Texas Register
(24 TexReg 10270). Sections 21.2302
- 21.2304 and 21.2306 are adopted without changes and will not be republished.
The amendments are necessary to implement House Bills 1097 and 1924 enacted
during the 76th Legislative Session, 1999, which modify the definitions and
notice requirements regarding the mandatory and permissive Health Pool notice
provisions. Both bills amend Chapter 3, Subchapter G, Article 3.77 of the
Texas Insurance Code. House Bill 1097 amended §10(a), Article 3.77 of
the Insurance Code by adding a new provision for Health Pool eligibility.
House Bill 1924 amended §2(7) by increasing the types of coverage that
do not meet the definition of "Health Insurance" under the article. This bill
also amended Article 3.77 by adding §16 which allows a health carrier
to provide notification to its covered individuals regarding the existence
of coverage available through the Health Pool. The amendments to the rules
modify the definitions, notice requirements, and form used for notification
of an individual's eligibility in the Health Pool.
The amendments to §21.2302 modify the definition of "health coverage"
by adding "substantially similar health coverage" to the term being defined,
by clarifying that the definition is applicable only to individual coverage,
and by expanding the types of coverage that do not fall under the definition.
Also, a definition for a "covered individual" is added. The amendments to §21.2303
clarify instances when a health carrier is required to provide written notice
of Health Pool availability to an eligible individual who has applied for
health coverage from the health carrier. This section also adds a new permissive
notice provision which allows a health carrier to provide its covered individuals
with information about the Health Pool.
The amendments to §21.2304 reflect changes in the criteria used to
determine eligibility for Health Pool coverage for the mandatory Health Pool
notice provisions. Furthermore, the amendments describe the Health Pool Notice
Form provided in §21.2305, or its substitute notice provisions, that
the health carrier should use when providing either the mandatory or permissive
notice.
The amendments to §21.2305 modify the Health Pool Notice Form. The
changes in this section are necessary to comply with legislative amendments
concerning eligibility for Health Pool coverage. The department corrected
the address of the Risk Pool in this section based on public comment. The
amendments to §21.2306 explain the different application dates that pertain
to the sections.
Comment: A commenter pointed out that the address of the Texas Health Insurance
Risk Pool in §21.2305(b), Figure 1 is incorrect.
Agency Response: The department agrees and has changed the address.
For with changes: Texas Health Insurance Risk Pool.
Against: None.
The amendments are adopted under the Insurance Code, Article
3.77 and §36.001 (former Article 1.03A). Article 3.77 §8 provides
that the commissioner may adopt rules as are necessary and proper to implement
the article. Article 3.77 §16(b) states that an insurer providing notice
under §16(a) shall provide such notice as prescribed by the commissioner
and that the commissioner may promulgate rules to implement this section.
Section 36.001 provides that the Commissioner of Insurance may adopt rules
necessary for the conduct and execution of the duties and functions of the
Texas Department of Insurance only as authorized by statute.
§21.2305. Form.
(a)
Form Health Pool Notice is included in subsection (b)
of this section in its entirety and has been filed with the Office of the
Secretary of State. The address and phone numbers are variable to encompass
any future changes. The form can be obtained from the Texas Department of
Insurance, Life/Health Division, MC 106-1A, P.O. Box 149104, Austin, Texas
78714-9014.
(b)
Form Health Pool Notice, Figure 1:
Figure: 28 TAC §21.2305(b)
This agency hereby certifies that the adoption has been reviewed
by legal counsel and found to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on January
3, 2000.
TRD-200000002
Lynda Nesenholtz
General Counsel and Chief Clerk
Texs Department of Insurance
Effective date: January 23, 2000
Proposal publication date: November 19, 2000
For further information, please call: (512) 463-6327