Texas Administrative Code

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…

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…

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…

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…

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…

(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…

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) 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…

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) 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…

(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) 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…

(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) 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…

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 …

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…

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.

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 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…

(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…

(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) 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) 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) 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) 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…

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) 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.…

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…

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 …

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…

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…

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…

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…

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 …

(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…

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 …

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 …

(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.…

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…

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…

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…

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…

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…

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…

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…

(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…

(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…