reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 7 - Life Insurance and Annuities › Subtitle C - Specialized Coverages › Chapter 1154 - Funding Agreements, Guaranteed Investment Contracts, and Synthetic Guaranteed Investment Contracts › Subchapter A. General Provisions › Section 1154.002. Purpose; Legislative Intent; Construction

Sec. 1154.002.  PURPOSE; LEGISLATIVE INTENT; CONSTRUCTION.  (a)  The purpose of this chapter is to:
(1)  promote the public welfare by regulating funding agreements, guaranteed investment contracts, and synthetic guaranteed investment contracts; and
(2)  clarify and codify the existing law pertaining to funding agreements, guaranteed investment contracts, and synthetic guaranteed investment contracts.
(b)  This chapter shall be liberally construed.
Added by Acts 2015, 84th Leg., R.S., Ch. 1187 (S.B. 1196), Sec. 2, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 7 - Life Insurance and Annuities › Subtitle C - Specialized Coverages › Chapter 1154 - Funding Agreements, Guaranteed Investment Contracts, and Synthetic Guaranteed Investment Contracts › Subchapter A. General Provisions › Section 1154.003. Definitions

Sec. 1154.003.  DEFINITIONS.  In this chapter:
(1)  "Annuity contract" means a contract, including a funding agreement, guaranteed investment contract, and synthetic guaranteed investment contract, issued by a life insurer, with or without a mortality or morbidity contingency, under which:
(A)  the owner deposits cash or assets in one or more installments with the life insurer; and
(B)  the owner or a beneficiary designated by the owner has a right to receive periodic payments for a specified future term.
(2)  "Funding agreement" means a type of annuity contract under which a life insurer:
(A)  accepts and accumulates funds, including noncash assets; and
(B)  makes one or more payments at a future date in amounts that are not based on mortality or morbidity contingencies.
(3)  "Governmental body" means a federal, state, municipal, local, or foreign court, tribunal, governmental department, commission, board, bureau, agency, authority, instrumentality, regulatory body, or quasi-regulatory body.
(4)  "Group" means a group to which a group life insurance policy may be issued under Subchapter B, Chapter 1131.
(5)  "Group annuity contract" means an annuity contract issued to a group and not an individual.
(6)  "Guaranteed investment contract" means a type of annuity contract issued by a life insurer:
(A)  that is a funding vehicle typically issued to a retirement plan; and
(B)  under which the life insurer accepts a deposit or series of deposits from the purchaser and guarantees to pay a specified interest rate of return on the funds deposited during a specified period.
(7)  "Life insurer" means an insurance company authorized to engage in the business of life insurance, including issuing annuity contracts, in this state.
(8)  "Synthetic guaranteed investment contract" means a group annuity contract or other agreement issued by a life insurer that, wholly or partly, establishes the life insurer's obligations by reference to a segregated portfolio of assets that the life insurer does not own.
Added by Acts 2015, 84th Leg., R.S., Ch. 1187 (S.B. 1196), Sec. 2, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 7 - Life Insurance and Annuities › Subtitle C - Specialized Coverages › Chapter 1154 - Funding Agreements, Guaranteed Investment Contracts, and Synthetic Guaranteed Investment Contracts › Subchapter A. General Provisions › Section 1154.004. Applicability of Certain Other Law

Sec. 1154.004.  APPLICABILITY OF CERTAIN OTHER LAW.  Chapters 521, 1107, 1115, and 1131 do not apply to funding agreements, guaranteed investment contracts, or synthetic guaranteed investment contracts without mortality or morbidity contingencies.
Added by Acts 2015, 84th Leg., R.S., Ch. 1187 (S.B. 1196), Sec. 2, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 7 - Life Insurance and Annuities › Subtitle C - Specialized Coverages › Chapter 1154 - Funding Agreements, Guaranteed Investment Contracts, and Synthetic Guaranteed Investment Contracts › Subchapter A. General Provisions › Section 1154.005. Rules

