TAX ADMINISTRATION

(a) Words shall be selected carefully with preference given to short, familiar words. (b) Words which are generally familiar, or are common speech, shall be used to the extent possible. (c) Use of technical or abstract words shall be avoided to the extent possible. (d) While prov…

A certificate issued pursuant to a group long-term care insurance policy, which certificate is delivered or issued for delivery in this state, shall include: (1) a description of the principal benefits and coverage provided in the policy; (2) a statement of the principal exclusio…

(a) Policy or certificate replacements and lapses. The purpose of this subsection is to specify requirements for insurers issuing long-term care insurance benefits in this state to report to the commissioner information on a statewide basis regarding long-term care insurance poli…

A long-term care insurance policy shall not be deemed to meet the standards and requirements set forth in this subchapter unless the filing company has complied with the requirements of the following paragraphs. (1) Each insurer or other entity providing long-term care insurance …

(a) Each insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its agents, shall establish and implement marketing procedures to assure that: (1) any comparison of policies by its agents or other producer…

A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners shall be provided to all prospective applicants of a long-term care insurance policy or certificate, as provided in this section. (1) In the case of agent sol…

Each insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: (1) Procedures applicable to unintentional lapse. (A) Notice before lapse or termination. No individual long-term care policy or certificate shall be issu…

(a) In recommending the purchase or replacement of any long-term care insurance policy or certificate, the company and the agent must make reasonable efforts to determine the appropriateness of the recommended purchase or replacement. (b) Each insurer, health care service plan, o…

Premium rates may not be raised for a covered individual unless: (1) either the covered individual requests and receives a change of benefits; or (2) the increase is made for all members of the class to which the individual has been assigned by the insurer. The provisions of para…

(a) Required Offering of Nonforfeiture Benefits and Contingent Benefits upon Lapse. No insurer or other entity may offer a long-term care insurance policy or certificate in this state unless such insurer or other entity also offers to the prospective insured, or to the group poli…

A long-term care policy that contains a refund of premium provision shall comply with the following: (1) The refund of premium benefit provision shall not provide a withdrawal value. (2) The refund of premium provision shall be appropriately captioned in the policy. (3) The amoun…

(a) For a policy or certificate that has been in force for less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation and an intent to deceive by the in…

(a) In marketing and issuing long-term care insurance contracts in Texas, no person shall state that any such contract is intended to be a "qualified long-term care insurance contract" as defined in § 3.3804 of this title (relating to Definitions) unless the contract: (1) provide…

(a) Definition and Applicability. Long-term care policies, certificates, and riders with limited premium payment options limit premium payments to a single payment or to a stated number of years not to exceed 10 years. Limited premium payment policies, certificates, and riders mu…

(a) Insurer requirements. (1) Any insurer issuing long-term care insurance to an association, as defined in the Insurance Code § 1251.052 , must file with the department in accordance with the requirements and procedures set forth in Subchapter A of this chapter (relating to Subm…

(a) At the time of delivery of a non-partnership life insurance policy or annuity contract that provides long-term care benefits by rider, a policy summary shall be delivered. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the appl…

(a) Notification and Offer of Exchange. Within 18 months from the date that an insurer begins to advertise, market, offer, or sell, policies under the Texas Long-Term Care Partnership Program the insurer is required to offer on a one-time basis, in writing, to all policyholders o…

(a) Standards. (1) General requirements. In addition to the required filing and approval pursuant to § 3.3873 of this title (relating to Filing Requirements for Long-Term Care Partnership Policies), any policy or certificate marketed or represented to qualify as a long-term care …

(a) Pursuant to §1917(b)(1)(C)(iii)(IV) of the Social Security Act (42 U.S.C. § 1396p(b)(1)(C)(iii)(IV) ), an insurer shall not issue a policy or certificate marketed or represented to qualify as an approved long-term care partnership policy unless the policy or certificate compl…

(a) Prior approval requirements. Each long-term partnership policy or certificate, including any long-term care partnership endorsement, that is to be delivered or issued for delivery in this state must comply with the requirements specified in paragraphs (1) and (2) of this subs…

(a) Insurer training verification and certification requirements for agents. The following requirements apply to an insurer that is offering partnership policies or certificates in this state. (1) The insurer is required to obtain verification that an agent has received the train…

(a) Submission. Companies must submit one copy of the filing to the Life and Health Division at the address set forth in § 3.3 (a) of this title (relating to Transmittal Information). A filing submitted electronically must be submitted in such form and format as determined by the…

(a) Application form filings must include an explanation of the purpose and use of the application that specifies: (1) the purpose of the application, including the type of contracts and products the application will be used for; and (2) whether the application will be in paper, …

The purpose of this subchapter is to exempt certain life and accident and sickness policy forms and annuity contract forms from certain of the requirements of Insurance Code Chapter 1701. Chapter 1701 requires that these forms may not be delivered, issued, or used in Texas unless…

All life and accident and sickness policy forms and annuity contract forms intended for use in this state, including application, rider, or endorsement forms not specifically exempted by this subchapter, must be filed to be reviewed and approved in accordance with Insurance Code …

