TAX ADMINISTRATION

(a) General. (1) Unearned premium reserves are required for all contracts with respect to the period of coverage for which premiums, other than premiums paid in advance, have been paid beyond the date of valuation. (2) Single premium credit accident and health insurance, both ind…

(a) General. (1) Contract reserves are required, unless otherwise specified in paragraph (2) of this subsection, for: (A) all individual and group contracts with which level premiums are used; or (B) all individual and group contracts with respect to which, due to the gross premi…

Increases to, or credits against reserves carried, arising because of reinsurance assumed or reinsurance ceded, must be determined in a manner consistent with these minimum reserve standards and with all applicable provisions of the reinsurance contracts which affect the insurer'…

(a) Morbidity. (1) Minimum morbidity standards for valuation of specified individual contract health insurance benefits are as follows. (A) Disability income benefits due to accident or sickness. (i) Contract reserves. (I) Contracts issued on or after January 1, 1965, and prior t…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Annual-claim cost--The net annual cost per unit of benefit before the addition of expenses, including claim settlement expenses, and…

(a) This section contains supplementary explanatory material. (b) Waiver of premium reserves involve several special considerations. First, the disability valuation tables promulgated by the National Association of Insurance Commissioners are based on exposures that include contr…

Notwithstanding any other provision of these sections, including § 3.7004 of this title (relating to Contract Reserves), any company licensed in Texas purchasing or assuming by assumption certificate any existing business on or after the effective date of these rules must establi…

These sections are promulgated to regulate individual and group variable annuity contracts and certificates delivered or issued for delivery in this state, on and after the effective date of these sections. Notes 28 Tex. Admin. Code § 3.701 The provisions of this §3.701 adopted t…

If any provision of §§ 3.7001 - 3.7009 of this title (relating to Introduction; Claim Reserves; Premium Reserves; Contract Reserves; Reinsurance; Specific Standards for Morbidity, Interest, and Mortality; Glossary of Technical Terms Used; Reserves for Waiver of Premium; and Purch…

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. (1) Agent--Any person, corporation, partnership, or other legal entity which is licensed as a life insurance agent. (2) Commissioner--The comm…

The following requirements are applicable to all insurers either seeking authority to issue variable annuities in this state or having the authority to issue variable annuity products in this state. (1) Licensing and approval to do business in this state. An insurer shall not del…

(a) Establishment of separate account. Any domestic life insurance company issuing variable annuity contracts must establish one or more separate accounts pursuant to Insurance Code Chapter 1152. (1) If no law or other regulation provides for the custody of separate account asset…

Variable annuity contracts must conform to the requirements of this section in order to obtain the commissioner's approval. (1) Filing of variable annuity contracts. All variable annuity contracts, all riders, endorsements, applications, and other documents which are attached to …

If any provision of these sections or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of these sections and the application of such provision to other persons or circumstances shall not be affected thereby. Notes 28 Tex. A…

The provisions of these sections shall apply to any form received by the department on or after June 1, 2003. Forms received by this department prior to June 1, 2003 shall be governed by the laws in effect at the time of the submission. Notes 28 Tex. Admin. Code § 3.8 The provisi…

(a) Purpose. This section implements Insurance Code § 1368.007 , concerning Treatment Standards. (b) Applicability. This section applies to a group health benefit plan that is subject to Insurance Code Chapter 1368, concerning Availability of Chemical Dependency Coverage. (c) Tre…

These sections are promulgated to regulate individual variable life insurance contracts issued or delivered for issue in this state, on and after the effective date of these sections. Notes 28 Tex. Admin. Code § 3.801 The provisions of this §3.801 adopted to be effective June 5, …

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise. (1) Affiliate of an insurer--Any person, directly or indirectly, controlling, controlled by, or under common control with such insurer; any pe…

The following requirements are applicable to all insurers either seeking authority to issue variable life insurance in this state or having the authority to issue variable life insurance in this state. (1) Licensing and approval to do business in this state. An insurer may not de…

The commissioner will not approve any variable life insurance form filed pursuant to these rules unless it conforms to the requirement of applicable law. (1) Filing of variable life contracts. All variable life contracts, and all riders, endorsements, applications, and other docu…

(a) Reserve liabilities for variable life insurance contracts must be established under Insurance Code Chapter 425, Subchapter B, in accordance with actuarial procedures that recognize the variable nature of the benefits provided and any mortality guarantees. (b) For scheduled pr…

The following requirements apply to the establishment and administration of variable life insurance separate accounts by any domestic insurer. (1) Establishment of separate accounts. Any domestic life insurance company issuing variable life contracts must establish one or more se…

An insurer delivering or issuing for delivery in this state any variable life insurance contracts shall deliver to the applicant for such contract, and obtain a written acknowledgment of receipt from such applicant coincident with or prior to the execution of the application, the…

The application for a variable life contract shall contain: (1) a prominent statement that the death benefit may be variable or fixed under specified conditions; (2) a prominent statement that cash values may increase or decrease in accordance with the experience of the separate …

Any insurer delivering or issuing for delivery in this state any variable life contracts shall mail to each variable life insurance contractholder at his or her last known address the following reports. (1) Within 30 days after each anniversary of the contract, a statement or sta…

If any provision of §§ 3.801 - 3.811 of this title (relating to Variable Life Insurance) or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the sections and the application of such provision to other persons or circumst…