Sec. 1154.005.  RULES.  The commissioner may adopt rules to implement or clarify this chapter.
Added by Acts 2015, 84th Leg., R.S., Ch. 1187 (S.B. 1196), Sec. 2, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 7 - Life Insurance and Annuities › Subtitle C - Specialized Coverages › Chapter 1154 - Funding Agreements, Guaranteed Investment Contracts, and Synthetic Guaranteed Investment Contracts › Subchapter B. Funding Agreements › Section 1154.051. Establishment of Funding Agreements

Sec. 1154.051.  ESTABLISHMENT OF FUNDING AGREEMENTS.  (a)  A life insurer may issue a funding agreement to generate an income stream for the purchaser of the agreement or fund a future liability or program of the purchaser or the purchaser's designee.  A life insurer may issue a funding agreement to:
(1)  an accredited investor, as defined by 17 C.F.R. Section 230.501;
(2)  a governmental body; or
(3)  an institution with assets in excess of $25 million.
(b)  A life insurer that issues a funding agreement in this state engages in the business of insurance for the purpose of regulation.
Added by Acts 2015, 84th Leg., R.S., Ch. 1187 (S.B. 1196), Sec. 2, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 7 - Life Insurance and Annuities › Subtitle C - Specialized Coverages › Chapter 1154 - Funding Agreements, Guaranteed Investment Contracts, and Synthetic Guaranteed Investment Contracts › Subchapter C. Guaranteed Investment Contracts › Section 1154.101. Establishment of Guaranteed Investment Contracts

Sec. 1154.101.  ESTABLISHMENT OF GUARANTEED INVESTMENT CONTRACTS.  A life insurer may issue a guaranteed investment contract to provide a benefit in a fixed amount or a variable amount or a fixed amount and a variable amount.
Added by Acts 2015, 84th Leg., R.S., Ch. 1187 (S.B. 1196), Sec. 2, eff. September 1, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.001. Definitions

Sec. 1201.001.  DEFINITIONS.  In this chapter:
(1)  "Accident and health insurance policy" includes any policy or contract that provides insurance against loss resulting from:
(A)  accidental bodily injury;
(B)  accidental death;  or
(C)  sickness.
(2)  "Policy" means the entire contract between an insurer and an insured and includes riders, endorsements, and the application, if attached.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.002. Purpose

Sec. 1201.002.  PURPOSE.  The purpose of this chapter is to:
(1)  provide for reasonable standardization, readability, and simplification of terms and coverages in individual accident and health insurance policies;
(2)  promote public understanding of coverages;
(3)  eliminate provisions in individual accident and health insurance policies that may be unjust, unfair, misleading, or unreasonably confusing in connection with:
(A)  the purchase of coverage;  or
(B)  the settlement of claims;  and
(4)  provide for full and fair disclosure in sales of accident and health coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.003. Applicability of Chapter

Sec. 1201.003.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to an accident and health insurance policy delivered or issued for delivery in this state.
(b)  Except as otherwise provided by this chapter, this chapter applies only to an individual accident and health insurance policy delivered or issued for delivery by:
(1)  a life, health, and accident insurance company;
(2)  a mutual insurance company, including:
(A)  a mutual life insurance company;  and
(B)  a mutual assessment life insurance company;
(3)  a local mutual aid association;
(4)  a mutual or natural premium life or casualty insurance company;
(5)  a general casualty company;
(6)  a Lloyd's plan;
(7)  a reciprocal or interinsurance exchange;
(8)  a nonprofit hospital, medical, or dental service corporation, including a corporation operating under Chapter 842;  or
(9)  another insurer required by law to be authorized by the department.
(c)  This chapter applies to an accident and health insurance policy issued by a stipulated premium company subject to Chapter 884.
(d)  This chapter does not apply to:
(1)  any society, company, or other insurer whose activities are exempt by statute from the control of the department and that is entitled by statute to a certificate from the department that shows the entity's exempt status;
(2)  a credit accident and health insurance policy issued under Chapter 1153;
(3)  a workers' compensation insurance policy;
(4)  a liability insurance policy, with or without supplementary expense coverage;
(5)  a reinsurance policy or contract;
(6)  a blanket or group insurance policy, except as otherwise provided by this chapter;  or
(7)  a life insurance endowment or annuity contract or a contract supplemental to a life insurance endowment or annuity contract if the contract or supplemental contract contains only provisions relating to accident and health insurance that:
(A)  provide additional benefits in case of accidental death, accidental dismemberment, or accidental loss of sight;  or
(B)  operate to:
(i)  safeguard the contract or supplemental contract against lapse;  or
(ii)  give a special surrender value, a special benefit, or an annuity if the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract.
(e)  Subchapters C and D do not apply to a conversion policy issued under a contractual conversion privilege under a group accident and health insurance policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.004. Construction of Chapter

