reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter QQ - PROVIDER NETWORK CONTRACT REGISTRATION › Section 3.9801 - Definitions and General Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a) Terms
				  in this subchapter have the same meaning as defined and used in Insurance Code
				  Chapter 1458.
(b) The following
				  words and terms when used in this subchapter have the following meanings unless
				  the context clearly indicates otherwise:
(1)
				  Affiliate--Includes each person that is an affiliate under Insurance Code
				  Chapter 823.
(2) Fee
				  schedule--Includes payment or reimbursement terms of the provider network
				  contract.
(3) Primary provider
				  network--A provider network in which the contracting entity submitting the form
				  is the contracting entity for the provider network.
(4) Other provider network--A provider
				  network that may be accessed by the contracting entity submitting the form or
				  the submitting entity's affiliate, but in which the contracting entity for the
				  provider network is not an affiliate of the entity submitting the
				  form.
(5) Subsidiary provider
				  network--A provider network in which the contracting entity or entities for the
				  provider network are an affiliate of the entity submitting the form, except for
				  provider networks that also qualify as a primary provider network.
(6) TDI--Texas Department of
				  Insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter QQ - PROVIDER NETWORK CONTRACT REGISTRATION › Section 3.9802 - Provider Network Contracting Entity Registration Form Filing Required

Current through Reg. 49, No. 28; July 12, 2024
(a) TDI adopts the Provider Network
				  Contracting Entity Registration Form by reference.
(b) Except as provided in subsection (c) of
				  this section, each person operating as a contracting entity must submit to TDI
				  a fully completed Provider Network Contracting Entity Registration Form with
				  the required fee established under §
										3.9804
				  of this title before the later of:
(1) the
				  30th day after the date on which the person begins acting as a contracting
				  entity in this state; or
(2)
				  December 1, 2014.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter QQ - PROVIDER NETWORK CONTRACT REGISTRATION › Section 3.9803 - Provider Network Contracting Entity Exemption of Affiliates Form Filing Required

Current through Reg. 49, No. 28; July 12, 2024
(a) TDI adopts the Provider Network
				  Contracting Entity Exemption of Affiliates Form by reference.
(b) Unless the commissioner has granted an
				  affiliate exemption to the contracting entity under this section, each
				  contracting entity that is a health maintenance organization or other entity
				  holding a certificate of authority issued by TDI to engage in the business of
				  insurance in this state must submit to TDI a fully completed Provider Network
				  Contracting Entity Exemption of Affiliates Form and the required fee
				  established under §
										3.9804
				  of this title before the later of:
(1) the
				  30th day after the date on which the submitting person begins acting as a
				  contracting entity in this state; or
(2) December 1, 2014.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter QQ - PROVIDER NETWORK CONTRACT REGISTRATION › Section 3.9804 - Required Fees

Current through Reg. 49, No. 28; July 12, 2024
(a) A Provider
				  Network Contracting Entity Registration Form under §
										3.9802
				  of this title or a Provider Network Contracting Entity Exemption of Affiliates
				  Form under §
										3.9803
				  of this title must be accompanied by the required fee of $1,000.
(b) No fee is required for submitting a
				  change in information under §
										3.9802
				  of this title or the annual registration update under §
										3.9803
				  of this title.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter QQ - PROVIDER NETWORK CONTRACT REGISTRATION › Section 3.9805 - Express Authority

Current through Reg. 49, No. 28; July 12, 2024
(a) Except as
				  provided in subsection (c) of this section, the grant of express authority of a
				  provider for access to their fee schedules cannot be presumed for any line of
				  business for the purposes of compliance with Insurance Code §
										1458.101.
(b) The contracting entity must notify the
				  provider about all applicable fee schedules, but such notification is not to
				  be, and must not be, construed as:
(1)
				  prohibiting a provider network contracting entity from only contracting with
				  providers who agree to all fee schedules; or
(2) requiring providers to agree to all fee
				  schedules.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter RR - VALUATION MANUAL › Section 3.9901 - Valuation Manual

