reglab/statecodes huggingface dataset:
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.119 - Savings Clause

Current through Reg. 49, No. 28; July 12, 2024
Each cause of action, pending litigation, matter in
						process before the Texas Department of Insurance or commissioner of insurance,
						or matter hereafter arising from an event occurring prior to the time this
						division becomes effective shall be determined in accordance with and governed
						by the provisions of statutes, rules, orders, or official interpretations in
						effect at the time of the occurrence of the subject event, and this section
						operates to save from repeal in that circumstance the application of such law
						and procedure in respect of any such circumstance from the amendment, change,
						or repeal contemplated by this division notwithstanding any provision of this
						division to the contrary, if any, or any provision of conflict or
						ambiguity.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.120 - Filing for Review

Current through Reg. 49, No. 28; July 12, 2024
(a) Any
					 advertisement required to be submitted or submitted voluntarily by an insurer
					 licensed to do business in Texas must be accompanied by a transmittal letter
					 addressed to the Texas Department of Insurance, Life and Health Lines,
					 MC-LH-LHL, P.O. Box 12030, Austin, Texas 78711-2030. The transmittal letter
					 must contain the following information:
(1)
					 the identifying form number of each form submitted including a separate
					 identifying form number for each Internet page and pop-up having a distinct
					 URL;
(2) the type of advertisement
					 submitted, i.e., institutional advertisement, invitation to inquire, or
					 invitation to contract;
(3) the
					 form number(s) of the approved policy and/or rider form(s)
					 advertised;
(4) the method or media
					 used for dissemination of the advertisement;
(5) the form number(s) for all other
					 advertising material to be used with the advertisement(s) being submitted;
					 and
(6) an attachment explaining
					 all variable material; the variable material must be identified with brackets
					 on the advertisement(s).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.121 - Lead Solicitations

Current through Reg. 49, No. 28; July 12, 2024
(a) An insurer
					 or agent who obtains a list of potential customers derived from use of a lead
					 solicitation, as defined in §21.102(1)(F) of this division (relating to
					 Scope), is responsible for the content of the lead solicitation used to
					 generate such list.
(b) A lead
					 solicitation shall prominently disclose that an insurer or agent may contact
					 the recipient of the solicitation, if that is a fact. In addition, an insurer
					 or agent who makes contact with a person as a result of acquiring that person's
					 name from a lead solicitation shall disclose that fact in the initial contact
					 with the person.
(c) In addition to
					 any other prohibition on untrue, deceptive, or misleading advertisements, no
					 advertisement for an event or group meeting where information will be
					 disseminated regarding insurance products, insurance products will be offered
					 for sale, or individuals will be enrolled, educated or assisted with the
					 selection of insurance products, may use the terms "seminar," "class,"
					 "informational meeting," "retirement," "estate planning," "financial planning,"
					 "living trust," or substantially equivalent terms to characterize the purpose
					 of the public gathering or event unless it adds the words "and insurance sales
					 presentation" immediately following those terms in the same type size and font
					 as those terms.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 1 - INSURANCE ADVERTISING › Section 21.122 - System of Control and Home Office Approval of Advertising Material Naming an Insurer

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions.
					 The following words and terms, when used in this section, shall have the
					 following meanings, unless the context clearly indicates otherwise.
(1) Advertisement--As defined in §21.102
					 of this division (relating to Scope), but, however, limited to those
					 advertisements, excluding institutional advertisements, where an insurer or its
					 policy is advertised.
(2) Agent--As
					 defined in §21.102(5) of this division (relating to Scope).
(3) Insurer--As defined in §21.102(4) of
					 this division (relating to Scope).
(4) Policy--As defined in §21.102(3) of
					 this division (relating to Scope).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 2 - DISCOUNT HEALTH CARE PROGRAM ADVERTISING › Section 21.151 - Purpose and Scope

Current through Reg. 49, No. 28; July 12, 2024
(a) The purpose of
					 this division is to establish advertising requirements necessary to assure that
					 the public receives truthful and adequate information to facilitate informed
					 purchasing decisions concerning discount health care programs.
(b) A discount health care program operator,
					 including the operator of a freestanding discount health care program or a
					 discount health care program operated and marketed by an insurer or a health
					 maintenance organization, shall comply with this division.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 2 - DISCOUNT HEALTH CARE PROGRAM ADVERTISING › Section 21.152 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
(a) In this division, the term
					 "advertisement" has the meaning assigned to the term "advertisement,
					 solicitation, or marketing material" by the Insurance Code §
											562.002.
(b) In this division, the following terms
					 have the meanings assigned by the Insurance Code §
											562.002 and §
											7001.001:
(1) Discount health care program;
					 and
(2) Discount health care
					 program operator.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 2 - DISCOUNT HEALTH CARE PROGRAM ADVERTISING › Section 21.153 - Content of Advertisement

