); or
(D)
An organization under a Medicare Select policy; and
(4)
The individual is enrolled under a Medicare supplement
policy and the enrollment ceases because:
(A)
Of the insolvency of the issuer or bankruptcy of the nonissuer
organization; or of other involuntary termination of coverage or enrollment
under the policy;
(B)
The issuer of the policy substantially violated a material
provision of the policy; or
(C)
The issuer, or an agent or other entity acting on the issuer's
behalf, materially misrepresented the policy's provisions in marketing the
policy to the individual;
(5)
The individual was enrolled under a Medicare
supplement policy and terminates enrollment and subsequently enrolls, for
the first time, with any Medicare+Choice organization under a Medicare+Choice
plan under Part C of Medicare, any eligible organization under a contract
under Section 1876 (Medicare risk or cost), any similar organization operating
under demonstration project authority, an organization under an agreement
under section 1833(a)(1)(A) (health care prepayment plan), or a Medicare Select
policy; and the subsequent enrollment is terminated by the individual during
any period within the first 12 months of such subsequent enrollment (during
which the individual is permitted to terminate such subsequent enrollment
under section 1851(e) of the federal Social Security Act); or
(6)
The individual, upon first becoming enrolled in Medicare
Part B for benefits at age 65 or older, enrolls in a Medicare+Choice plan
under Part C of Medicare, and disenrolls from the plan no later than 12 months
after the effective date of enrollment.
(c)
Products to Which Eligible Persons are Entitled. The Medicare
supplement policy to which eligible persons are entitled under:
(1)
Subsection (b)(1), (2), (3) and (4) of this section is
a Medicare supplement policy which has a benefit package classified as Plan
A, B, C, or F offered by any issuer.
(2)
Subsection (b)(5) of this section is the same Medicare
supplement policy in which the individual was most recently previously enrolled,
if available from the same issuer, or, if not so available, a policy described
in paragraph (1) of this subsection.
(3)
Subsection (b)(6) of this section shall include any
Medicare supplement policy offered by any issuer.
§3.3324.Open Enrollment.
(a) - (b)
(No change.)
(c)
If an applicant qualifies under subsection
(a) of this section, is 65 years of age or older, and submits an application
during the time period referenced in subsection (a) of this section and, as
of the date of application:
(1)
has had a continuous period of creditable
coverage of at least six months, the issuer shall not exclude benefits based
on a preexisting condition; or
(2)
has had a continuous period of creditable
coverage that is less than six months, the issuer shall reduce the period
of any preexisting condition exclusion by the aggregate of the period of creditable
coverage applicable to the applicant as of the enrollment date.
(d)
[
(e)
The following examples illustrate the
application of subsection (c)(1) and (2) of this section, as prescribed by
the Secretary:
(1)
Individual A: No preexisting condition
exclusion period. Relevant creditable coverage history: Individual A had coverage
under an individual policy for four months beginning on May 1, 1998, through
August 31, 1998, followed by a gap in coverage of 61 days until October 31,
1998. Individual A had coverage under an individual health plan beginning
on November 1, 1998, for three months through January 31, 1999, followed by
a gap in coverage of 59 days or until March 31, 1999 on which date Individual
A submitted an application for a Medicare supplement policy. Under this example,
the Medicare supplement issuer may not apply a preexisting condition exclusion
period because Individual A has seven months of creditable coverage without
a gap in coverage greater than 63 days.
(2)
Individual B: Subject to a three
months preexisting condition exclusion period. Relevant creditable coverage
history: Individual B is covered under an individual health insurance policy
for one month beginning May 1, 1998 through May 31, 1998, followed by a gap
in coverage of 61 days from June 1, 1998 through July 31, 1998. On August
1, 1998, Individual B is covered under an association health plan for two
months through September 30, 1998, followed by a gap in coverage of 31 days
or until October 31, 1998 on which date Individual B's submitted an application
for Medicare supplement coverage. Individual B has three months of creditable
coverage. Under this example, the issuer of a Medicare supplement policy must
give Individual B a three-month credit against any preexisting condition exclusion
period.
(3)
Individual C: Subject to a six month
preexisting condition exclusion period. Relevant creditable coverage history:
Individual C is covered under an individual health insurance policy for one
month beginning May 1, 1998 through May 31, 1998, followed by a gap in coverage
of 61 days from June 1, 1998 through July 31, 1998. On August 1, 1998, Individual
C is covered under an association health plan for two months through September
30, 1998, followed by a gap in coverage of 64 days or until November 4, 1998
on which date Individual C submitted an application for Medicare supplement
coverage. Individual C has a gap in coverage of greater than 63 days. As a
result, under this example, the Medicare supplement issuer can fully apply
the preexisting condition exclusion provision to Individual C.
