1. (a) Prescribed notices consist of the following:

   1. (1) For a health benefit plan that provides coverage and/or benefits for the treatment of breast cancer, a carrier shall issue a notice which includes the language provided in Figure 1 of subsection (b) of §21.2106 of this title (relating to Forms, Form Number 349 Mastectomy).
   2. (2) For a health benefit plan that provides coverage and/or benefits for diagnostic medical procedures, a carrier shall issue a notice which includes the language provided in Figure 2 of subsection (b) of §21.2106 of this title (relating to Forms, Form Number 258 Prostate).
   3. (3) For a health benefit plan that provides coverage and/or benefits for maternity, including benefits for childbirth, a carrier shall issue a notice which includes the language provided in Figure 3 of subsection (b) of §21.2106 of this title (relating to Forms, Form Number 102 Maternity).
   4. (4) If the health benefit plan described in paragraph (3) of this subsection includes benefits and/or coverage for in-home postdelivery care, the following language, or substantially similar language, shall be inserted immediately before the "Prohibitions" portion of the notice language at Figure 3 of subsection (b) of §21.2106 of this title (relating to Forms): "Since we provide in-home postdelivery care, we are not required to provide the minimum number of hours outlined above unless (a) the mother's or child's physician determines the inpatient care is medically necessary or (b) the mother requests the inpatient stay."

2. (b) In lieu of the prescribed notices outlined in subsection (a) of this section, a carrier may opt to provide notices with substantially similar language rather than the notices contained in subsection (b) of §21.2106 of this title. The substantially similar language must be in a readable and understandable format, and must include a clear, complete and accurate description of these items in the following order:

   1. (1) a heading in bold print and all capital letters indicating the information in the notice relates to mandated benefits;
   2. (2) a statement that the notice is being provided to advise the enrollee of the appropriate coverage(s)/benefit(s), including the carrier's complete licensed name;
   3. (3) a heading in bold print describing the benefit/coverage being provided, for example, Examinations for Detection of Prostate Cancer;
   4. (4) a description of the benefit/coverage for which the notice is being provided;
   5. (5) for the notice required by subsections (a)(1) and (3) of this section, the heading "Prohibitions" in bold print, followed by a summary of the prohibited acts by a carrier in providing the benefit/coverage for which the notice is being provided; and
   6. (6) a statement identifying the carrier, and providing a phone number and address to which an enrollee may direct questions regarding the coverage(s)/benefit(s) for which the notice is being provided.
3. (c) If a health benefit plan provides coverage and/or benefits of more than one of the required notices described in subsection (a) of this section, the carrier may combine the language of the required notices into one notice.
4. (d) If, before the effective date of these rules, a carrier has provided notice(s) to its enrollees that contains the information required by the notices described in this subchapter, such notices shall be deemed to comply with the requirements of this subchapter as to those enrollees.

Source Note:The provisions of this §21.2103 adopted to be effective March 29, 1998, 23 TexReg 3009.