Current through Reg. 49, No. 28; July 12, 2024
(a) An
					 advertisement shall identify the discount health care program operator offering
					 the discount health care program that is the subject of the advertisement. It
					 is sufficient to state the full registered name of the discount health care
					 program operator or an assumed name filed with the department pursuant to
					 §
											19.1602
					 of this title (relating to Registration Requirement).
(b) The format and content of an
					 advertisement of a discount health care program shall be sufficiently complete
					 and clear to avoid deception or the capacity or tendency to mislead or
					 deceive.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter B - ADVERTISING, CERTAIN TRADE PRACTICES, AND SOLICITATION › Division 2 - DISCOUNT HEALTH CARE PROGRAM ADVERTISING › Section 21.154 - Severability

Current through Reg. 49, No. 28; July 12, 2024
If a court of competent jurisdiction holds that any
						provision of this division is inconsistent with any statutes of this state, is
						unconstitutional, or is invalid for any reason, the remaining provisions of
						this division shall remain in effect.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter C - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 21.201 - Short Title

Current through Reg. 49, No. 28; July 12, 2024
These regulations shall be known as the "Unfair Claims
					 Settlement Practices Rules."
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter C - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 21.202 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words or phrases, as used in these
					 regulations, shall have the meanings placed opposite them unless the explicit
					 wording of a regulation shall otherwise direct.
(1) Business day--A day other than a
				  Saturday, Sunday, or holiday recognized by this state.
(2) Claim--A request or demand reduced to
				  writing and filed by a Texas resident with an insurer for payment of funds or
				  the providing of services under the terms of a policy, certificate, or binder
				  of insurance.
(3) Claimant--A
				  person making or having made a claim.
(4) Complaint--Any written communication to
				  an insurer, not solicited by such insurer, primarily expressing a grievance
				  relating to an unfair claims settlement practice as defined in §
										21.203
				  of this title (relating to Unfair Claims Settlement Practices). For purposes of
				  this subchapter, any written communication to an insurer by the same person
				  which relates to the same claim, issue or question and requests or demands the
				  same kind of relief and which arises out of the same transaction or
				  transactions is considered to be part of the same complaint. A complaint is not
				  a misunderstanding or a problem of misinformation that is resolved promptly by
				  clearing up the misunderstanding and/or supplying the appropriate information
				  to the satisfaction of the person submitting the written communication, as
				  applicable.
(5) First-party
				  coverage--Benefits and other rights provided by an insurance contract to an
				  insured.
(6) Insurer--Stock and
				  mutual life, health, accident, fire, casualty, fire and casualty, hail, storm,
				  title, and mortgage guarantee companies; mutual assessment companies; local
				  mutual aid associations; local mutual burial associations; statewide mutual
				  assessment companies; stipulated premium companies; fraternal benefit
				  societies; group hospital service organizations; county mutual insurance
				  companies; Lloyds; reciprocal or interinsurance exchanges; and farm mutual
				  insurance companies.
(7)
				  Policyholder--The owner of a policy, certificate, or binder of insurance, and
				  any insured, named insured, or obligee under a bond.
(8) Third-party coverage--Benefits and other
				  rights provided by an insurance contract to any person other than the
				  insured.
(9) Written
				  communication--Any communication that is documented by publication or otherwise
				  being written onto a medium which is capable at the point of receipt of being
				  viewed, stored, retrieved and reproduced by the recipient without any
				  transcription. Such communication expressly includes, but is not limited to,
				  facsimile transmissions and electronic mail transmissions.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter C - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 21.204 - Special Claim Reports and Statistical Plan