Sec. 1201.004.  CONSTRUCTION OF CHAPTER.  This chapter does not enlarge the powers of an entity listed in Section 1201.003.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.005. References to Chapter

Sec. 1201.005.  REFERENCES TO CHAPTER.  In this chapter, a reference to this chapter includes a reference to:
(1)  Section 1202.052;
(2)  Section 1271.005(a), to the extent that the subsection relates to the applicability of Section 1201.105, and Sections 1271.005(d) and (e);
(3)  Chapter 1351;
(4)  Subchapters C and E, Chapter 1355;
(5)  Chapter 1356;
(6)  Chapter 1365;
(7)  Subchapter A, Chapter 1367;  and
(8)  Subchapters A, B, and G, Chapter 1451.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.006. Rulemaking Authority

Sec. 1201.006.  RULEMAKING AUTHORITY.  The commissioner may adopt reasonable rules as necessary to implement the purposes and provisions of this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.007. Notice and Hearing

Sec. 1201.007.  NOTICE AND HEARING.  The commissioner may adopt a general rule or order relating to a matter covered by this chapter only after a hearing held after the 10th day following the date the department by mail notifies each insurer to which this chapter applies.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.008. Judicial Review

Sec. 1201.008.  JUDICIAL REVIEW.  An insurer that is dissatisfied with an order, act, rule, administrative ruling, or decision of the commissioner under this chapter may, after failing to get relief from the commissioner, file a petition seeking judicial review of the order, act, rule, ruling, or decision in accordance with Subchapter D, Chapter 36.  The action has precedence over all other causes on the docket of a different nature.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.009. Nonconforming Policy

Sec. 1201.009.  NONCONFORMING POLICY.  (a)  This chapter governs the rights, duties, and obligations of the insurer, the insured, and the beneficiary of an accident and health insurance policy regardless of a provision in the policy that conflicts with this chapter.
(b)  An accident and health insurance policy that violates this chapter is a valid policy, but the policy shall be construed in a manner to make the policy consistent with this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.010. Third-Party Ownership of Policy

Sec. 1201.010.  THIRD-PARTY OWNERSHIP OF POLICY.  The use of "insured" in this chapter does not prevent a person with an insurable interest, other than the insured, from:
(1)  applying for and owning an individual accident and health insurance policy covering the insured;  or
(2)  being entitled to an indemnity, right, or benefit provided for in an individual accident and health insurance policy covering the insured.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.011. Coverage for Premium Period With Limitations by Age or Date; Misstatement of Age of Insured

Sec. 1201.011.  COVERAGE FOR PREMIUM PERIOD WITH LIMITATIONS BY AGE OR DATE;  MISSTATEMENT OF AGE OF INSURED.  (a)  Regardless of a provision in an individual accident and health insurance policy that specifies a date, by age limitation or otherwise, after which coverage under the policy is not effective, coverage continues in force, subject to any right of cancellation, until the end of the period for which the insurer accepts a premium if:
(1)  the insurer accepts the premium after the specified date;  or
(2)  the specified date falls before the end of the period for which the insurer accepts the premium.
(b)  Notwithstanding Subsection (a), if the age of the insured is misstated and, because of the insured's correct age, coverage of the insured would not have become effective or would have terminated before the insurer's acceptance of a premium, the liability of the insurer is limited to the refund, on request, of the premiums paid for the period not covered by the policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.012. Defense of Claim