(f)
[
This agency hereby certifies that the proposal has been reviewed
by legal counsel and found to be within the agency's legal authority to adopt.
Filed with the Office of the Secretary of State, on
February 12, 1999.
TRD-9900931
Lynda H. Nesenholtz
General Counsel and Chief Clerk
Texas Department of Insurance
Earliest possible date of adoption: March 28, 1999
For further information, please call: (512) 463-6327
28 TAC §§3.3603-3.3609, 3.3613
The amendments are proposed under the Insurance Code Articles
3.74, 3.70-3 and 1.03A. Article 3.74, §5(d) provides that the department
may promulgate reasonable rules for captions or notice requirements determined
to be in the public interest and designed to inform prospective insureds,
subscribers, or enrollees that particular coverages are not Medicare supplement
coverages. Article 3.74, §10 provides that the department shall adopt
rules in accordance with federal law necessary for the state to retain certification
under 42 U.S.C. Section 1395ss, as well as any other reasonable rules necessary
and proper to enforce Texas' minimum statutory standards for Medicare supplement
policies. Article 3.70-3 authorizes the department to adopt rules and regulations
for the filing and submission of health insurance policies as are necessary,
proper or advisable. Article 1.03A authorizes the commissioner to adopt rules
and regulations for the conduct and execution of the duties and functions
of the department as authorized by statute.
The following articles are affected by this proposal: Insurance Code Articles
3.70-3, 3.74, 21.21.
§3.3603.Purpose and Scope.
(a)
The purpose and scope of these sections is to codify the
notice requirements for the content and format of
seven
[
(b)
On and after the effective date set out by federal requirements,
issuers of the policies that duplicate Medicare benefits must display the
applicable statement in a prominent manner as part of, or together with, the
application for the policy. [
(c)
Each of the statements applies to one of
seven
[
(d)
Issuers who fail to provide the duplication notice are
in violation of both federal and state law, and subject to both federal and
state penalties.
(e)
The
seven
[
(1)
policies that provide benefits for expenses incurred for
an accidental injury only;
(2)
policies that provide benefits for specified limited
services;
(3)
policies that reimburse expenses incurred for specified
disease or other specified impairments (including cancer policies, specified
disease policies and other policies that limit reimbursement to named medical
conditions);
(4)
policies that pay fixed dollar amounts for specified
disease or other specified impairments (including cancer, specified disease
policies and other policies that pay a scheduled benefit or specified payment
based on diagnosis of the conditions named in the policy);
(5)
indemnity policies and other policies that pay a fixed
dollar amount per day, excluding long-term care policies;
(6)
policies that provide benefits for both expenses incurred
and fixed indemnity;
(7)
[
[
[
[
other health insurance policies not
specifically identified in paragraphs (1)-
(6)
[
(f)
(No change.)
§3.3604.Notice for Policies That Provide Benefits for Expenses Incurred for an Accidental Injury Only.
The notice in this section is for policies that provide benefits for
expenses incurred for an accidental injury only
, and shall follow the
content and format of one of the two statements (but not both simultaneously)
set out in this section, as follows:
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3604(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3604(2)
[
§3.3605.Policies That Provide Benefits For Specified Limited Services.
The notice in this section is for policies that provide benefits for
specified limited services
, and shall follow the content and format of
one of the two statements (but not both simultaneously) set out in this section,
as follows:
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3605(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3605(2)
[
§3.3606.Policies That Reimburse Expenses Incurred for Specified Diseases or Impairments.
The notice in this section is for policies that reimburse expenses
incurred for specified diseases or other specified impairments (including
expense-incurred cancer, specified disease and other types of health insurance
policies that limit reimbursement to named medical conditions)
, and shall
follow the content and format of one of the two statements (but not both simultaneously)
of this section as follows:
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3606(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3606(2)
[
§3.3607.Policies that Pay Fixed Dollar Amounts for Specified Diseases or Impairments.
The notice in this section is for policies that pay fixed dollar amounts
for specified diseases or other specified impairments (including cancer, specified
disease, and other health insurance policies that pay a scheduled benefit
or specific payment based on diagnosis of the conditions named in the policy)
, and shall follow the content and format of one of the two statements (but
not both simultaneously) set out in this section, as follows:
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3607(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3607(2)
[
§3.3608.Indemnity or Other Policies that Pay a Fixed Dollar Amount Per Day.