Current through Reg. 49, No. 28; July 12, 2024
(a) The
				  Commissioner adopts by reference the National Association of Insurance
				  Commissioners (NAIC) Valuation Manual, including subsequent changes that were
				  adopted by the NAIC through August 16, 2023, as required by Insurance Code
				  §
										425.073.
(b) The operative date of the NAIC Valuation
				  Manual in Texas is January 1, 2017.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter RR - VALUATION MANUAL › Section 3.9902 - Single State Company Exemptions

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Single state company. A single state company is a domestic company that is
				  licensed and doing business only in this state. A domestic company is doing
				  business only in this state if the company does not have direct or assumed
				  risks for policies issued outside of this state.
(b) Single state exemption. The commissioner
				  may grant a single state company a single state exemption from the NAIC
				  Valuation Manual principle-based valuation requirements for specific product
				  forms or product lines. This exemption is a single state exemption.
(1) To request approval for a single state
				  exemption, a company must submit a written request to TDI and include detailed
				  information regarding the request for the exemption. The request should
				  identify the product forms or product lines proposed for the single state
				  exemption. An exemption is not considered approved until written approval is
				  issued by the commissioner or his designee.
(2) A single state company granted a single
				  state exemption must compute reserves using the assumptions and methods that it
				  used before January 1, 2017. Single state company business exempted by the
				  commissioner with a single state exemption must be reserved with assumptions
				  and methods required by the NAIC Valuation Manual other than the
				  principle-based valuation requirements.
(3) A single state company granted a single
				  state exemption must comply with all other requirements of the NAIC Valuation
				  Manual, including the actuarial opinion and memorandum requirements of the NAIC
				  Valuation Manual.
(4) The
				  commissioner may revoke a single state exemption by revoking the exemption in
				  writing if the reserving methods and assumptions do not adequately reflect the
				  company's risks or if the company no longer qualifies for the exemption under
				  Insurance Code § 425.077. A single state exemption may also be revoked if
				  the commissioner determines that the NAIC Valuation Manual principle-based
				  reserving would be more appropriate for protection of Texas policyholders and
				  industry.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter C - CONSUMER NOTICES FOR LIFE INSURANCE POLICY AND ANNUITY CONTRACT REPLACEMENTS › Section 4.201 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of this subchapter is to specify the content
					 and procedural requirements for consumer notices for life insurance policy and
					 annuity contract replacements as required by Insurance Code §
										1114.006, concerning
					 Consumer Notice Documents.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter C - CONSUMER NOTICES FOR LIFE INSURANCE POLICY AND ANNUITY CONTRACT REPLACEMENTS › Section 4.202 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
When used in this subchapter, the words "agent" and
					 "producer" mean, unless the context clearly indicates otherwise, an individual
					 who holds a license under Insurance Code Chapter 4054, concerning Life,
					 Accident, and Health Agents, and who sells, solicits, or negotiates life
					 insurance or annuities in this state.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter C - CONSUMER NOTICES FOR LIFE INSURANCE POLICY AND ANNUITY CONTRACT REPLACEMENTS › Section 4.203 - Consumer Notice Content and Format Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) The text contained in Figure: 28 TAC
				  §
										4.204(b), Figure:
				  28 TAC §
										4.205(1), and
				  Figure: 28 TAC §
										4.205(2) must be
				  in at least 10-point type and presented in the same order as indicated in each
				  figure and without any change to the specified text, including bolding effects,
				  except as provided in subsections (b), (c), and (d) of this section.
(b) Under §
										4.206 of this title (relating to
				  Filing Procedures for Substantially Similar Consumer Notices), in lieu of using
				  the notices contained in Figure: 28 TAC §
										4.204(b) or
				  Figure: 28 TAC §
										4.205(1), an
				  insurer may file a notice with the department that is substantially similar to
				  the text contained in Figure: 28 TAC §
										4.204(b) or
				  Figure: 28 TAC §
										4.205(1) for
				  review and approval by the commissioner. The commissioner will approve the
				  notice if, in the commissioner's opinion, the notice protects the rights and
				  interests of applicants to at least the same extent as the notices adopted in
				  Figure: 28 TAC §
										4.204(b) or
				  Figure: 28 TAC §
										4.205(1). An
				  insurer required to send the notice specified in Figure: 28 TAC §
										4.205(2) may not
				  file a notice that is substantially similar to that figure for review and
				  approval by the commissioner.
(c)
				  Commissioner approval of a notice is not required if a notice promulgated or
				  approved under this subchapter is used and amendments to that notice are
				  limited to the omission of references not applicable to the product being sold
				  or replaced. For purposes of this subchapter, a reference in any notice
				  required under this subchapter to a product that is being sold or replaced is
				  applicable if the reference could be applicable under any possible
				  circumstances and therefore may not be omitted from the required
				  notice.
(d) An insurer may add a
				  company name and identifying form number to notices specified under this
				  subchapter without obtaining commissioner approval.
(e) The promulgated forms specified in this
				  subchapter are available upon request from the Life and Health Division, Life
				  and Health Lines, MC: LH-LHL, Texas Department of Insurance, P.O. Box 12030,
				  Austin, Texas 78711-2030, or by accessing the department website at
www.tdi.texas.gov/forms
.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter C - CONSUMER NOTICES FOR LIFE INSURANCE POLICY AND ANNUITY CONTRACT REPLACEMENTS › Section 4.204 - Consumer Notice Regarding Replacement for Insurers Using Agents

