TAX ADMINISTRATION

The standards and principles for the application of presumptive rates established for credit life insurance are as follows. (1) The credit life insurance contract may require submission of the debtor's written and signed evidence of the debtor's insurability or that the debtor be…

If the premiums are determined according to age of the insured debtor or by age brackets, appropriate adjustments in the rate and premium may be made according to age if such adjustments are actuarially consistent with the foregoing rates when applied regardless of actual age at …

If a contract of insurance includes other lawful benefit or benefits for which standards or reasonableness of benefits in relation to premium are not elsewhere in these sections determined or described, any premium charged therefor in excess of the rates set forth in these sectio…

The standards and principles for the application of presumptive rates established for credit accident and health insurance are as follows. (1) The initial amount of insured indebtedness to which the rate is applied shall not exceed the aggregate of the insured portion of the peri…

(a) Joint debtors, for purposes of credit accident and health insurance written under Insurance Code, Chapter 1153 means only spouses or business partners, and such persons must be jointly and severally liable for repayment of the single indebtedness and be joint signers of the i…

Two types of rate deviation are allowed, automatic deviation and approved deviation as defined in § 3.5002 of this title (relating to Definitions). (1) Automatic Deviation. An insurer electing to deviate from the presumptive premium rate established by the commissioner shall file…

A request for an approved deviated rate must be made in writing and must include all of the information which is required under this subchapter. It must be accompanied by a list of the creditors whose experience is the basis for such request, and must be attested to by an officer…

The following table shall be used to determine the credibility factor of a case, as defined in § 3.5002 of this title (relating to Definitions). Attached Graphic Notes 28 Tex. Admin. Code § 3.5603 The provisions of this §3.5603 adopted to be effective June 7, 2005, 30 TexReg 3210

(a) For credit life insurance, the currently charged premium rates will be considered the case rates if the single premium (or its equivalent) case rate per $100 of initial amount of insured indebtedness repayable in 12 equal monthly installments as determined under this subchapt…

Subchapters A through F of this chapter apply to all applications for funding and grants submitted to the Public Safety Office (PSO), Office of the Governor (OOG). A PSO-funded grantee must comply with the provisions of Subchapters A through F in effect on the date the grant is a…

A downward approved deviated single account case rate as determined in § 3.5609 of this title (relating to Notice of Change of Insurer on Deviated Presumptive Rates Required) remains with the case, regardless of any change of insurers, and shall continue for a period equal to the…

An upward approved deviated single account case rate shall continue for a period equal to the experience period on which it was based, not to exceed three years, subject however to the provisions of § 3.5608 of this title (relating to Annual Review of Approved Deviated Rates). If…

All approved deviated rates shall be filed for review for each case in accordance with this subchapter each year for each case. At the time of such review of approved deviated rates, adjustments may be made in the rates if the commissioner finds that experience shows that an adju…

When a creditor changes insurers, and that creditor is charging a rate other than the presumptive premium rate, the previous insurer shall within 60 days file written notice of the change with the commissioner. Notes 28 Tex. Admin. Code § 3.5609 The provisions of this §3.5609 ado…

(a) For cases which are not of credible size, or have no experience, no approved deviation may be made in the presumptive premium rates under these deviation procedures; except that nothing herein may be construed as preventing any insurer from filing an automatic deviation pursu…

(a) Insurers writing credit life insurance and accident and health insurance in Texas must keep statistical data for a period of no less than five years to enable the Commissioner to determine whether rates are reasonable in relation to the benefits afforded by the various policy…

If a company proposes to write any type of coverage other than those set forth in this subchapter, it may request the department to set a public hearing to determine if a public need exists for such coverage and to determine, through credible statistics, whether the rate proposed…

With respect to policies issued and certificates delivered after the effective date of these sections: (1) the refund of an unearned amount paid by or charged to a debtor for credit life insurance, or for credit accident and health insurance, on which charges to the debtor are pa…

Upon termination of insurance prior to maturity, and in accordance with the refund formulas prescribed herein, and in accordance with the insurer's established refund procedures, each insured debtor shall receive from the insurer any refund of unearned identifiable insurance char…

Where insurance charges or premiums were paid by or charged to the debtor, the insurer is responsible for making the refund to the debtor (or to the debtor's estate). Where discharge of the insurer's responsibility for completion of such refunds is delegated by the insurer to the…

The requirement for filing refund formulas will be satisfied if the formulas are set forth in the individual policy or group policy filed with the commissioner of insurance and not disapproved. All individual policies and certificates of insurance shall contain a description of t…

No refund of premium need be made of an amount paid or charged to the debtor for credit insurance regulated under the Insurance Code, Chapter 1153, in the event of termination of the indebtedness or the insurance prior to the scheduled maturity date of the indebtedness if the amo…

In calculating refunds upon termination, no charge for credit insurance may be made for the first 15 days of a loan month, and a full month may be charged for 16 days or more of a loan month. Notes 28 Tex. Admin. Code § 3.5906 The provisions of this §3.5906 adopted to be effectiv…

(a) A company must include the certification(s), attachment(s), and additional information referred to in this section as follows: (1) A filing must include the following certifications, as applicable: (A) Specific certification. Filings submitted as file and use pursuant to § 3.…

Issuers are required to submit rate filings or other actuarial information as required by law, including: (1) Insurance Code Chapter 1105, concerning Standard Nonforfeiture Law for Life Insurance; (2) Insurance Code Chapter 1107, concerning Standard Nonforfeiture Law for Certain …