Sec. 1201.012.  DEFENSE OF CLAIM.  The following actions by an insurer do not operate as a waiver of the insurer's rights in defense of a claim that arises under an individual accident and health insurance policy:
(1)  acknowledgment of the receipt of notice given under the policy;
(2)  provision of a form for filing a proof of loss;
(3)  acceptance of a proof of loss;  or
(4)  investigation of a claim under the policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter A. General Provisions › Section 1201.013. Programs Promoting Disease Prevention, Wellness, and Health

Sec. 1201.013.  PROGRAMS PROMOTING DISEASE PREVENTION, WELLNESS, AND HEALTH.  (a)  An insurer issuing an accident and health insurance policy may establish premium discounts, rebates, or a reduction in otherwise applicable copayments, coinsurance, or deductibles, or any combination of these incentives, for an insured who participates in programs promoting disease prevention, wellness, and health.
(b)  A discount, rebate, or reduction established under this section does not violate Section 541.056(a).
Added by Acts 2007, 80th Leg., R.S., Ch. 112 (H.B. 2252), Sec. 2, eff. May 17, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.051. Entire Consideration

Sec. 1201.051.  ENTIRE CONSIDERATION.  An individual accident and health insurance policy must state the entire monetary and other consideration for the policy in the policy or in the application, if the application is made a part of the policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.052. Time of Effectiveness and Termination

Sec. 1201.052.  TIME OF EFFECTIVENESS AND TERMINATION.  An individual accident and health insurance policy must state the time the insurance takes effect and the time the insurance terminates.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.053. Persons Insured

Sec. 1201.053.  PERSONS INSURED.  (a)  Except as provided by this section, an individual accident and health insurance policy may not insure more than one individual.
(b)  On the application of an adult member of a family, an individual accident and health insurance policy may, at the time of original issuance or by subsequent amendment, insure two or more eligible members of the adult's family, including a spouse, unmarried children younger than 25 years of age, including a grandchild of the adult as described by Section 1201.062(a)(1), a child the adult is required to insure under a medical support order or dental support order, if the policy provides dental coverage, issued under Chapter 154, Family Code, or enforceable by a court in this state, and any other individual dependent on the adult.
(c)  The adult who applies for the individual accident and health insurance policy is considered the policyholder.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 56, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.054. Appearance of Text

Sec. 1201.054.  APPEARANCE OF TEXT.  (a)  In this section, "text" includes all printed matter of an individual accident and health insurance policy except:
(1)  the name and address of the insurer;
(2)  the name or title of the policy;
(3)  the brief description, if any;  and
(4)  captions and subcaptions.
(b)  An individual accident and health insurance policy must have:
(1)  a style, arrangement, or overall appearance that does not give undue prominence to any portion of the text;  and
(2)  every printed portion of its text and of any endorsements or attached papers printed plainly in a lightfaced type:
(A)  of a style in general use;  and
(B)  in a uniform size not less than 10-point with a lowercase unspaced alphabet length not less than 120-point.
(c)  Subsection (b)(2) does not apply to a copy of an application or identification card.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.055. Exceptions and Reductions of Indemnity

Sec. 1201.055.  EXCEPTIONS AND REDUCTIONS OF INDEMNITY.  (a)  An individual accident and health insurance policy must state each exception to or reduction of indemnity for the policy.
(b)  Except as provided by Subchapter E, each exception to or reduction of indemnity for the policy must be printed, at the insurer's option:
(1)  with the benefit provision to which the exception or reduction applies;  or
(2)  under an appropriate caption such as:
(A)  "Exceptions";  or
(B)  "Exceptions and Reductions."
(c)  Notwithstanding Subsection (b), if an exception or reduction specifically applies only to a particular benefit of an individual accident and health insurance policy, the statement of the exception or reduction must be included with the benefit provision to which the exception or reduction applies.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.056. Form Number

Sec. 1201.056.  FORM NUMBER.  Each form that constitutes a part of an individual accident and health insurance policy, including each rider or endorsement, must be identified by a form number placed in the lower left corner of the first page of the form.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.057. Incorporation of or Reference to Other Documents