Current through Reg. 49, No. 28; July 12, 2024
(a) An agent who initiates an application for
				  a life insurance policy or annuity contract must submit to the insurer, with or
				  as part of the application, a statement signed by both the applicant and the
				  agent as to whether the applicant has existing life insurance policies or
				  annuity contracts.
(b) If the
				  applicant states that the applicant does have existing policies or contracts,
				  the agent must present and read to the applicant, not later than at the time of
				  taking the application, a notice regarding replacement that contains the text
				  contained in Figure: 28 TAC §
										4.204(b), or
				  substantially similar notice filed with the department and approved under this
				  subchapter. The notice must be signed by both the applicant and the agent
				  attesting that the notice has been read aloud by the agent or that the
				  applicant did not wish the notice to be read aloud, in which case the agent is
				  not required to read the notice aloud.
Attached Graphic
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter C - CONSUMER NOTICES FOR LIFE INSURANCE POLICY AND ANNUITY CONTRACT REPLACEMENTS › Section 4.205 - Direct Response Consumer Notices

Current through Reg. 49, No. 28; July 12, 2024
In the case of a life insurance or annuity application
					 initiated as a result of a direct response solicitation, the insurer must
					 inquire whether the applicant, by applying for the proposed policy or contract,
					 intends to replace, discontinue, or change an existing life insurance policy or
					 annuity contract. The inquiry may be included with, or submitted as a part of,
					 each completed application for such policy or contract.
(1) If the insurer has proposed the
				  replacement or if the applicant indicates a replacement is intended and the
				  insurer continues with the replacement, the insurer must send a notice that
				  contains the text in Figure: 28 TAC §
										4.205(1), or a
				  substantially similar notice filed with the department and approved under this
				  subchapter.
Attached Graphic
(2) If the applicant indicates a
				  replacement or change is not intended or if the applicant fails to respond to
				  the statement, the insurer must send the applicant, with the policy or
				  contract, a new policy or contract notice that contains the statements in
				  Figure: 28 TAC §
										4.205(2).
Attached Graphic
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter C - CONSUMER NOTICES FOR LIFE INSURANCE POLICY AND ANNUITY CONTRACT REPLACEMENTS › Section 4.206 - Filing Procedures for Substantially Similar Consumer Notices

Current through Reg. 49, No. 28; July 12, 2024
(a) An insurer may not use, issue, or deliver
				  a notice that is substantially similar to a promulgated consumer notice
				  specified in Figure: 28 TAC §
										4.204(b) or
				  Figure: 28 TAC §
										4.205(1) until it
				  has been approved.
(1) An insurer subject to
				  Insurance Code Chapter 1114, concerning Replacement of Certain Life Insurance
				  Policies and Annuities, using agents must either use the text of the notice
				  contained in Figure: 28 TAC §
											4.204(b), which
				  is not subject to filing and approval, or a consumer notice substantially
				  similar to the text contained in Figure: 28 TAC §
											4.204(b), which
				  has been filed under this section and approved.
(2) In the case of an applicant responding to
				  a direct response solicitation, an insurer subject to Insurance Code Chapter
				  1114 must either use the text contained in Figure: 28 TAC §
											4.205(1), which
				  is not subject to filing and approval, or a consumer notice substantially
				  similar to the text contained in Figure: 28 TAC §
											4.205(1), which
				  has been filed under this section and approved.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.601 - Payment of Premiums