The notice in this section is for indemnity policies and other policies
that pay a fixed dollar amount per day, excluding long-term care policies
, and shall follow the content and format of one of the two statements (but
not both simultaneously) set out in this section, as follows:
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3608(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3608(2)
[
§3.3609.Policies that Provide Benefits Upon Both an Expense-Incurred and Fixed Indemnity Basis.
The notice in this section is for policies that provide benefits upon
both an expense-incurred and fixed indemnity basis
, and shall follow
the content and format of one of the two statements (but not both simultaneously)
set out in this section, as follows:
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3609(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3609(2)
[
§3.3613.Other Health Insurance Policies.
The notice in this section is for other health insurance policies not
specifically identified in
§§3.3604 - 3.3609
[
(1)
Original disclosure statement:
Figure: 28 TAC §3.3613(1)
(2)
Alternative disclosure statement:
Figure: 28 TAC §3.3613(2)
[
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
February 12, 1999.
TRD-9900932
Lynda H. Nesenholtz
General Counsel and Chief Clerk
Texas Department of Insurance
Earliest possible date of adoption: March 28, 1999
For further information, please call: (512) 463-6327
28 TAC §§3.3610-3.3612
(Editor's note: The text of the following sections proposed for
repeal will not be published. The sections may be examined in the offices
of the Texas Department of Insurance or in the Texas Register office, Room
245, James Earl Rudder Building, 1019 Brazos Street, Austin.)
The Texas Department of Insurance proposes the repeal
of §§3.3610 - 3.3612, concerning notices for Medicare supplement
policies. Repeal of these sections are necessary to bring Texas into compliance
with the federal Balanced Budget Act of 1997 (BBA). Disclosure notices are
no longer necessary for these referenced policies because changes to the BBA
clarify that the policies are not considered to provide benefits that duplicate
Medicare. Simultaneous to this proposed repeal, proposed amendments to Subchapter
W of Chapter 3 are published elsewhere in this issue of the
Texas Register
. The department will consider the repeal of §§3.3610
- 3.3612, in a public hearing under Docket Number 2400, scheduled for 9:00
a.m. on March 30, 1999, in Room 100 of the William P. Hobby, Jr. State Office
Building, 333 Guadalupe Street, Austin, Texas.
Kim Stokes, associate commissioner for life/health and managed care, has
determined that for each year of the first five years the proposed sections
will be in effect, there will be no additional fiscal impact on state or local
government nor to as a result of enforcing or administering the sections.
There will be no measurable effect on local employment or the local economy
as a result of the proposal.
Ms. Stokes has also determined that for each year of the first five years
the proposed sections are in effect, the public benefit anticipated as a result
of this repeal will be compliance with federal laws relating to disclosure
relating to Medicare supplement coverage so that the state will maintain its
regulatory authority over Medicare supplement coverage.
Ms. Stokes estimates that this repeal will not result in any cost to persons
affected by these sections, but should cost occur it is the result of the
federal enactment of the Balanced Budget Act of 1997 (Public Law 105-33) and
is not as a result of the repeal of these proposed sections.
Comments on the proposal must be submitted within 30 days after publication
of the proposed section in the
Texas Register
to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-1C,
Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.
An additional copy of the comment must be submitted to Linda von Quintus,
Deputy Commissioner, Regulation and Safety Division, Mail Code 107-2A, Texas
Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104.
The repeals are proposed under the Insurance Code Articles 3.70-3,
3.74, and 1.03A. Article 3.70-3 authorizes the department to adopt rules and
regulations for the filing and submission of health insurance policies as
are necessary, proper or advisable. Article 3.74, §5(d) provides that
the department may promulgate reasonable rules for captions or notice requirements
determined to be in the public interest and designed to inform prospective
insureds, subscribers, or enrollees that particular coverages are not Medicare
supplement coverages. Article 3.74, §10 provides that the department
shall adopt rules in accordance with federal law as necessary for the state
to retain certification under 42 U.S.C. Section 1395ss, as well as any other
reasonable rules necessary and proper to enforce Texas' minimum statutory
standards for Medicare supplement policies. Article 1.03A authorizes the commissioner
to adopt rules and regulations for the conduct and execution of the duties
and functions of the department as authorized by statute.