Current through Reg. 49, No. 28; July 12, 2024
If the department finds based on complaint or complaints of
					 unfair claim settlement practices as described in §
										21.203
					 of this title (relating to Unfair Claim Settlement Practices), that an insurer
					 should be subjected to closer supervision with respect to such practices, it
					 may require the insurer to file a report at such periodic intervals as the
					 department deems necessary. The periodical reports must contain the following
					 information:
(1) the total number of
				  written claims filed, including the original amount filed for by the insured
				  and the classification by line of insurance of each individual written claim,
				  for the past 12-month period or from the date of the insurer's last periodic
				  report, whichever time is shorter;
(2) the total number of written claims denied
				  for the past 12-month period or from the date of the insurer's last periodic
				  report, whichever is shorter;
(3)
				  the total number of written claims settled, including the original amount filed
				  for by the insured, the settled amount, and the classification by line of
				  insurance of each individual settled claim, for the past 12-month period or
				  from the date of the insurer's last periodic report, whichever time is
				  shorter;
(4) the total number of
				  written claims for which lawsuits were instituted against the insurer,
				  including the original amount filed for by the insured, the amount of final
				  adjudication, the reason for the lawsuit, and the classification by line of
				  insurance of each individual written claim, for the past 12-month period or
				  from the date of the insurer's last periodic report, whichever time is shorter;
				  and
(5) the total number of
				  complaints, their classification by line of insurance, the nature of each
				  complaint, the disposition of these complaints, and the time it took to process
				  each complaint. Such periodic reports must be filed with the
				  department.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter C - UNFAIR CLAIMS SETTLEMENT PRACTICES › Section 21.205 - Minimum Standard of Performance

Current through Reg. 49, No. 28; July 12, 2024
All insurers must maintain their affairs so that no unfair
					 claims settlement practices are committed and the minimum standard of
					 performance for all insurers (as that term is used in Insurance Code Chapter
					 542, Subchapter A) is to comply with the provisions of §
										21.203
					 of this title (relating to Unfair Claims Settlement
					 Practices).
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter D - STATISTICAL AGENTS › Section 21.301 - Performance Standards for Designated Statistical Agent

Current through Reg. 49, No. 28; July 12, 2024
(a) Definitions. The following words and
				  terms when used in this section have the following meanings unless the context
				  clearly indicates otherwise.
(1) Agreed upon
				  standards of performance--A set of standards of performance for each
				  statistical agent which is negotiated and agreed upon by the statistical agent
				  affected and the department. For statistical agents already designated as of
				  the effective date of this section, the standards of performance must be agreed
				  upon within eight months of the effective date of this section. For statistical
				  agents designated after the effective date of this section, the standards of
				  performance must be agreed upon prior to the effective date of the statistical
				  agent's designation.
(2)
				  Commissioner--Commissioner of Insurance of the State of Texas.
(3) Department--Texas Department of
				  Insurance.
(4) Designated
				  statistical agent--An organization duly designated by or contracted with the
				  Commissioner to gather insurance data from insurers according to a statistical
				  plan.
(5) Statistical plan--A
				  document promulgated by the Commissioner that specifies the information to be
				  reported, the insurers who must report the information, and the procedures and
				  format for the information to be reported to the designated statistical
				  agent.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.401 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of these sections is to eliminate unfair
					 discrimination based upon sex or marital status in the terms and conditions of
					 insurance policies, in the underwriting criteria of insurers, and in the rates,
					 rating plans, and rating classifications of insurers.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.402 - Applicability and Scope

Current through Reg. 49, No. 28; July 12, 2024
These sections apply to all individual, group, and blanket
					 policies and contracts, and individual certificates of insurance delivered or
					 issued for delivery in this state on or after January 1, 1978. They apply to
					 all group certificates issued pursuant to group policies when the group policy
					 is delivered or issued for delivery in this state on or after January 1, 1978.
					 Provided, however, that to the extent these sections apply to group and
					 individual accident and health policies, contracts, and certificates, the
					 effective date is May 1, 1978.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.403 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings unless the context clearly indicates
					 otherwise.
(1) Insurer--Includes, but
				  is not be limited to, all life, health, and accident companies; capital stock
				  companies; mutual assessment life insurance companies; statewide mutual
				  assessment corporations; county mutual insurance companies; local mutual aid
				  associations; farm mutual insurance companies; mutual or natural premium life
				  or casualty insurance companies; general casualty companies; Mexican casualty
				  companies; Lloyds, reciprocal, or inter-insurance exchanges; nonprofit
				  hospital, medical, or dental service corporations including, but not limited
				  to, companies subject to the Insurance Code Chapter 842, as amended; stipulated
				  premium insurance companies; fidelity, guaranty, and surety companies; title
				  insurance companies; ] health maintenance organizations; and all other
				  organizations, corporations, or persons engaged in the business of insurance,
				  whether or not named previously; provided, however, these sections do not apply
				  to any society, company, or other insurer whose activities are by statute
				  exempt from the regulation of the department and which are entitled by statute
				  to an exemption certificate from the department in evidence of their exempt
				  status; nor to fraternal benefit societies.
(2) Policy--Includes any insurance policy,
				  plan, certificate or subscriber agreement, statement of coverage, binder,
				  rider, endorsement, or application, if attached, offered by any person or
				  entity engaged in the business of insurance or board-regulated prepaid services
				  in this state.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.404 - Underwriting