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  provide that premiums are payable in advance. The policy may provide that the
				  premium is payable at the home office; it may provide that the premium is
				  payable to an agent of the company; or it may provide that the premium is
				  payable at the home office of the company or to an agent of the
				  company.
(b) The policy must
				  provide that a receipt signed by one or more of the officers of the company
				  will be delivered upon payment of the premium. The policy must designate the
				  officers who may sign the receipt. Any manner of "designation" is acceptable if
				  it will enable the policyholder to determine that the receipt has been signed
				  by an authorized person.
(c) A
				  policy that permits a change in the manner of payment of premium (e.g., from
				  annual to semiannual, quarterly, etc.):
(1)
				  may either specify the amount of premiums required for the periods authorized
				  or the formula for the determination of such premiums; or
(2) may define the amounts by appropriate
				  reference to rates being charged at the date of issue.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.602 - Grace Period

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  provide for a grace period of at least one month for the payment of every
				  premium after the first, during which period the policy must remain in full
				  force and effect. If the grace period is expressed in days, at least 31 days of
				  grace must be granted.
(b) The
				  policy may provide for an interest charge on the unpaid premium during the
				  grace period. If an interest charge is provided for, the interest rate must be
				  specified.
(c) The policy may
				  stipulate that if the insured should die during the grace period, the overdue
				  premium or overdue installment will be deducted from any settlement under the
				  policy. If an interest charge is provided against the overdue payment, the
				  accrued interest may also be deducted.
(d) This section is not applicable to single
				  premium policies.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.603 - Entire Contract

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  provide that the policy, or policy and application, constitute the entire
				  contract between the parties. Regardless of any statement to the contrary, the
				  policy will be deemed incomplete if it attempts to incorporate by reference the
				  provisions of any instrument that changes or adds to the terms of the
				  policy.
(b) Some policy forms
				  contain a provision that the application, if attached, constitute a part of the
				  contract. If a policy containing such a provision is submitted without the
				  application, the approval will authorize its issuance only without the
				  application.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.604 - Incontestable Clause

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  provide that it will be incontestable not later than two years from its date as
				  provided in Insurance Code §
										1101.006, concerning
				  Incontestability. If a reinstatement is contested for misrepresentation, then
				  no representation other than one causing the reinstatement may be used to
				  contest the policy. Any contest of the reinstatement may be for a material and
				  fraudulent misrepresentation only and reinstatement may not be contested more
				  than two years after it is effectuated, provided that this provision does not
				  affect the company's right to contest a policy for a representation respecting
				  the initial policy issuance or a different reinstatement during the
				  incontestable period applicable to such issuance or reinstatement. Accidental
				  death benefits and disability benefits need not be subject to such
				  provision.
(b) Any provision that
				  could lengthen the contestable period of a policy beyond two years from its
				  date is prohibited. For example, the policy may not state that it is
				  incontestable after two years "while the policy is continuously in
				  force."
(c) The policy may contain
				  provisions that allow its validity to be contested at any time for:
(1) nonpayment of premium; or
(2) violation of the conditions of the policy
				  relating to naval or military services in time of war. Note: War clauses are
				  discussed in §
											4.621(e) of this
				  title (relating to Settlement at Maturity).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.605 - Statements of the Insured