Sec. 1201.057.  INCORPORATION OF OR REFERENCE TO OTHER DOCUMENTS.  (a)  An individual accident and health insurance policy that provides that a portion of the charter, rules, constitution, or bylaws of the insurer are a part of the policy must state that portion fully in the policy.
(b)  An individual accident and health insurance policy may incorporate or refer to:
(1)  a statement of rates or classification of risks;  or
(2)  a short-rate table filed with the department.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.058. Notification That Policy Is Returnable; Effect of Return

Sec. 1201.058.  NOTIFICATION THAT POLICY IS RETURNABLE;  EFFECT OF RETURN.  (a)  An individual accident and health insurance policy must include a notice that states in substance that the individual to whom the policy is issued is entitled to have the premium paid refunded if, after the individual examines the policy, the individual is not satisfied with the policy for any reason and returns the policy not later than the 10th day after the date the policy is delivered to the individual.
(b)  An individual accident and health insurance policy returned to the insurer at the insurer's home or branch office or to the agent through whom the policy was purchased within the time provided by the notice is void from the date the policy was issued, and the parties are in the same position as if the policy had not been issued.
(c)  The notice required by this section may be printed on the policy or attached to the policy.
(d)  This section does not apply to a single premium nonrenewable policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.059. Termination of Coverage Based on Age of Child in Individual, Blanket, or Group Policy

Sec. 1201.059.  TERMINATION OF COVERAGE BASED ON AGE OF CHILD IN INDIVIDUAL, BLANKET, OR GROUP POLICY.  (a)  An accident and health insurance policy, including an individual, blanket, or group policy, and including a policy issued by a corporation operating under Chapter 842, that provides that coverage of a child terminates when the child attains a limiting age specified in the policy must provide in substance that the child's attainment of that age does not terminate coverage while the child is:
(1)  incapable of self-sustaining employment because of an intellectual or physical disability; and
(2)  chiefly dependent on the insured or group member for support and maintenance.
(b)  To obtain coverage for a child as described by Subsection (a), the insured or group member must provide to the insurer proof of the child's incapacity and dependency:
(1)  not later than the 31st day after the date the child attains the limiting age;  and
(2)  subsequently as the insurer requires, except that the insurer may not require proof more frequently than annually after the second anniversary of the date the child attains the limiting age.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 30 (H.B. 446), Sec. 8.02, eff. September 1, 2023.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.060. Required Definition of "Emergency Care" in Individual or Group Policy

Sec. 1201.060.  REQUIRED DEFINITION OF "EMERGENCY CARE" IN INDIVIDUAL OR GROUP POLICY.  An individual or group accident and health insurance policy that provides an emergency care benefit, including a policy issued by a corporation operating under Chapter 842, must define "emergency care" as follows:
"Emergency care" means bona fide emergency services provided after the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in:
(1)  placing the patient's health in serious jeopardy;
(2)  serious impairment to bodily functions;  or
(3)  serious dysfunction of any bodily organ or part.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.0601. Required Definitions: Specified Disease Policy

Sec. 1201.0601.  REQUIRED DEFINITIONS:  SPECIFIED DISEASE POLICY.  An individual or group specified disease insurance policy that uses the term "actual charge" or "actual fee" must define the terms as follows:
"Actual charge" or "actual fee" means the amount actually paid by or on behalf of the insured and accepted by a provider for services provided.
Added by Acts 2005, 79th Leg., Ch. 974 (H.B. 1775), Sec. 1, eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.061. Coverage for Adopted Child

Sec. 1201.061.  COVERAGE FOR ADOPTED CHILD.  (a)  An individual accident and health insurance policy that provides coverage for an insured's immediate family or children may not, solely because the insured's child is adopted:
(1)  exclude the child from coverage;  or
(2)  limit coverage for the child.
(b)  For the purposes of this section, a child is an insured's child if the insured is a party to a suit in which the insured seeks to adopt the child.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.062. Coverage for Certain Children in Individual or Group Policy or in Plan or Program