Current through Reg. 49, No. 28; July 12, 2024
Availability of any policy may not be denied to an insured
					 or prospective insured on the basis of sex or marital status of the insured or
					 prospective insured. However, nothing contained in this section shall be
					 construed to prohibit any insurance underwriter or insurance agent requiring
					 the joinder of both spouses as a condition of issuance of any policy of
					 insurance where such joinder is required by any provision of the constitution
					 or laws of the State of Texas. Specific practices prohibited by this section
					 shall include, but not be limited to, the following.
(1) No insurer may deny coverage to females
				  gainfully employed at home, employed part time, or employed by relatives when
				  that coverage is offered to males similarly employed.
(2) No insurer may deny policy riders to
				  females when the riders are available to males.
(3) No insurer may exclude from prescription
				  drug benefits oral contraceptives when all other prescription drugs are
				  covered.
(4) No insurer may deny,
				  under group policies, coverage to eligible husbands of female employees, when
				  dependent coverage is available to eligible wives of male employees.
(5) No insurer may deny disability income
				  policies to women employed in high risk classifications when coverage is
				  offered to men similarly employed.
(6) No insurer may deny maternity benefits to
				  insureds or prospective insureds purchasing an individual policy when
				  comparable family coverage policies offer maternity benefits.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.405 - Policy Terms and Conditions

Current through Reg. 49, No. 28; July 12, 2024
The amount of benefits payable, or any term, condition, or
					 type of coverage may not be restricted, modified, excluded, or reduced on the
					 basis of the sex or marital status of the insured or prospective insured.
					 However, nothing in these sections shall prohibit an insurer from taking
					 marital status into account for the purpose of defining persons eligible for
					 dependents' benefits. Specific practices prohibited by this section shall
					 include, but not be limited to, the following.
(1) No policy may treat complications of
				  pregnancy differently than any other illness or sickness under the policy. For
				  the purpose of this section, complications of pregnancy means:
(A) conditions, requiring hospital
				  confinement (when the pregnancy is not terminated), whose diagnoses are
				  distinct from pregnancy but are adversely affected by pregnancy or are caused
				  by pregnancy, such as acute nephritis, nephrosis, cardiac decompensation,
				  missed abortion, and similar medical and surgical conditions of comparable
				  severity, but shall not include false labor, occasional spotting, physician
				  prescribed rest during the period of pregnancy, morning sickness, hyperemesis
				  gravidarum, pre-eclampsis, and similar conditions associated with the
				  management of a difficult pregnancy not constituting a nosologically distinct
				  complication of pregnancy; and
(B)
				  non-elective cesarean section, termination of ectopic pregnancy, and
				  spontaneous termination of pregnancy, occurring during a period of gestation in
				  which a viable birth is not possible.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.406 - Rates

Current through Reg. 49, No. 28; July 12, 2024
When rates differ by sex or marital status, the insurer may
					 be required to justify that the differential equitably reflects the difference
					 in the risk assumed. Rates shall be based on a reasonable classification system
					 according to actual or expected loss and expense data where available. In the
					 absence of actual loss and expense data, rates must be based upon reasonable
					 actuarial assumptions. Rates may differ by sex or marital status when approved
					 or promulgated by the board.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.407 - Continuance of Coverage