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  provide that all statements made by the insured will, in the absence of fraud,
				  be deemed representations and not warranties. The policy may provide that
				  statements made on behalf of the insured will also, in the absence of fraud, be
				  deemed representations and not warranties.
(b) Policy applications sometimes contain
				  agreements that call attention to some, or all, of the elements that must be
				  proved in avoiding the policy for misrepresentation. Such agreements are
				  acceptable, provided:
(1) they do not attempt
				  to burden the insured's representations with the legal consequences of
				  warranties;
(2) they do not attempt
				  to require the insured to prove the nonexistence of grounds upon which the
				  insurer could contest the policy; and
(3) they do not attempt to permit the insurer
				  to avoid liability on grounds less stringent than under Insurance Code §
											705.004, concerning
				  Policy Provision: Misrepresentation in Policy Application, or other applicable
				  law.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.606 - Misstatement of Age

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  provide that if the age of the insured has been understated, the amount payable
				  under the policy is the amount that the premium paid would have purchased at
				  the correct age. The word "misstated" may be used instead of
				  "understated."
(b) If more than one
				  life is insured (e.g., by inclusion of premium payor benefits or under family
				  group plan), the amount payable on the death of deceased may be adjusted
				  because of a misstatement in the age of a surviving insured if the actuarial
				  construction of the contract so requires.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.607 - Policy Loans

Current through Reg. 49, No. 28; July 12, 2024
(a) A policy loan
				  provision is not required in term insurance policies, nor in pure endowments
				  issued or granted as original policies or in exchange for lapsed or surrendered
				  policies.
(b) Loans must be made
				  available at any time while the policy is in force after premiums for three
				  full years have been paid and a cash value is available.
(c) The loan clause must provide for proper
				  assignment of the policy to the company.
(d) The policy must be the sole security for
				  the loan.
(e) Insurance Code
				  Chapter 1110, concerning Interest Rates on Certain Policy Loans, deals with
				  interest rates. Insurers may comply with Chapter 1110 by refiling reprinted and
				  renumbered policies with a new loan provision or by filing a loan endorsement
				  that may be attached to newly issued policies on and after an effective date
				  specified by the insurer. The maximum rate of interest must be specified in the
				  policy or loan endorsement. The policy may provide that interest may be made
				  payable in advance to the end of the current policy year.
(f) The loan clause must provide for lending
				  a sum equal to or, at the option of the policy owner, less than the cash value
				  of the policy and any dividend additions to the policy.
(g) The policy may provide that the company
				  may deduct from such loan value any existing indebtedness on the policy and any
				  unpaid balance of the premium for the current policy year and may collect
				  interest in advance on the loan to the end of the current year.
(h) The policy may provide that loans may be
				  deferred for not more than six months after application for the loan is made.
				  The six-month period may commence with the date of receipt of the request by
				  the company, if the policy so provides.
(i) The loan clause must provide that failure
				  to repay any such advance, or to pay interest on the loan, will not void the
				  policy until the total indebtedness to the company equals or exceeds the cash
				  value of the policy. The policy may not be terminated merely for failure to pay
				  loan interest when due. Since the policy may be voided when the indebtedness
				  equals or exceeds the cash value, this provision may be so worded that benefits
				  cease upon the precise moment that the indebtedness equals such
				  value.
(j) No condition other than
				  as provided in this subchapter will be exacted as a prerequisite to any such
				  loan.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.608 - Automatic Nonforfeiture Benefits

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Nonforfeiture values are governed by Insurance Code Chapter 1105, concerning
				  Standard Nonforfeiture Law for Life Insurance.
(b) Occasionally, the cash value (because of
				  the inclusion of accumulated dividends, coupon benefits, or other guaranteed
				  returns) is more than sufficient to purchase the maximum amount of extended
				  term insurance available under the policy. In such cases, the policy must
				  clearly provide for the equitable disposition of the entire cash
				  value.
(c) Automatic nonforfeiture
				  benefits are not applicable to single premium policies.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.611 - Reinstatement

Current through Reg. 49, No. 28; July 12, 2024
(a) All policies that have nonforfeiture
				  benefits must provide that if, in the event of default in premium payments, the
				  value of the policy must be applied for the purchase of other insurance, and if
				  such insurance is in force and the original policy has not been surrendered to
				  the company and cancelled, the policy may be reinstated within three years, or
				  longer at the option of the company, from such default upon evidence of
				  insurability satisfactory to the company and payment of arrears of premiums
				  with interest. Evidence of insurability need not be restricted to evidence of
				  good health only.
(b) If more than
				  one life is insured, evidence of insurability may be required on each
				  individual as a condition precedent to reinstatement of the policy, but the
				  policy may provide for reinstatement of only those lives which are
				  insurable.
(c) This section is not
				  applicable to single premium policies.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.613 - Family Group Special Requirements