Each insurer transacting credit insurance business in this state shall, in compliance with the laws of this state and the regulations promulgated thereunder, be responsible for: (1) the approval, production, reproduction, amendment, and modification of its policies, certificates …

(a) The insurer, by its group policy, may authorize the group policyholder-creditor to issue certificates of group insurance or may authorize a legally appointed insurance agent of the insurer to issue certificates of insurance or policies of insurance, and respectively, to colle…

No group policy may be issued to other than a bona fide creditor. No first beneficiary may be designated except a creditor. No creditor may be designated as owner of the individual policy, nor have any rights thereunder other than that of first beneficiary except as specifically …

The insurer may designate or engage one or more representatives for the purpose of investigating or settling claims, processing production reports, calculating reserves, printing of approved forms, and performing other administrative services authorized by law, provided: (1) such…

The insurance company shall establish and maintain an adequate claims register and claim files, which may be reviewed and examined by the commissioner of insurance. Notes 28 Tex. Admin. Code § 3.6005 The provisions of this §3.6005 adopted to be effective October 1, 1980, 5 TexReg…

Adequate proofs of loss must be in the possession of the insurance company at the time its funds are disbursed in payment of claims, except as provided in § 3.6008 of this title (relating to Additional Restrictions on Settlement and Adjustment of Claims). Such proofs of loss shal…

All claims shall be paid either by draft drawn upon the insurance company or by check of the insurance company to the order of the specific beneficiary to whom payment of the claim is due. Notes 28 Tex. Admin. Code § 3.6007 The provisions of this §3.6007 adopted to be effective O…

No plan or arrangement shall be used whereby any person, firm, or corporation other than the insurer or its designated claim representatives shall be authorized to settle or adjust claims. The creditor shall not be designated as a claim representative for the insurer in settling …

On at least an annual basis and to assure compliance with the insurance laws of this state and the regulations promulgated thereunder, the insurer shall audit its credit insurance business with each of its creditors, general agents, and other persons or entities providing adminis…

(a) Purpose and scope. The sections contained in this subchapter are intended to implement Insurance Code § 1501.260 and to establish plain language requirements for health benefit plans or forms that will be approved by the department and issued by health carriers in this state.…

Upon request by the commissioner of insurance, the insurer shall procure and make available at its home office legally acceptable copies of all source documents relating to any of its credit insurance transactions. Such copies shall be made available at the home office within a r…

(a) The commissioner adopts by reference the Consumer Bill of Rights for Credit Life, Credit Disability, and Credit Involuntary Unemployment Insurance form. All insurers writing credit life, credit disability, and credit involuntary unemployment insurance policies must provide wi…

(a) All health benefit plan certificates, policies, evidences of coverage, endorsements, amendments, applications, or riders shall be written in plain language and shall comply with the requirements set forth in this subchapter. (b) A health benefit plan certificate, policy, evid…

(a) This section applies to: (1) individual accident and health products under Insurance Code § 1701.057 , concerning Withdrawal of Individual Accident and Health Insurance Policy Form Approval; and (2) group accident and health coverage issued to alternative types of group polic…

(a) Except as provided in § 3.6102 of this subchapter (relating to Claims Reserves), the minimum reserves for premium refunds required by these rules and the payment of benefits under outstanding credit life insurance policies and certificates issued prior to January 1, 2009, may…

(a) The insurer shall set up adequate reserves for claims on credit life and credit accident and health insurance, in addition to the policy reserves already described in § 3.6101 of this subchapter (relating to Policy Reserves). Claim reserves for single premium credit accident …

(a) Each life filing that changes the nonforfeiture values of a particular policy or certificate must be accompanied by the information described in this subsection. (1) For a life insurance product that is subject to Insurance Code Chapter 1105, concerning Standard Nonforfeiture…

The following practices, when engaged in either directly or by reciprocal agreement by an insurer or by any insurance agent in connection with the sale or placement of credit insurance as an inducement thereto, shall constitute unfair methods of competition: (1) the offer or gran…

Retroactive adjustment of rates of premiums for group insurance policies based upon the loss or expense experience thereunder (experience refunds) may only be made in accordance with the terms of the group insurance policy and may be made only at the end of a policy year and may …

The effective date of this subchapter is October 1, 1980. Notes 28 Tex. Admin. Code § 3.6401 The provisions of this §3.6401 adopted to be effective October 1, 1980, 5 TexReg 2772.

Each cause of action, pending litigation, matter in process before the Texas Department of Insurance, or matter hereafter arising from an event occurring prior to the time the amendments to this subchapter became effective shall be determined in accordance with and governed by th…

If any provision of this subchapter or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect the other provisions or any other application of said sections which can be given effect without the invalid provisions or …

(a) Acceptance or rejection. (1) A filing received by the department which is in compliance with the requirements of this subchapter and § 7.1302 of this title (relating to Billing System) will be accepted and processed according to subsection (b) of this section. (2) A filing re…

(a) Scope and general standards. (1) Pursuant to Insurance Code § 425.072 , all individual and group accident and health insurance coverages, including single premium credit accident and health insurance contracts, issued on and after January 1, 2017, are required to follow the s…

(a) General. (1) Claim reserves are required for all incurred but unpaid claims on all health insurance policies. (2) Appropriate claim expense reserves are required with respect to the estimated expense of settlement of all incurred but unpaid claims. (3) All such reserves for p…