Each cause of action, pending litigation, or matter in process before the Texas Department of Insurance or commissioner of insurance will be determined in accordance with and governed by the applicable statutes, rules, orders, or interpretations of the Texas Department of Insuran…

(a) Occupations Code § 651.159 mandates the Texas Department of Insurance, the Texas Funeral Service Commission, and the Texas Department of Banking to adopt by rule a joint memorandum of understanding relating to prepaid funeral services and transactions that: (1) outlines the r…

(a) Pursuant to Occupations Code § 651.159 the Texas Funeral Service Commission (TFSC), the Texas Department of Insurance (TDI), and the Texas Department of Banking (DOB) adopt the following joint memorandum of understanding (JMOU) relating to prepaid funeral benefits as defined …

The purpose of this subchapter is to address the reinstatement requirements for individual life policies that lapse due to the mental incapacity of the insured under certain conditions as prescribed in this subchapter. Notes 28 Tex. Admin. Code § 3.901 The provisions of this §3.9…

This subchapter applies to all individual life policies which do not provide nonforfeiture benefits issued to Texas residents by insurers licensed in this state, including stipulated premium companies and fraternal benefit societies, which lapse due to the mental incapacity of th…

Where any term or section of this subchapter is determined by a court of competent jurisdiction to be inconsistent with the statutes of this state or to be unconstitutional, the remaining terms and provisions of this subchapter shall remain in effect. Notes 28 Tex. Admin. Code § …

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) Commissioner--The Commissioner of Insurance. (2) Department--The Texas Department of Insurance. (3) Insured--The person whose life i…

An eligible policy that is subject to this subchapter shall be reinstated, without evidence of insurability, on payment of past due premiums and interest if it meets the requirements set forth in paragraphs (1)-(4) of this subsection: (1) it has been in force continuously for at …

The insurer may require, as a condition of reinstatement, payment of past due premiums, plus interest at a rate not to exceed 6.0% per annum. Notes 28 Tex. Admin. Code § 3.906 The provisions of this §3.906 adopted to be effective January 10, 1996, 20 TexReg 11121.

Upon reinstatement, the policy will continue in force as though it had not lapsed. Notes 28 Tex. Admin. Code § 3.907 The provisions of this §3.907 adopted to be effective January 10, 1996, 20 TexReg 11121.

An insurer is not required to reinstate coverage or pay benefits under this subchapter if the insured first became mentally incapacitated after the expiration of the grace period contained in the policy. Notes 28 Tex. Admin. Code § 3.908 The provisions of this §3.908 adopted to b…

(a) The insurer is required to send notice of the conditions set forth in this subchapter under which the policy may qualify for reinstatement due to the mental incapacity of the insured. The notice must be sent to the owner of any individual life policy which does not provide no…

(a) The insurer shall accept a request for reinstatement and proof of mental incapacity that is filed by: (1) the insured, or the owner, if the insured and owner are not the same party; (2) the legal guardian of the insured; (3) other legal representative of the insured; or (4) t…

The purpose of this subchapter is to recognize, permit, and prescribe the use of the 2001 Commissioners Standard Ordinary (CSO) Mortality Table in accordance with Insurance Code § 425.058(c)(3) and § 1105.055(h) and § 3.4505 of this title (relating to General Calculation Requirem…

The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise. (1) 2001 CSO Mortality Table--mortality tables, consisting of separate rates of mortality for male and female lives, developed by the Am…

(a) At the election of the company for any one or more specified plans of insurance and subject to the conditions stated in this subchapter, the 2001 CSO Mortality Table may be used as the minimum standard for policies issued on or after May 1, 2003, and before the date specified…

(a) For each plan of insurance with separate rates for smokers and nonsmokers, an insurer may use: (1) Composite mortality tables to determine minimum reserve liabilities and minimum cash surrender values and amounts of paid-up nonforfeiture benefits; (2) Smoker and nonsmoker mor…

(a) The 2001 CSO Mortality Table may be used in applying Chapter 3, Subchapter EE of this title (relating to Valuation of Life Insurance Policies) in the following manner, subject to the transition dates for use of the 2001 CSO Mortality Table in § 3.9103 of this title (relating …

(a) For any ordinary life insurance policy delivered or issued for delivery in this state on and after May 1, 2003, that utilizes the same premium rates and charges for male and female lives or is issued in circumstances where applicable law does not permit distinctions on the ba…

The insurer shall pay the death benefit under an eligible policy if the insured dies within one year of the date of lapse and the requirements for submitting proof of mental incapacity and request for reinstatement are met. The insurer shall reduce the death benefit under a polic…

(a) For all new forms subject to this subchapter filed on or after September 1, 1995, the insurer must include with the form filing written notification to the department specifying the method of notification as set forth in § 3.909 of this title (relating to Notification and Dis…

(a) If the elected method of compliance is notification to all existing policyholders as described in § 3.902 (a)(2) of this title (relating to Notification and Disclosure Requirements), the notice required by this subchapter shall be provided in the following manner: Attached Gr…

This subchapter applies to an exclusive provider benefit plan (EPP) written by an issuer which has contracted with the Health and Human Services Commission (HHSC) to provide services under the Texas Children's Health Insurance Program (CHIP), Medicaid or with the Statewide Rural …

The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise: (1) Adverse determination--A determination by a utilization review agent that the health care services furnished or proposed to be furnished t…