Sec. 1201.062.  COVERAGE FOR CERTAIN CHILDREN IN INDIVIDUAL OR GROUP POLICY OR IN PLAN OR PROGRAM.  (a)  An individual or group accident and health insurance policy that is delivered, issued for delivery, or renewed in this state, including a policy issued by a corporation operating under Chapter 842, or a self-funded or self-insured welfare or benefit plan or program, to the extent that regulation of the plan or program is not preempted by federal law, that provides coverage for a child of an insured or group member, on payment of a premium, must provide coverage for:
(1)  each grandchild of the insured or group member if the grandchild is:
(A)  unmarried;
(B)  younger than 25 years of age; and
(C)  a dependent of the insured or group member for federal income tax purposes at the time application for coverage of the grandchild is made; and
(2)  each child for whom the insured or group member must provide medical support or dental support, if the policy provides dental coverage, under an order issued under Chapter 154, Family Code, or enforceable by a court in this state.
(b)  Coverage for a grandchild of the insured or group member may not be terminated solely because the grandchild is no longer a dependent of the insured or group member for federal income tax purposes.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 57, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.063. Prohibition of Certain Criteria Relating to Child's Coverage in Individual or Group Policy

Sec. 1201.063.  PROHIBITION OF CERTAIN CRITERIA RELATING TO CHILD'S COVERAGE IN INDIVIDUAL OR GROUP POLICY.  Regarding a natural or adopted child of an insured or group member or a child for whom the insured or group member must provide medical support or dental support, if the policy provides dental coverage, under an order issued under Chapter 154, Family Code, or enforceable by a court in this state, an individual or group accident and health insurance policy that provides coverage for a child of an insured or group member may not set a different premium for the child, exclude the child from coverage, or discontinue coverage of the child because:
(1)  the child does not reside with the insured or group member; or
(2)  the insured or group member does not claim the child as an exemption for federal income tax purposes under Section 151(c), Internal Revenue Code of 1986.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 58, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.064. Coverage for Child of Spouse in Individual or Group Policy

Sec. 1201.064.  COVERAGE FOR CHILD OF SPOUSE IN INDIVIDUAL OR GROUP POLICY.  An individual or group accident and health insurance policy that provides coverage for a child of an insured or group member may not:
(1)  set a premium for a child that is different from the premium for other children because the child is the natural or adopted child of the spouse of the insured or group member;
(2)  exclude a child described by Subdivision (1) from coverage;  or
(3)  discontinue coverage of a child described by Subdivision (1).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter B. Policy Terms › Section 1201.065. Age and School Enrollment Eligibility Criteria for Dependent Children in Individual or Group Policy; Late Enrollment

Sec. 1201.065.  AGE AND SCHOOL ENROLLMENT ELIGIBILITY CRITERIA FOR DEPENDENT CHILDREN IN INDIVIDUAL OR GROUP POLICY;  LATE ENROLLMENT.  (a)  An individual or group accident and health insurance policy may contain criteria relating to a maximum age or enrollment in school to establish continued eligibility for coverage of a child 25 years of age or older.
(b)  In the case of a late enrollment, an insurer may require evidence of insurability that is satisfactory to the insurer before a child is included for coverage under the policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.023(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.101. Standards for Policy Provisions

Sec. 1201.101.  STANDARDS FOR POLICY PROVISIONS.  (a)  The commissioner shall adopt reasonable rules establishing specific standards for:
(1)  the content of an individual accident and health insurance policy;  and
(2)  the manner of sale of an individual accident and health insurance policy, including disclosures required to be made in connection with the sale.
(b)  Rules adopted under this section must establish standards for:
(1)  policy readability;  and
(2)  full and fair policy disclosures.
(c)  Standards established under this section may include standards that address:
(1)  terms of policy renewability;
(2)  initial and subsequent conditions of eligibility;
(3)  nonduplication of coverage;
(4)  coverage of dependents;
(5)  preexisting conditions;
(6)  termination of insurance;
(7)  probationary periods;
(8)  limitations;
(9)  exceptions;
(10)  reductions;
(11)  elimination periods;
(12)  requirements for replacement;
(13)  recurrent conditions;  and
(14)  definitions of terms, including definitions of:
(A)  "accident";
(B)  "accidental means";
(C)  "guaranteed renewable and noncancellable";
(D)  "hospital";
(E)  "injury";
(F)  "nervous disorder";
(G)  "partial disability";
(H)  "physician";
(I)  "sickness";  and
(J)  "total disability."
(d)  A definition of "hospital" adopted under Subsection (c) may not apply to a corporation operating under Chapter 842.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.102. Prohibition of Policy Provisions