Current through Reg. 49, No. 28; July 12, 2024
(a) A
				  family group life insurance policy is considered to be any life insurance
				  policy, other than a regular joint life insurance policy, that grants benefits
				  upon the death of each of the insured members of the family. This does not
				  include individual policies with payor death benefits or beneficiary death
				  benefits when such benefits are provided as a part of the basic policy, or by
				  supplementary agreement and when such additional benefits are designed
				  primarily to promote the continuance of the basic policy. The requirements
				  pertaining to family group policies may not be avoided, however, by merely
				  adding insureds under an individual contract by means of riders or
				  supplementary agreements.
(b) There
				  must be included on the face of the policy the name and age of each insured;
				  the name of the beneficiary; the maximum amount that is payable to the payee in
				  the policy in the case of death of such insured person or persons; and
				  designation of all paragraphs or provisions limiting or reducing the payment to
				  less than the maximum provided in the policy. Suicide clauses are the most
				  common type of reduction provision. The suicide clause, if used, should clearly
				  indicate any effect that the suicide of one insured would have on the insurance
				  of other insureds.
(c) Premiums
				  deductible by the terms of the policy and indebtedness to the company on the
				  policy are considered as counterclaims by the company against the beneficiary.
				  It is not necessary that provisions for such deductions be placed on the face
				  of the policy.
(d) The "face" of
				  the policy means the first page of the policy.
(e) If the policy provides for coverage that
				  will become effective on the lives of persons who become members of the family
				  group (by birth or adoption) after the policy is issued, information relative
				  to these future members need not be stated on the face of the policy. The
				  policy form will be acceptable if the provisions relative to these additional
				  members are clear and unambiguous.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.614 - Dependent Child Riders and Family Term Riders

Current through Reg. 49, No. 28; July 12, 2024
(a) The rider must specify the effect on the
				  rider of the death of the insured(s) under the base policy before the expiry
				  date(s) of the rider. The following are acceptable:
(1) the rider may terminate, in which case no
				  incontestability provision is required;
(2) the rider may convert to paid-up term
				  insurance;
(3) if paid-up term
				  insurance can be surrendered for its cash value, the rider must contain the
				  "surrender within 30 days" statement required by Insurance Code §
											1105.007, concerning
				  Computation of Cash Surrender Value Following Default; or
(4) the premium for the rider may be waived
				  to the expiry date(s).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.615 - Requirements for a Package Consisting of a Deferred Life Policy with an Accidental Death Rider Attached

Current through Reg. 49, No. 28; July 12, 2024
(a) The application
				  must contain a statement that discloses the deferred nature of the insurance
				  and that reflects the amount of insurance in force during the deferred period.
				  It may not state only the ultimate amount.
(b) The brief description on the face page
				  and filing back, if any, must call attention to the deferred nature of the
				  insurance, and in no way refer to the accidental death benefit.
(c) If a separate premium is charged for the
				  accidental death benefit, the schedule page must reflect the gross premium
				  broken down in such a manner as to reflect the gross premium for the deferred
				  life insurance and the accidental death benefit independently.
(d) The policy schedule page must reflect the
				  reduced death benefit payable each year the reduction in benefits is
				  maintained, as well as the ultimate face amount payable after the full face
				  amount becomes available. This provision may be in the form of actual figures,
				  a percentage of the ultimate face amount, the premiums plus interest, if
				  applicable, or other provision not in violation of Insurance Code Chapter 1701,
				  concerning Policy Forms, or other laws.
(e) The death benefit during the period of
				  deferred insurance must be as great as the sum of the gross premiums paid (with
				  or without interest). The death benefit may be based on the gross annual
				  premium even though other modes are available under the policy.
(f) The accidental death benefit must be made
				  a part of the entire contract.
(g)
				  The contract of deferred insurance and accidental death benefit must reflect a
				  different form number from any other contract of deferred insurance the company
				  offers.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.616 - Substitute or Change of Insured Riders

