TAX ADMINISTRATION

(a) An issuer submitting a filing for a group policy, agreement, evidence of coverage, or contract must comply with the requirements in this section. (1) An issuer must identify the specific group type the form is being filed under by indicating the applicable Insurance Code sect…

(a) A filing that includes a copy of a form that is submitted in braille as an exact copy of a previously approved form, or that is submitted in a non-English language that is translated from a previously approved English language form, must include a certification as required un…

(a) Acceptance, approval, and exemption of filings. Upon submission, a filing will be accepted for preliminary review of compliance with the filing requirements in this subchapter. If the filing requirements in this subchapter have not been satisfied, the department will consider…

(a) All filings submitted pursuant to this subchapter must be accompanied by the department 's transmittal checklist except for the documents listed in § 3.1 (11)(B) of this title (relating to Scope), which must be accompanied by the department 's transmittal form as described in…

(a) Unless otherwise specified, this subchapter applies to all individual accident and sickness insurance policies and subscriber contracts of hospital and medical and dental service associations, delivered, issued for delivery, or renewed in this state on and after the effective…

(a) Unless otherwise provided by law or this subchapter, every individual accident and sickness insurance policy or subscriber contract that is subject to the provisions of this subchapter and that is delivered, issued for delivery or renewed on or after the effective date of thi…

Except as otherwise provided by law or these sections, no individual accident and sickness insurance policy or hospital, medical and dental service corporation subscriber contract delivered or issued for delivery in this state may contain definitions respecting the matters set fo…

The term "hospital" may be defined in relation to its status, facilities, and available services. The definition may not stipulate as a condition that a hospital be incorporated or that it be recognized by any accrediting organizations. (1) Except as provided in these sections, t…

The term "convalescent nursing home" or "extended care facility" shall be defined in relation to its status, facilities, and available services. (1) Except as provided in these sections, a definition of such home or facility may not be more restrictive than one requiring that it:…

(a) These terms shall be defined to employ "result" language and may not include words which establish an accidental means test. Except for accidental death or dismemberment, said definitions may not include words such as "external, violent, visible wounds" or similar words of de…

Grantees must establish a contract administration system to consistently ensure that contract deliverables are being provided as specified in the contracts. Notes 1 Tex. Admin. Code § 3.77 The provisions of this §3.77 adopted to be effective February 24, 2000, 25 TexReg 1297; Ame…

Whenever hydrocarbon, brine or geothermal resource fluids are encountered in any well drilled for oil, gas, brine, or geothermal resources in this state, such fluid shall be confined in its original stratum until it can be produced and utilized without waste. Each such stratum sh…

(a) Applicability. (1) In accordance with Texas Natural Resources Code § 86.044 , this section applies to a gas supply chain facility that is: (A) included on the electricity supply chain map created under Texas Utilities Code § 38.203 ; and (B) designated as critical in § 3.65 o…

(a) Certified organic and/or transitional cotton growers in active eradication zones may negotiate and enter into voluntary indemnification agreements with the foundation provided that those agreements are negotiated and made in good faith by both parties and are approved by the …

(a) The term "noncancellable" may be used only in a policy which the insured has the right to continue by the timely payment of premiums set forth in the policy until at least age 50, or in the case of a policy issued after age 44, for at least five years. The insurer may not uni…

(a) Subject to the conditions set forth in subsection (b) of this section, a policy subject to this subchapter may contain provisions limiting or denying coverage based on the existence of a preexisting condition or conditions. "Preexisting condition" may not be defined to be mor…

(a) Definitions. (1) In this section, the term "energy emergency" means any event that results in firm load shed or has the potential to result in firm load shed required by the reliability coordinator of a power region in Texas. An event that has the "potential to result in firm…

One period of confinement-continuous hospital confinement means consecutive days of in-hospital service received as an inpatient, or successive confinements when discharge from and readmission to the hospital occurs within a period of time not more than 90 days or three times the…

A definition of "mental or nervous disorder" as used in a policy may not be more restrictive than a neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder of any kind. Notes 28 Tex. Admin. Code § 3.3016 The provisions of this §3.3016 adopted …

This subchapter does not waive the Land Office's sovereign immunity to suit or liability. Notes 16 Tex. Admin. Code § 3.63 The provisions of this §3.63 adopted to be effective January 1, 1976; Adopted by Texas Register, Volume 44, Number 47, November 22, 2019, TexReg 7186 , eff. …

(a) Crop destruction. A grower who has been notified that destruction of the grower's organic cotton crop is necessary will have no more than seven calendar days from the date of receipt of notification to destroy that crop by plow-up. (b) Extension requests. A request for a dead…

(a) If the PSO determines a municipality has defunded its police department as specified by Chapter 109, Local Government Code, the PSO shall issue a written determination to the municipality. (b) The PSO shall send the written determination made under this Section to the Texas C…

(a) No indeterminate premium reduction policy may be approved for use in Texas unless the insurer files with the Texas Department of Insurance in conjunction with such indeterminate premium reduction policy a statement: (1) that, to the best of its knowledge and belief, the polic…

(a) In regards to individual hospital, medical or surgical coverage, the term "guaranteed renewable" shall not be defined more restrictively than set forth in § 3.3038 of this title (relating to Mandatory Guaranteed Renewability Provisions for Individual Hospital, Medical or Surg…

Complications of pregnancy shall be treated, in all cases, as any other sickness. Complications of pregnancy mean: (1) conditions, requiring hospital confinement (when the pregnancy is not terminated), whose diagnoses are distinct from pregnancy but are adversely affected by preg…