Sec. 1201.102.  PROHIBITION OF POLICY PROVISIONS.  The commissioner may adopt rules prohibiting specific individual accident and health insurance policy provisions not specifically authorized by statute that the commissioner determines are unjust, unfair, or unfairly discriminatory to:
(1)  the policyholder;
(2)  an insured under the policy;  or
(3)  a beneficiary.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.103. Compliance With Minimum Standards for Benefits

Sec. 1201.103.  COMPLIANCE WITH MINIMUM STANDARDS FOR BENEFITS.  (a)  An individual accident and health insurance policy must meet the minimum standards for benefits established under Section 1201.104 for each category of coverage provided under the policy.
(b)  Subsection (a) does not apply if the commissioner determines that the policy is a supplemental policy or experimental policy or determines that the policy will fulfill a reasonable public need and the policy meets the requirements of Chapter 1701.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.104. Minimum Standards for Benefits

Sec. 1201.104.  MINIMUM STANDARDS FOR BENEFITS.  (a)  For individual accident and health insurance policies, the commissioner shall adopt rules establishing minimum standards for benefits under each of the following categories of coverage:
(1)  basic hospital expense;
(2)  basic medical-surgical expense;
(3)  hospital indemnity or other fixed indemnity;
(4)  major medical expense;
(5)  disability income protection;
(6)  accident only;
(7)  specified disease;
(8)  specified accident; and
(9)  limited benefit.
(b)  This section does not prohibit the issuance of an individual accident and health insurance policy that combines categories of coverage listed by this section.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 25 (S.B. 979), Sec. 1, eff. May 15, 2015.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.105. Minimum Standards for Benefits for Long-Term Care in Individual, Group, or Blanket Policy

Sec. 1201.105.  MINIMUM STANDARDS FOR BENEFITS FOR LONG-TERM CARE IN INDIVIDUAL, GROUP, OR BLANKET POLICY.  (a)  The commissioner shall adopt rules establishing minimum standards for benefits for long-term care coverage under individual, group, and blanket accident and health insurance policies and certificates delivered or issued for delivery in this state.
(b)  Rules adopted under this section apply to group coverages delivered or issued for delivery by a corporation operating under Chapter 842.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.106. Identification of Policies According to Coverage Provided

Sec. 1201.106.  IDENTIFICATION OF POLICIES ACCORDING TO COVERAGE PROVIDED.  The commissioner shall prescribe the method to identify an individual accident and health insurance policy according to the coverages the policy provides.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.107. Outline of Coverage Required

Sec. 1201.107.  OUTLINE OF COVERAGE REQUIRED.  (a)  An outline of coverage for an individual accident and health insurance policy must be delivered to the applicant at the time application is made, and an acknowledgment of receipt or certificate of delivery of an outline of coverage must be provided to the insurer with the application.
(b)  If the policy issued differs from the policy for which the applicant applied, an outline of coverage that properly describes the policy must:
(1)  accompany the policy when delivered;  and
(2)  clearly state that the policy is not the policy for which the applicant applied.
(c)  Subsection (a) does not apply to a direct response insurance product.
(d)  An outline of coverage under a direct response insurance product must accompany the policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.108. Format and Content of Outline of Coverage

