PART 1. TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3. LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER V. COORDINATION OF BENEFITS
28 TAC §§3.3502, 3.3503, 3.3510
The commissioner of insurance adopts amendments to 28 TAC §§3.3502, 3.3503, and 3.3510, concerning the applicability of coordination of benefits (COB) to vision and eye care plans. The amendments implement Senate Bill 861, 88th Legislature, 2023, and Senate Bill 1367, 83rd Legislature, 2013. The amendments are adopted without changes to the proposed text published in the February 9, 2024, issue of the Texas Register (49 TexReg 626). Figure: 28 TAC §3.3510(d) was republished for consistency and clarity in the March 1, 2024, issue of the Texas Register (49 TexReg 1315) without markup and with all proposed changes incorporated. The sections will not be republished.
REASONED JUSTIFICATION. The amendments are necessary to enact changes in accordance with SB 1367, which abolished the Texas Health Insurance Pool, and SB 861, which specified COB requirements for vision benefit plans under Insurance Code Chapter 1203, Subchapter C. SB 861 set out provisions for the coordination of vision and eye care benefits. It also specified the responsibilities of the primary and secondary issuers of an applicable health or vision benefit plan for an enrollee who is covered by at least two different health or vision benefit plans that provide the enrollee coverage for the same vision or medical eye care services, procedures, or products.
The amendments to the sections are described in the following paragraphs.
Section 3.3502. To implement SB 861, an amendment to §3.3502 expands the applicability of the subchapter to include individual and group health benefit plans or vision benefit plans, as described by Insurance Code Chapter 1203, Subchapter C, by adding new subsection (a)(6) listing such plans.
A nonsubstantive amendment relocates an exclusion addressing disability income protection coverage exclusion, removing it from subsection (a)(1) and addressing it with new text in (b)(1). Another amendment to subsection (a)(1) adds the title of Chapter 1251. And the acronym "(HMO)" is added to subsection (a)(2).
An amendment also removes a reference in subsection (b)(1) to the Texas Health Insurance Pool. The Texas Health Insurance Pool was dissolved by SB 1367, effective September 1, 2015.
Subsections (c) - (f) are also eliminated. The dates specified in these subsections have passed, and the transition period they establish is no longer needed. Existing subsection (g) is redesignated as new subsection (c).
Section 3.3503. To implement SB 861, the definition of "plan" under §3.3503(15) is expanded to include vision plans. An amendment to paragraph (15)(A)(iii) adds the terms "self-funded" and "self-insured" in parentheses to clarify the types of arrangements that are included in the definition. A nonsubstantive amendment to paragraph (15)(B) conforms to the changes made in §3.3502 by replacing the reference to the Texas Health Insurance Pool with a clarification of the exclusion of disability income protection coverage. An Insurance Code reference is also added to paragraph (15)(B)(v).
Section 3.3510. Amendments to Figure: 28 TAC §3.3510(d) update the definition of "plan" to add a reference to vision coverage and remove a reference to the Texas Health Insurance Pool, consistent with changes made in §3.3502 and §3.3503. These changes ensure the model COB contract provisions are consistent with the rules. Use of the model COB contract provisions contained in Figure: 28 TAC §3.3510(d) is optional. Issuers may use the model COB provisions or make nonsubstantive changes to the provisions, as long as the contract provisions accurately reflect the COB rules. TDI also makes nonsubstantive amendments to Figure: 28 TAC §3.3510(e) to update the model COB notice to use more plain language and make the information easier for consumers to understand. The model COB notice is a resource for health benefit plan issuers. The notice provides a summary of the most common COB circumstances and does not replace or change the contract provisions.
SUMMARY OF COMMENTS. TDI provided an opportunity for public comment on the rule proposal for a period that ended on March 11, 2024. TDI did not receive any comments on the proposed amendments.
STATUTORY AUTHORITY. The commissioner adopts the amendments to §§3.3502, 3.3503, and 3.3510 under Insurance Code §1203.107 and §36.001.
Insurance Code §1203.107 provides that the commissioner may adopt rules necessary to implement Chapter 1203, Subchapter C.
Insurance Code §36.001 provides that the commissioner may adopt any rules necessary and appropriate to implement the powers and duties of TDI under the Insurance Code and other laws of this state.
The agency certifies that legal counsel has reviewed the adoption and found it to be a valid exercise of the agency's legal authority.
Filed with the Office of the Secretary of State on April 29, 2024.
TRD-202401884
Jessica Barta
General Counsel
Texas Department of Insurance
Effective date: May 19, 2024
Proposal publication date: February 9, 2024
For further information, please call: (512) 676-6555