(a) The initial premium charge and its period of guarantee, the maximum premium charge, the fact that the maximum premium charge might be charged, and the frequency of premium redetermination dates must be set forth prominently in: (1) any advertising containing an application or…

(a) Except as provided by this section, all individual hospital, medical, or surgical coverage (as defined in § 3.3002 (b)(12) of this title (relating to Definitions)) must be renewed or continued in force at the option of the insured. (b) Medicare eligibility or entitlement is n…

(a) Each individual policy of accident and sickness insurance, including a policy issued by a company subject to Insurance Code Chapter 842, that is delivered, issued for delivery, or renewed in Texas on or after January 1, 1988, must contain a benefit provision which states, "Al…

(a) Upon application for an indeterminate premium reduction policy or group certificate, a separate form containing a summary which adequately describes the contractual premium provisions must be signed by the applicant and submitted to the insurer in conjunction with the applica…

(a) No policies or riders for additional coverage may be issued as a dividend unless an equivalent cash payment is offered to the policyholder as an alternative to such a dividend policy or rider. (b) All riders or endorsements added after date of issue, except those by which the…

If the policy offers an initial premium which is different from the maximum guaranteed premium specified in the policy for later policy years, no solicitation or advertisement may display or state the smaller premium in such a fashion that the larger premium charge is rendered ob…

(a) Each policy subject to this subchapter: (1) Shall include a renewal, continuation, or nonrenewal provision, consistent with the requirements of this subchapter. The language or specifications of such provision must be consistent with the type of contract to be issued (e.g., g…

A family policy providing hospital, surgical, medical expense, hospital confinement indemnity, or accident only insurance shall include provisions which specify the indemnity and qualifications applicable to those family members who may become insured under the policy initially o…

A definition of "Medicare" shall be included in any hospital, surgical, or medical expense policy which relates its coverage to eligibility for Medicare or Medicare benefits. The term Medicare may not be defined as more restrictive than: (1) "the Health Insurance for the Aged Act…

(a) The policy must clearly disclose the intent of the insurer as to the applicability or nonapplicability of coverage to preexisting conditions. In accordance with § 3.3018 of this title (relating to Policy Definition of Preexisting Condition), a policy offering individual hospi…

A probationary or waiting period, if one is specified in the policy, is that period of time commencing with the date a person is initially insured under the policy to the date the coverage or coverages of the policy shall become effective as to such person. (1) A probationary or …

The limitations on the risk undertaken, whether applicable to amounts, durations of benefits (age, or other matters) must be specified with clarity and certainty in the appropriate provision of the contract. Notes 28 Tex. Admin. Code § 3.3056 The provisions of this §3.3056 adopte…

(a) An exception or exclusion is any provision in a policy whereby coverage for a specified hazard in entirely eliminated. It is a statement of a risk not assumed under the terms and provisions of the contract. Extensive listing of diseases to be excluded will not be acceptable u…

Elimination period shall relate to the initial period of time, during the continuance of a condition insured against, for which such benefit will not be paid. Such periods must be clearly expressed in the policy schedule of benefits page and clearly expressed or referenced in the…

A policy may contain provisions relating to recurrent disability; provided, however, a recurrent disability provision may not specify that such disabilities be separated by a period greater than six months. Notes 28 Tex. Admin. Code § 3.3059 The provisions of this §3.3059 adopted…

No policy may provide for premium changes more often than once per policy year. Notes 28 Tex. Admin. Code § 3.306 The provisions of this §3.306 adopted to be effective May 8, 1980, 5 TexReg 1579.

(a) If a policy contains a conversion privilege, the caption shall be "Conversion Privilege," or words of similar import. The provision shall indicate the persons eligible for conversion. The circumstances applicable to the conversion privilege, including any limitations on the c…

(a) Application forms shall include a question relating to replacement designed to elicit information as to whether the insurance to be issued is intended to replace any other accident and sickness insurance presently in force. A supplementary application or other form to be sign…

The following provisions shall apply to conditional receipts. (1) A conditional receipt which requires a determination of insurability as a condition precedent to coverage shall include an agreement to provide: (A) coverage subject to any limit regarding the amount of insurance s…

No insurer may, for premium redetermination purposes, reclassify into subclasses or new classes the original class established for an indeterminate premium reduction policy at date of issue. Notes 28 Tex. Admin. Code § 3.307 The provisions of this §3.307 adopted to be effective M…

The following minimum standards for benefits are prescribed for the categories noted in §§ 3.3071 - 3.3077 and § 3.3079 of this title (relating to Minimum Standards and Benefits and Readability for Accident and Health Insurance Policies). No individual policy of accident and sick…

(a) "Basic hospital expense insurance" is a policy of accident and health insurance which provides coverage for a period of not less than 31 days during any one period of confinement for each person insured under the policy for the expense incurred for necessary treatment and ser…

(a) "Basic medical-surgical expense coverage" is a policy of accident and sickness insurance which provides coverage for each person insured under the policy for the expenses incurred for the necessary services rendered by a physician for treatment of an injury or sickness for at…

(a) "Hospital Confinement Indemnity Coverage" is a policy of accident and sickness insurance which provides daily benefits for hospital confinement on an indemnity basis in an amount not less than $15 per day or $100 per week and not less than 31 days during any "one period of co…

Residual disability shall be defined in relation to the insured's reduction in earnings and may be related either to the inability to perform one or more, but not all, of the "major," "important," or "essential" duties of employment or occupation, or to the inability to perform a…