Current through Reg. 49, No. 28; July 12, 2024
In individual policies, if a person loses coverage due to a
					 change in marital status, that person shall be issued a policy which the
					 insurer is then issuing which most nearly approximates the coverage of the
					 policy which was in effect prior to the change in marital status. The new
					 policy will be issued without evidence of insurability and will have the same
					 effective date as the policy under which coverage was afforded prior to the
					 change in marital status. Provided, however, as respects insurance other than
					 life, accident, and health, the inception date of the policy issued to provide
					 continuity of coverage need not precede the earliest date required to maintain
					 such continuity, and such policy shall have the same expiration date as the
					 policy under which coverage was issued prior to the change in marital status
					 except that the insurer and insured may agree on a later expiration
					 date.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.408 - Amendments

Current through Reg. 49, No. 28; July 12, 2024
The subject matters covered by this subchapter treat only a
					 portion of the subject matters contemplated by Insurance Code Chapter 541 and
					 are not exhaustive on this subject; therefore, these sections remain open for
					 corrections and future additions as the needs may arise or procedures
					 require.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter E - UNFAIR DISCRIMINATION BASED ON SEX OR MARITAL STATUS › Section 21.409 - Severability Clause

Current through Reg. 49, No. 28; July 12, 2024
If any provision of a section of these sections or its
					 application to any person or circumstance is held invalid, the invalidity does
					 not affect other provisions or applications of the sections which can be given
					 effect without the invalid provision or application, and to this end the
					 provisions of each section are declared to be severable.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter H - UNFAIR DISCRIMINATION › Section 21.701 - Purpose

Current through Reg. 49, No. 28; July 12, 2024
The purpose of these sections is to identify specific acts
					 or practices which are prohibited by Insurance Code §
										541.057
					 and §
										544.002.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter H - UNFAIR DISCRIMINATION › Section 21.702 - Unfairly Discriminatory Acts or Practices

Current through Reg. 49, No. 28; July 12, 2024
(a) The following are hereby identified as
				  acts or practices in life and health insurance which constitute unfair
				  discrimination between individuals of the same class:
(1) refusing to insure, or refusing to
				  continue to insure, or limiting the amount, extent, or kind of coverage
				  available to an individual, or charging a different rate for the same coverage
				  solely because of a physical or mental impairment, except where the refusal,
				  limitation, or rate differential is based on sound actuarial principles,
				  including actual or reasonably anticipated experience; or
(2) without exception, refusing to insure, or
				  refusing to continue to insure, or limiting the amount, extent, or kind of
				  coverage available to an individual, or charging an individual a different rate
				  for the same coverage solely because of blindness or partial
				  blindness.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter H - UNFAIR DISCRIMINATION › Section 21.703 - Definitions Concerning Discrimination

Current through Reg. 49, No. 28; July 12, 2024
For the purpose of §
										21.702
					 of this title (relating to Unfairly Discriminatory Acts or Practices) and to
					 effectuate the objectives of Insurance Code §
										544.002,
					 the definitions specified in this section are applicable. The words "physical
					 or mental impairment" include, but are not limited to, any psychological
					 disorder or condition, cosmetic disfigurement or anatomical loss affecting one
					 or more of the following bodily systems: neurological, musculoskeletal, special
					 sense organs, respiratory and speech organs, cardiovascular, reproductive,
					 digestive, genito-urinary, hemic and lymphatic, skin, and endocrine system or
					 any mental or physiological disorder such as intellectual disability, organic
					 brain syndrome, emotional or mental illness, and specific learning
					 disabilities. As used in Insurance Code §
										544.002,
					 the words "disability or partial disability" mean a physical or mental
					 impairment which substantially limits one or more of the person's major life
					 activities.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter H - UNFAIR DISCRIMINATION › Section 21.704 - Unfair Discrimination

Current through Reg. 49, No. 28; July 12, 2024
(a) General
				  propositions.
(1) No inquiry in an application
				  for health or life insurance coverage, or in an investigation conducted by or
				  on behalf of an insurer in connection with an application for such coverage,
				  may be directed toward determining the proposed insured's sexual
				  orientation.
(2) Sexual orientation
				  may not be used in the underwriting process or in the determination of
				  insurability.
(3) Insurers may not
				  direct, require, or request insurance support organizations to investigate,
				  directly or indirectly, the sexual orientation of a proposed insured or a
				  beneficiary.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter H - UNFAIR DISCRIMINATION › Section 21.705 - Nondiscriminatory Testing for Human Immunodeficiency Virus