Sec. 1201.108.  FORMAT AND CONTENT OF OUTLINE OF COVERAGE.  (a)  In this section, "format" means style, arrangement, and overall appearance, including:
(1)  the size, color, and prominence of type;  and
(2)  the arrangement of text and captions.
(b)  The commissioner shall prescribe the format and content of an outline of coverage required by Section 1201.107.
(c)  An outline of coverage must include:
(1)  a statement that identifies the applicable categories of coverage listed by Section 1201.104 and provided by the policy;
(2)  a description of the principal benefits and coverage provided by the policy;
(3)  a statement of the exceptions, reductions, and limitations in the policy;
(4)  a statement of the renewal provision, including any reservation of the insurer's right to change premiums;
(5)  a statement that:
(A)  the outline is a summary of the policy issued or applied for;  and
(B)  the policy should be consulted to determine governing contractual provisions;
(6)  as the commissioner determines necessary to carry out the purposes of this chapter, a summary of the provisions required by Subchapter E to be in the policy;  and
(7)  any other statement, description, or outline that the commissioner determines is reasonably necessary to carry out the purposes of this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter C. General Policy Standards and Provisions › Section 1201.109. Notice of Rate Increase for Major Medical Expense Insurance Policy

Sec. 1201.109.  NOTICE OF RATE INCREASE FOR MAJOR MEDICAL EXPENSE INSURANCE POLICY.  (a)  Not less than 60 days before the date on which a premium rate increase takes effect on an individual accident and health insurance policy that provides major medical expense coverage and that is delivered or issued for delivery in this state by an insurer, the insurer shall:
(1)  give written notice to the insured of the effective date of the increase; and
(2)  provide the insured a table that clearly lists:
(A)  the actual dollar amount of the premium on the date of the notice;
(B)  the actual dollar amount of the premium after the premium rate increase; and
(C)  the percentage change between the amounts described by Paragraphs (A) and (B).
(b)  The notice required by this section must be based on coverage in effect on the date of the notice.
(c)  This section may not be construed to prevent an insurer, at the request of an insured, from negotiating a change in benefits or rates after delivery of the notice required by this section.
(d)  An insurer may not require an insured entitled to notice under this section to respond to the insurer to renew the policy or take other action relating to the renewal or extension of the policy before the 45th day after the date the notice described by Subsection (a) is given.
(e)  The notice required by this section must include:
(1)  contact information for the department, including information concerning how to file a complaint with the department;
(2)  contact information for the Texas Consumer Health Assistance Program, including information concerning how to request from the program consumer protection information or assistance with filing a complaint; and
(3)  the addresses of Internet websites that provide consumer information related to rate increase justifications, including the websites of the department and the United States Department of Health and Human Services.
(f)  For purposes of this section, "major medical expense coverage" means an individual major medical expense insurance policy to which this chapter applies under Section 1201.003 that constitutes creditable coverage under Section 1205.004.
Added by Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 3.002, eff. September 1, 2011.
Amended by:
Acts 2013, 83rd Leg., R.S., Ch. 454 (S.B. 853), Sec. 1, eff. June 14, 2013.
Acts 2013, 83rd Leg., R.S., Ch. 454 (S.B. 853), Sec. 2, eff. June 14, 2013.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter D. Preexisting Conditions › Section 1201.151. Compliance With Subchapter; Prohibition of Defense

Sec. 1201.151.  COMPLIANCE WITH SUBCHAPTER;  PROHIBITION OF DEFENSE.  Except as provided by this subchapter, an individual accident and health insurance policy may not include a provision that permits a defense based on a preexisting condition.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle A - Health Coverage in General › Chapter 1201 - Accident and Health Insurance › Subchapter D. Preexisting Conditions › Section 1201.152. Coverage Under Simplified Application Form

Sec. 1201.152.  COVERAGE UNDER SIMPLIFIED APPLICATION FORM.  (a)  Notwithstanding Clause (b) of the provision required by Section 1201.208(a), an individual accident and health insurance policy must cover any loss that occurs after 12 months from a preexisting condition if the insurer uses a simplified application form that does not include a question concerning the applicant's health history or medical treatment history.
(b)  This section applies regardless of whether the simplified application form includes a question regarding the applicant's health at the time of application.
(c)  This section does not require an insurer to cover a loss from a condition that the policy specifically excludes from coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.