(a) Group and individual life forms. The group and individual life insurance forms specified in this subsection are exempt from the review and approval requirements of Insurance Code Chapter 1701, concerning Policy Forms, unless the forms are required by the laws of Texas, anothe…

(a) This section does not relieve any insurer or other licensee from complying with the Insurance Code or the rules and regulations of the Texas Department of Insurance. (b) Insurers must cause all forms to comply with all required provisions of all applicable law, including the …

Any form intended for use in Texas which contains provisions or will create conditions or concepts which may be construed as new, uncommon, or unusual must be filed for review and approval whether or not it falls within one of the exempt filing categories as specified in these se…

All forms intended for use in Texas for all newly licensed insurers shall be filed for review and approval for a period of two years from the date the insurer receives a certificate of authority to do business in Texas. Notes 28 Tex. Admin. Code § 3.4007 The provisions of this §3…

(a) In order to monitor the appropriateness and effectiveness of the exemption provisions, the department will conduct periodic random and targeted audits of forms filed under these sections. Any compliance deficiencies identified during the audit process will be communicated to …

(a) The privileges under this subchapter that permit an insurer to make exempt filings may be canceled if the insurer makes an exempt filing that fails to comply with one or more provisions of this title or the Insurance Code that results in the department determining that the fi…

The forms adopted and referenced in § 3.4004 (g) of this title (relating to Copies of Previously Approved Forms) and § 3.4005 of this title (relating to General Information) are included in the following appendix to these sections. Attached Graphic Notes 28 Tex. Admin. Code § 3.4…

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

(a) When conducting business electronically, an issuer must comply with Insurance Code Chapter 35, concerning Electronic Transactions. (b) For all applications, including applications that involve electronic or telephonic transactions, the issuer must provide the applicant with a…

This subchapter provides for exempting certain contracts or coverage from the requirement in Insurance Code Chapter 1701 that such contracts or coverage be filed for review with the Texas Department of Insurance before being delivered, issued, or used in this state; this exemptio…

The following classes of insurance coverage may be exempted: (1) group life or accident or health insurance coverage delivered or issued for delivery to the groups authorized by Insurance Code §§ 1131.051 , 1131.052 , 1251.051 , and 1251.052 , insofar as it applies to a labor uni…

The exemption specified in § 3.4102 of this title (relating to Coverage Which May Be Exempted) is conditioned as follows. (1) The insurer has an affirmative duty to comply with the following: (A) the insurer must file with the Texas Department of Insurance a statement signed by a…

Contracts submitted in accordance with § 3.4103 of this title (relating to Obtaining Exemption) will be reviewed in the normal course. The duration of the period of an exemption provided for in these sections, unless otherwise determined on either an individual or class basis by …

The Texas Department of Insurance may at any time revoke the exemption specified in this subchapter on the grounds that a company: (1) has not complied with this subchapter ; or (2) by failing to abide by other applicable law is found to be unworthy of the exemption. The departme…

This subchapter applies to a health insurance policy, including a health insurance policy that incorporates a preferred provider benefit plan, issued, delivered, issued for delivery, entered into or renewed in this state in which an insurer provides benefits for pharmaceutical se…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Health insurance policy--An individual, group, blanket, or franchise insurance policy, insurance policy or agreement, or group hospi…

(a) An insurer shall, upon request, provide information concerning the application process and qualification requirements for participation in providing pharmaceutical services under a health insurance policy. (b) An insurer must notify a pharmacy or pharmacist of acceptance or n…

(a) An insurer may establish reasonable application and recertification fees for each licensed pharmacy which participates or applies to participate as a contract provider under a health insurance policy. An application or recertification fee charged under this section shall be c…

(a) An insurer must apply the same administrative, financial and professional conditions to all pharmacies and pharmacists participating or applying to participate as contract providers under a health insurance policy. (b) An insurer may establish additional compensation or reimb…

(a) The commissioner enacts this subchapter to: (1) Expand the circumstances under which insurers can offer acceleration-of-life-insurance benefits, thus enhancing financial choices for insureds facing terminal or life-threatening illnesses or conditions; (2) Implement revised st…

(a) An acceleration-of-life-insurance benefit provision provides a special benefit under a life insurance contract, which prepays all or a portion of the death benefit, based either on a long-term care illness, specified disease, or terminal illness. (b) The following words and t…

(a) Acceleration-of-life-insurance benefits, and the illness, condition, care or confinement necessary to evidence that the insured has either a long-term care illness, specified disease or terminal illness, shall be clearly defined in the life insurance contract consistently wit…

The acceleration-of-life-insurance benefit provision may require a medical diagnosis of conditions and/or documentation of care or confinement as defined in the life insurance contract to establish eligibility for acceleration-of-life-insurance benefits. This may include a writte…

The life insurance contract may contain a provision terminating the acceleration-of-life-insurance benefit if the contract is continued under a nonforfeiture option. Notes 28 Tex. Admin. Code § 3.4305 The provisions of this §3.4305 adopted to be effective March 1, 1998, 23 TexReg…

The acceptable methods for determining an acceleration-of-life-insurance benefit, and allowable charges and fees associated with the benefit, are as specified in this section. (1) Additional Premium or Cost of Insurance Charge Method. The acceleration-of-life-insurance benefit pr…