Current through Reg. 49, No. 28; July 12, 2024
A proposed insured for life or health and accident
					 insurance, or for coverage by a company licensed under Insurance Code Chapter
					 842, or with a licensed health maintenance organization may be required to be
					 tested for the presence of the human immunodeficiency virus (HIV). Requiring
					 such testing is not unfair discrimination provided:
(1) the testing is required on a
				  nondiscriminatory basis for all individuals in the same class; and
(2) no proposed insured is denied coverage or
				  rated a substandard risk on the basis of such testing unless:
(A) an initial enzyme linked immunosorbent
				  assay (ELISA) test is administered to the proposed insured, and it indicates
				  the presence of HIV antibodies;
(B)
				  a second ELISA test is conducted and it indicates the presence of HIV
				  antibodies; and
(C) a Western Blot
				  test is conducted and it confirms the results of the two ELISA tests.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter I - PROHIBITED AGENT PRACTICES › Section 21.901 - Prohibition Against Solicitation or Acceptance of Power of Attorney

Current through Reg. 49, No. 28; July 12, 2024
(a) Scope and application. This section
				  applies to any person required to be licensed as an agent pursuant to the
				  provisions of the Insurance Code or other insurance law of this state. For
				  purposes of this section, "person" means both natural persons and business
				  association entities.
(b)
				  Prohibition. No person subject to the provisions of this section is permitted,
				  directly or indirectly, to require, solicit or accept any power of attorney to
				  act as attorney-in-fact for any applicant for any insurance coverage in this
				  state for purposes of placing, procuring, instituting, maintaining, canceling
				  or nonrenewing any insurance coverage, or for any other act in connection with
				  the placement or institution of such insurance coverage.
(c) Exceptions. This section does not apply
				  to the situations described in paragraphs (1) and (2) of this subsection, as
				  follow:
(1) insurance activities for which
				  the Insurance Code or other insurance law of this state expressly authorizes a
				  person to conduct such insurance activities as an attorney-in-fact pursuant to
				  a power of attorney; or
(2)
				  instances in which a person required to be licensed as an agent under the
				  Insurance Code is appointed attorney-in-fact by a relative or household member
				  of such person for purposes which include placing personal lines insurance
				  coverages for such relative or household member.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter J - PROHIBITED TRADE PRACTICES › Section 21.1001 - Prohibition against Insurer's Non-Renewing Personal Auto Policy Solely Because of Age of Young Driver

Current through Reg. 49, No. 28; July 12, 2024
No insurer may refuse to renew a personal auto policy or
					 require a named driver exclusion for any family member as a condition of
					 renewal solely on the basis that a family member of the insured reaches driving
					 age.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter J - PROHIBITED TRADE PRACTICES › Section 21.1004 - Restrictions on Certain Claims in Residential Property Insurance and Transition Plan Requirement

Current through Reg. 49, No. 28; July 12, 2024
(a) Purpose and
				  Applicability. The purpose of this section is to protect homeowners in Texas
				  from increases in residential property insurance rates and premiums that vary
				  greatly between renewal periods and to provide homeowners in Texas with just,
				  fair, and reasonable residential property insurance rates and premiums. This
				  section places restrictions on the use of residential property insurance claims
				  in rates and premiums due to the introduction of, or changes to, a claims-free
				  program or premium surcharge program in accordance with the Insurance Code and
				  also establishes the requirements and procedures for insurers to file a
				  transition plan. This section applies to the rates and premiums applicable to
				  residential property insurance policies that are delivered, issued for
				  delivery, or renewed on or after January 1, 2006.
(b) Definitions for the purposes of this
				  section.
(1) Residential property
				  insurance--Property or property and casualty insurance covering a dwelling,
				  including homeowner's insurance, residential fire and allied lines insurance,
				  farm and ranch insurance, or farm and ranch owners insurance.
(2) Premium surcharge--An additional amount
				  due to a policyholder's claims experience that is added to the base rate. The
				  term does not include a reduction or elimination of a discount previously
				  received by an insured, reassignment of an insured from one rating tier to
				  another, re-rating an insured, or re-underwriting an insured by using multiple
				  affiliates.
(3) Claims-free
				  program--Any program that considers a policyholder's claim experience, in whole
				  or in part, whether through the use of discounts, a tier classification, or
				  other program that does not qualify as a premium surcharge if the policyholder
				  has been a residential property insurance policyholder with that insurer or an
				  affiliate of that insurer.
(4)
				  Transition plan--A plan that promotes rates and premiums that are fair, just,
				  and reasonable by moderating rate and premium increases caused by the
				  introduction of, or change to, a claims-free or premium surcharge program,
				  including a tier classification system.
(5) Natural cause--A weather related
				  cause.
(6) Claim that is filed but
				  is not paid or payable--A claim that is filed, including a customer inquiry,
				  that does not result in an indemnity payment under the provisions of the
				  policy.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter J - PROHIBITED TRADE PRACTICES › Section 21.1005 - Prohibition of Underwriting Guidelines Based on the Purchase of Types or Amounts of Coverage in Excess of Minimum Limits Liability Coverage