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  The rider must contain a statement requiring submission of an application
				  signed by both the owner and the substitute insured.
(b) The rider may require evidence of
				  insurability of the substitute insured.
(c) The following must be clearly specified:
(1) policy date;
(2) face amount;
(3) premium structure, including a
				  description of the determination of premiums for a substitute insured;
				  and
(4) the plan of
				  insurance.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.617 - Preliminary Term Life Insurance

Current through Reg. 49, No. 28; July 12, 2024
The following requirements apply to a contract of life
					 insurance containing a preliminary term insurance rider:
(1) a grace period must be allowed for
				  payment of the first premium due on the principal policy; and
(2) the date of commencement of the
				  preliminary term insurance, which is the date of inception of the contract as a
				  whole, must be used to measure the period of contestability and
				  suicide.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.618 - Conversion Provision

Current through Reg. 49, No. 28; July 12, 2024
A conversion provision in a policy must comply with the
					 following:
(1) the conversion
				  provision must state the plan and face amount of the new policy;
(2) the text of the provision must state what
				  premium rates will apply to the new policy;
(3) the text of the provision must discuss
				  the settlement of cash values under the original contract if the policy is
				  converted on a date other than the expiry date; and
(4) the provision must specify that evidence
				  of insurability is not required.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.619 - Limitations of Lawsuits

Current through Reg. 49, No. 28; July 12, 2024
The policy must not contain a provision limiting the time
					 within which any action at law or in equity may be commenced to less than two
					 years after the cause of action accrues.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.620 - Backdating Policies

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy must
				  not contain a provision by which it is issued or takes effect more than six
				  months before the original application for the insurance was made, if the
				  insured would rate at an age younger than their age at the date when the
				  application was made, according to their age at the nearest birthday.
(b) The restrictions against backdating are
				  not violated by the exercise of conversion privileges contained in the original
				  policy and that relate back to the original issue date of the policy, even
				  though the conversion privilege by its terms is such that the amount of
				  insurance at the conversion may exceed what was in force before
				  conversion.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.621 - Settlement at Maturity

Current through Reg. 49, No. 28; July 12, 2024
(a) If the policy
				  provides that proceeds may be paid in installments, it must contain a
				  representative table showing the amounts of such installments.
(b) If the settlement options provision
				  indicates that modes of payment other than monthly may be available, then the
				  amount of such payments must be determinable from the text. If the settlement
				  option indicates a commuted value or present value, to be paid upon death of a
				  payee, the interest rate used to determine this value must be given.
(c) No policy may contain a provision for any
				  mode of settlement at maturity of less value than the amount insured on the
				  face of the policy, plus dividend additions, if any, less any indebtedness to
				  the company on the policy, and less any premium that may, by the terms of the
				  policy, be deducted. The policy may provide an exception to this general rule,
				  and reduce the amount of insurance payable on maturity if death occurs from the
				  following causes:
(1) suicide, while sane or
				  insane;
(2) by following stated
				  hazardous occupations; or
(3) from
				  aviation activities under conditions specified by the policy.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.622 - Tontine Provisions

Current through Reg. 49, No. 28; July 12, 2024
Any life insurance policy that is a tontine policy or that
					 contains a tontine provision will be disapproved. Provisions by which dividends
					 during the participating period are not allocated or paid annually are
					 prohibited as being within the tontine principle unless the policyholder
					 acquires, on termination of the policy, a vested interest in the dividends that
					 have accrued.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.623 - Assignment Provisions

Current through Reg. 49, No. 28; July 12, 2024
There is no prohibition against a provision that permits
					 the assignment of the policy benefits or proceeds. However, policies that make
					 provision for dividends, coupon accumulations, or other guaranteed returns, and
					 that also contain provision for the assignment of these funds to a third party
					 for the purpose of establishing an investment for the policyholder are
					 prohibited.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.624 - Provisions Relating to Dividends, Coupon Benefits, or Other Guaranteed Returns