The proposed repeals affect the following statutes: Insurance Code Articles
3.74 and 3.70-3
§3.3610.Long-Term Care Policies Providing Nursing Home and Non-institutional Coverage.
§3.3611.Policies Providing Nursing Home Benefits Only.
§3.3612.Policies Providing Home Care Benefits Only.
This agency hereby certifies that the proposal has been
reviewed by legal counsel and found to be within the agency's legal authority
to adopt.
Filed with the Office of the Secretary of State, on
February 12, 1999.
TRD-9900933
Lynda H. Nesenholtz
General Counsel and Chief Clerk
Texas Department of Insurance
Earliest possible date of adoption: March 28, 1999
For further information, please call: (512) 463-6327
Subchapter M. Mandatory [Benefit] Notice Requirements
covered
] required by federal law, an evidence
of coverage issued by a health maintenance organization subject to the Texas
Health Maintenance Organization Act, which policy, subscriber contract, or
such evidence of coverage is advertised, marketed, or designed primarily as
a supplement to reimbursements under Medicare for the hospital, medical, or
surgical expenses of persons eligible for Medicare. The term does not include:
(5)(A)-(J)
] of this section.
fecal occult blood test and/or
] digital rectal
examination[
, or both
];
mammogram;
]
(III)
]
(
IV
)
] pure tone (air only) hearing screening test, administered or ordered
by a physician;
(
V
)
] serum cholesterol screening (every five years);
(
VI
)
] thyroid function test; or
(
VII
)
] diabetes screening;
influenza vaccine administered at any appropriate
time during the year and
] tetanus and diphtheria booster (every 10 years);
(5)(B)-(J)
] of this section. All benefit plans
shall conform to the definitions set out in §3.3303 of this title (relating
to Definitions) and §3.3304 of this title (relating to Policy Definitions
and Terms). Each benefit shall be structured in accordance with the format
provided in paragraphs (2) and (3) of this section. Each benefit plan shall
list the benefits in the order shown in paragraph
(5)(A)-(L)
[
(5)(A)-(J)
] of this section. For purposes of this paragraph, "structure,
language, and format" means style, arrangement and overall content of a benefit.
In addition to the benefit plan designations required in this paragraph, an
issuer may use other designations to the extent permitted by law.
(A)-(J)
] of this paragraph set out the composition of benefit
plans. Each benefit plan shall meet the requirements of this subchapter.
(G)
] Standardized Medicare Supplement
Benefit Plan "G." Medicare supplement benefit Plan "G" shall include only
the Core Benefit as defined in paragraph (2) of this section, plus the Medicare
Part A Deductible, Skilled Nursing Facility Care, Eighty Percent of the Medicare
Part B Excess Charges, Medically Necessary Emergency Care in a Foreign Country,
and the At-Home Recovery Benefit as defined in paragraph (3) of this section.
(H)
] Standardized Medicare Supplement
Benefit Plan "H." Medicare supplement benefit Plan "H" shall include only
the Core Benefit as defined in paragraph (2) of this section, plus the Medicare
Part A Deductible, Skilled Nursing Facility Care, Basic Prescription Drug
Benefit and Medically Necessary Emergency Care in a Foreign Country as defined
in paragraph (3) of this section.
(I)
] Standardized Medicare Supplement
Benefit Plan "I." Medicare supplement benefit Plan "I" shall include only
the Core Benefit as defined in paragraph (2) of this section, plus the Medicare
Part A Deductible, Skilled Nursing Facility Care, One Hundred Percent of the
Medicare Part B Excess Charges, Basic Prescription Drug Benefit, Medically
Necessary Emergency Care in a Foreign Country and At-Home Recovery Benefit
as defined in paragraph (3) of this section.
(J)
] Standardized Medicare Supplement
Benefit Plan "J." Medicare supplement benefit Plan "J" shall include only
the Core Benefit as defined in paragraph (2) of this section, plus the Medicare
Part A Deductible, Skilled Nursing Facility Care, Medicare Part B Deductible,
One Hundred Percent of the Medicare Part B Excess Charges, Extended Prescription
Drug Benefit, Medically Necessary Emergency Care in a Foreign Country, Preventive
Medical Care and At-Home Recovery Benefit as defined in paragraph (3) of this
section.
,
]
.
]"
The
] term "preexisting condition" [
shall be defined
when used in a Medicare supplement policy or certificate
] and
shall provide
an explanation of the term [
shall appear
] in
its accompanying outline of coverage
; and
[
.