Current through Reg. 49, No. 28; July 12, 2024
(a) Prohibition. Effective September 1, 1995,
				  an insurer or agent may not use an underwriting guideline for private passenger
				  automobile insurance based, in whole or in part, on whether an insured or
				  applicant purchases types or amounts of coverage in excess of the minimum
				  automobile liability coverage required to show proof of financial
				  responsibility under the Motor Vehicle Safety Responsibility Act,
				  Transportation Code, Chapter 601. The failure to comply with this section
				  constitutes an unfair trade practice in the business of insurance in violation
				  of Insurance Code Chapter 541, and is subject to the provisions
				  thereof.
(b) Definition of
				  "Underwriting Guideline." For the purposes of this rule, an "underwriting
				  guideline" is a rule, standard, marketing decision, guideline, or practice,
				  whether written, oral or electronic, used by an insurer or its agent to
				  examine, bind, accept, reject, renew, non-renew, cancel or limit coverages made
				  available to classes of consumers.
(c) Definition of "Private Passenger
				  Automobile Insurance." For the purposes of this rule, "private passenger
				  automobile insurance" is the insurance for which a personal auto policy is
				  issued.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter J - PROHIBITED TRADE PRACTICES › Section 21.1006 - Prohibition Against Declining to Write Residential Property Insurance Based on the Age or Value of the Property

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  "Residential property insurance" means insurance against loss to real or
				  tangible personal property at a fixed location provided in a homeowners policy
				  or residential fire and allied lines policy.
(b) An insurer may not decline to write
				  residential property insurance based on the age of the property sought to be
				  insured. This provision does not prohibit an insurer from declining to write
				  coverage based on physical conditions of the property, including wiring,
				  heating, air conditioning, plumbing, and roofing. This provision does not
				  prohibit the Texas Windstorm Insurance Association from requiring, in
				  accordance with the provisions of Chapter 2210 of the Insurance Code, different
				  building code standards to qualify for coverage based on the date that the
				  structure was constructed, repaired, or additions were made.
(c) An insurer may not decline to write
				  residential property insurance based on a minimum value of the property sought
				  to be insured.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter J - PROHIBITED TRADE PRACTICES › Section 21.1007 - Restrictions on Using Guidelines Based on a Water Damage Claim, Previous Mold Damage, or a Mold Damage Claim

Current through Reg. 49, No. 28; July 12, 2024
(a)
				  Purpose. The purpose of this section is to protect persons and property from
				  being unfairly stigmatized in obtaining residential property insurance due to
				  previous mold damage, or by filing a mold damage claim, a water damage claim,
				  or certain appliance-related claims under a residential property insurance
				  policy.
(b) Definitions. The
				  following words and terms, when used in this section, have the following
				  meanings:
(1) Appliance--A household device
				  operated by gas or electric current, including hoses directly attached to the
				  device. The term includes air conditioning units, heating units, refrigerators,
				  dishwashers, icemakers, clothes washers, water heaters, and
				  disposals.
(2) Appliance-related
				  claim--A claim for a loss arising from the discharge or leakage of water or
				  steam from an appliance that is the direct result of the failure of the
				  appliance.
(3) Consumer--The person
				  making the application to insure a property and includes both existing insureds
				  and applicants for insurance.
(4)
				  Insurer--An insurance company, reciprocal or interinsurance exchange, mutual,
				  capital stock company, county mutual insurance company, farm mutual insurance
				  company, association, Lloyd's plan company, or other entity writing residential
				  property insurance in this state. The term includes an affiliate as described
				  by Insurance Code §
											823.003
				  if that affiliate is authorized to write and is writing residential property
				  insurance in Texas. The term does not include the Texas Windstorm Insurance
				  Association, the FAIR Plan, or an eligible surplus lines insurer regulated
				  under Insurance Code Chapter 981.
(5) Residential property insurance--Insurance
				  against loss to residential real property at a fixed location or tangible
				  personal property provided in a homeowners policy, including a tenant policy, a
				  condominium owners policy, or a residential fire and allied lines
				  policy.
(6) Underwriting
				  guideline--A rule, standard, guideline, or practice, whether written, oral, or
				  electronic, that is used by an insurer or an agent of an insurer to decide to
				  accept or reject an application for a residential property insurance policy or
				  to determine how to classify risks that are accepted for the purpose of
				  determining a rate.
(7) Water
				  damage claim--A claim for a loss arising from the discharge or leakage of water
				  or steam that is the direct result of the failure of a plumbing system or other
				  system that contains water or steam.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter K - CERTIFICATION OF CREDITABLE COVERAGE › Section 21.1101 - Definitions

