§1060.2. Notice and disclosure of certain information required
A health insurance issuer of a health benefit plan that covers prescription drugs and uses one or more drug formularies to specify the prescription drugs covered under the plan shall:
(1) Provide in plain language in the coverage documentation provided to each enrollee each of the following:
(a) Notice that the plan uses one or more drug formularies.
(b) An explanation of what a drug formulary is.
(c) A statement regarding the method the health insurance issuer uses to determine the prescription drugs to be included in or excluded from a drug formulary.
(d) A statement of how often the health insurance issuer reviews the contents of each drug formulary.
(e) Notice, on a form approved by the Department of Insurance, that an enrollee may contact the health insurance issuer to determine whether a specific drug is included in a particular drug formulary.
(2) Disclose to an individual upon request, not later than the third business day after the date of the request, whether a specific drug is included in a particular drug formulary.
(3) Notify an enrollee and any other individual who requests information pursuant to this Section that the inclusion of a drug in a drug formulary does not guarantee that an enrollee's physician or other authorized prescriber will prescribe the drug for a particular medical condition or mental illness.
Acts 2011, No. 350, §1, eff. Jan. 1, 2012.
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