]
(b)
] Agents shall list the following:
(c)
] In the case of a direct response
issuer, a copy of the application or supplemental form, signed by the applicant,
and acknowledged by the issuer, shall be returned to the applicant by the
issuer upon delivery of the policy.
(d)
] Upon determining that a sale
will involve replacement of Medicare supplement coverage, any issuer, other
than a direct response issuer, or its agent, shall furnish the applicant,
prior to issuance or delivery of the Medicare supplement policy or certificate,
a notice regarding replacement of Medicare supplement coverage. One copy of
such notice signed by the applicant and the agent, except where the coverage
is sold without an agent, shall be provided to the applicant and an additional
signed copy shall be retained by the issuer. A direct response issuer shall
deliver to the applicant at the time of the issuance of the policy the notice
regarding replacement of Medicare supplement coverage.
(e)
] The notice required by subsection
(e)
[
(d)
] of this section shall be provided in substantially
the following form and shall be in a typeface no smaller than 12-point type.
Figure: 28 TAC §3.3309
(e)
]
(f)
] Subsection
(f)
[
(e)
](1) and (2) of this section (applicable to preexisting conditions)
may be deleted by an issuer if the replacement does not involve application
of a new preexisting condition limitation.
(c)
]
Except as provided in
subsection (c) of this section and §3.3306(1)(A) of this title (relating
to Minimum Benefit Standards), subsection
[
Subsection
] (a)
of this section shall not be construed as preventing the exclusion of benefits
under a policy during the first six months, based on a preexisting condition
for which the policyholder or certificate holder received treatment or was
otherwise diagnosed during the six months before the coverage became effective.
(d)
] Invitation to contract advertisements,
as defined in §21.113(b) of this title (relating to Rules Pertaining
Specifically to Accident and Health Insurance Advertising and Health Maintenance
Organization Advertising) shall include the following statement: "Benefits
and premiums under this policy may be suspended for up to 24 months if you
become entitled to benefits under Medicaid. You must request that your policy
be suspended within 90 days of becoming entitled to Medicaid. If you lose
(are no longer entitled to) benefits from Medicaid, this policy can be reinstated
if you request reinstatement within 90 days of the loss of such benefits and
pay the required premium."
Subchapter W. Miscellaneous Rules for Group and Individual Accident and Health Insurance
ten
] disclosure statements which must be provided to inform prospective
buyers of health insurance policies about the extent to which benefits under
such policies duplicate Medicare benefits. The disclosure statements in these
sections have been developed by the National Association of Insurance Commissioners
and approved by the U.S. Secretary of Health and Human Services. Health insurance
policy issuers subject to the requirements to provide such disclosure must
comply with such requirements on and after August 11, 1995. These sections
in no way impact the effective date on which issuers must provide affirmative
disclosure of Medicare duplication to prospective insureds.
On and after the effective date of these
sections, issuers of policies that duplicate Medicare benefits must also include
such notices along with any filings which contain applications filings.
]
ten
] different types of health insurance policy identified as
needing a disclosure based on its potential to duplicate Medicare benefits,
even if only incidentally.
ten
] separate types of
health insurance policies which must be accompanied by an individualized statement
of the extent to which the policy duplicates Medicare are listed in paragraphs
(1)-
(7)
[
(10)
] of this subsection. Each of these listed
policy types must contain the disclosure statement, which may not vary from
the statements set out in sections 3.3604-
3.3309 and
3.3613 of
this title (relating to Required Disclosure Statements for Policies That Duplicate
Medicare) in terms of language or format, including type size, spacing, boldfacing,
line spacing, and use of boxes to surround text. The specific policy types
are:
long-term care policies providing both nursing
home and non-institutional coverage;
]
(8)
long-term care policies primarily
providing nursing home benefits only;
]
(9)
home care policies; and
]
(10)
]
(9)
]
of this subsection.
.
]
Figure: 28 TAC §3.3604
]
.
]
Figure: 28 TAC §3.3605
]
.
]
Figure: 28 TAC §3.3606
]
.
]
Figure: 28 TAC §3.3607
]
.
]
Figure: 28 TAC §3.3608
]
.
]
Figure: 28 TAC §3.3609
]
§§3.3604
- 3.3612
] of this title (relating to Required Disclosure Statements
for Policies that Duplicate Medicare)
, and shall follow the content and
format of one of the two statements (but not both simultaneously) set out
in this section, as follows:
[
.
]
Figure: 28 TAC §3.3613
]
Chapter 21.
Trade Practices