Current through Reg. 49, No. 28; July 12, 2024
The following words and terms, when used in this
					 subchapter, have the following meanings, unless the context clearly indicates
					 otherwise.
(1) Affiliation period--A
				  period of time that under the terms of the coverage offered by an HMO, must
				  expire before the coverage becomes effective. During an affiliation period an
				  HMO is not required to provide health care services or benefits to the
				  participant or beneficiary and a premium may not be charged to the participant
				  or beneficiary.
(2) COBRA--Title X
				  of the Consolidated Omnibus Budget Reconciliation Act of 1985, as amended
				  (29
				  USC Section 1161, et seq.).
(3) COBRA continuation coverage--Coverage
				  that satisfies an applicable COBRA continuation provision.
(4) Commissioner--The Commissioner of
				  Insurance .
(5) Creditable
				  coverage--
(A) An individual's coverage is
				  creditable if the coverage is provided under:
(i) a self-funded or self-insured employee
				  welfare benefit plan that provides health benefits and that is established in
				  accordance with the Employee Retirement Income Security Act of 1974
				  (29 U.S.C. Section
				  1001 et seq.);
(ii) a group health benefit plan provided by
				  a health insurance carrier or an HMO;
(iii) an individual health insurance policy
				  or evidence of coverage;
(iv) Part
				  A or Part B of Title XVIII of the Social Security Act (42
				  U.S.C. Section 1395c et seq.);
(v) Title XIX of the Social Security Act
				  (42 U.S.C. Section
				  1396 et seq.), other than coverage consisting
				  solely of benefits under Section 1928 of that Act (42 U.S.C. Section
				  1396s) ;
(vi) Chapter 55 of Title 10, United States
				  Code (10 U.S.C. Section
				  1071 et seq.);
(vii) a medical care program of the Indian
				  Health Service or of a tribal organization;
(viii) a state or political subdivision
				  health benefits risk pool;
(ix) a
				  health plan offered under Chapter 89 of Title 5, United States Code
				  (5
				  U.S.C. Section 8901 et seq.);
(x) a public health plan as defined in this
				  section;
(xi) a health benefit plan
				  under Section 5(e) of the Peace Corps Act (22 U.S.C. Section
				  2504(e)) ; and
(xii) short-term limited duration insurance
				  as defined in this section.
Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 21 - TRADE PRACTICES › Subchapter K - CERTIFICATION OF CREDITABLE COVERAGE › Section 21.1102 - Certification of Coverage

Current through Reg. 49, No. 28; July 12, 2024
Each issuer of a health benefit plan shall provide a
					 certification of coverage in accordance with §
										21.1103
					 of this title (relating to Timing of Issuance of Written Certificate of
					 Creditable Coverage to an Individual) through §
										21.1108
					 of this title (relating to Notification of Creditable Coverage and Preexisting
					 Condition Exclusion), as necessary to determine the period of applicable
					 creditable coverage of health benefit plans. An issuer of a health benefit plan
					 may enter into an agreement with a third party administrator or plan sponsor
					 for the purpose of providing a certification of creditable coverage as provided
					 in this subchapter. The agreement may provide that the requirements of this
					 subchapter may be complied with by either the issuer of the health benefit plan
					 or a third party administrator or plan sponsor on behalf of the issuer. If an
					 issuer of a health benefit plan enters into an agreement with a third party
					 administrator or plan sponsor under this section, it is the issuer of the
					 health benefit plan's responsibility to meet the requirements of this
					 subchapter or to assure that the requirements are met.