Current through Reg. 49, No. 28; July 12, 2024
(a) Any provision
				  by which the insurer undertakes to pay specific amounts will be treated as
				  definite contract benefits and valued in accordance with Insurance Code §
										841.253, concerning
				  Life Insurance Company's Payment of Dividends.
(b) Any policy that contains a provision
				  promising to pay "dividends" from specified sources must clearly state that the
				  payment of such dividends must be made from profits or expense
				  loading.
(c) Any policy that
				  provides for the payment of dividends, coupon benefits, or other guaranteed
				  returns must specify the disposition that will be made of such accumulations if
				  no option is exercised by the policyholder either on their maturity or in the
				  event of default in premium payments. Acceptable dispositions are that they be:
(1) applied to the purchase of additional
				  insurance;
(2) left to accumulate
				  at interest;
(3) withdrawn in cash;
				  or
(4) applied to the payment of
				  premiums.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.625 - Premiums Paid in Advance

Current through Reg. 49, No. 28; July 12, 2024
(a) The policy may
				  contain provisions under which the company will accept advance payments of
				  premiums; but in no event may the company undertake to accept deposits that
				  would exceed the maximum amount required to pay all future premiums that will
				  become due under the policy, including any options contained in the policy. The
				  contract may permit the insured to withdraw excess deposits in cash, but any
				  provisions that would cause a forfeiture of principal or exact a surrender
				  charge are prohibited. The contract must state the interest rate used to
				  discount the future premiums and must provide for disposition of any unused
				  premiums on surrender of the contract or death of the insured.
(b) This section is not applicable to single
				  premium policies.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.626 - Annuity Contracts

Current through Reg. 49, No. 28; July 12, 2024
All sections in Subchapter F of this chapter (relating to
					 Individual Life Insurance Policy Form Checklist and Affirmative Requirements)
					 apply to the review of ordinary life insurance policies and are not applicable
					 to annuity contracts. Any contract that provides death benefits in excess of
					 the total premium paid, without interest or with interest at a specified rate,
					 or the cash value at time of death, if greater, will be considered a life
					 insurance policy. This requirement cannot be avoided by combining riders or
					 endorsements to a basic annuity, as all pertinent instruments collectively
					 constitute the contract.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.627 - Certain Prohibited Provisions

Current through Reg. 49, No. 28; July 12, 2024
(a) Any policy that
				  contains a title, heading, or other indication of its provisions that is
				  misleading will be disapproved. For example, a title, heading, etc., will be
				  misleading if it contradicts the provisions of the policy. A life insurance
				  policy may not be described or referred to as a "bond," nor may premiums be
				  described or referred to as "deposits."
(b) The policy may not contain the words
				  "Approved by the Texas Department of Insurance," "Approved by TDI," "Approved
				  by the commissioner of insurance," or words of a similar import or
				  nature.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter F - INDIVIDUAL LIFE INSURANCE POLICY FORM CHECKLIST AND AFFIRMATIVE REQUIREMENTS › Section 4.628 - Renewal Premium on Term Policies

Current through Reg. 49, No. 28; July 12, 2024
Renewable term policies may specify rates for renewal terms
					 in dollars and cents, by reference to rates in use by the company on the
					 original issue date or by reference to the rates in use by the company on the
					 renewal date. If such rates are specified by reference to the rates in effect
					 on the date of issue, such rates must be submitted with the
					 policy.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 4 - LIFE AND ANNUITY › Subchapter J - INDETERMINATE PREMIUM REDUCTION POLICIES › Section 4.1001 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) This subchapter
				  is promulgated to regulate life insurance policies that have the following
				  characteristics:
(1) the premium for the
				  policy is guaranteed for an initial period of time but after such initial
				  period, a maximum premium charge is specified in the policy; thereafter, the
				  insurer reserves the right to charge a lesser unspecified amount (this type of
				  policy is hereinafter referred to as "an indeterminate premium reduction
				  policy"); and
(2) one of the
				  purposes of the policy is to provide insureds with insurance coverage at a
				  lower initial premium than would be obtainable from the insurer if the premiums
				  were required to be unchangeable by the insurer for the life of the
				  policy.