Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES › Subchapter Y - STANDARDS FOR LONG-TERM CARE INSURANCE, NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE COVERAGE UNDER INDIVIDUAL AND GROUP POLICIES AND ANNUITY CONTRACTS, AND LIFE INSURANCE POLICIES THAT PROVIDE LONG-TERM CARE BENEFITS WITHIN THE POLICY › Division 2 - NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE › Section 3.3829 - Required Disclosures

Current through Reg. 49, No. 28; July 12, 2024
(a) Required
					 disclosure of policy provisions.
(1)
					 Long-term care insurance policies and certificates must contain a renewability
					 provision as required by §
												3.3822
					 of this title (relating to Minimum Standard for Renewability of Long-term Care
					 Coverage). Such provision must be appropriately captioned, appear on the first
					 page of the policy, and clearly state the duration, where limited, of
					 renewability and the duration of the coverage for which the policy is issued
					 and for which it may be renewed.
(2) Except for riders or endorsements by
					 which the insurer effectuates a request made in writing by the policyholder
					 under a long-term care insurance policy and/or certificate, all riders or
					 endorsements added to a long-term care insurance policy and/or certificate
					 after the date of issue or at reinstatement or renewal, which reduce or
					 eliminate benefits or coverage in the policy and/or certificate, require a
					 signed acceptance by the policyholder. After the date of policy issue, any
					 rider or endorsement which increases benefits or coverage with a concomitant
					 increase in premium during the policy term must be agreed to in writing signed
					 by the policyholder, except if the increased benefits or coverage are required
					 by law. Where a separate additional premium is charged for benefits in
					 connection with riders or endorsements, such premium charge must be set forth
					 in the policy, certificate, rider, or endorsement.
(3) A long-term care insurance policy and
					 certificate which provides for the payment of benefits on standards described
					 as usual and customary, reasonable and customary, or words of similar import,
					 must include a definition of such terms and an explanation of such terms in its
					 accompanying outline of coverage.
(4) If a long-term care insurance policy or
					 certificate contains any limitations with respect to preexisting conditions,
					 such limitations must appear as a separate paragraph of the policy or
					 certificate and be labeled as "Preexisting Condition Limitations."
(5) Long-term care insurance applicants have
					 the right to return the policy or certificate within 30 days of its delivery
					 and to have the premium refunded if, after examination of the policy or
					 certificate, the applicant is not satisfied for any reason. Long-term care
					 insurance policies and certificates must have a notice prominently printed on
					 the first page or attached thereto stating in substance that the applicant has
					 the right to return the policy or certificate within 30 days of its delivery
					 and to have the premium refunded if, after examination of the policy or
					 certificate, the applicant is not satisfied for any reason.
(6) A long-term care insurance policy or
					 certificate containing any limitations or conditions for eligibility other than
					 those prohibited in Insurance Code Chapter 1651 or §
												3.3824
					 of this title (relating to Preexisting Conditions Provisions) must set forth a
					 description of such limitations or conditions in a separate paragraph of the
					 policy or certificate and label each paragraph "Limitations or Conditions on
					 Eligibility for Benefits."
(7)
					 Long-term care insurance policies and certificates must appropriately caption
					 and describe the nonforfeiture benefit provision, if elected.
(8) Long-term care insurance policies and
					 certificates must contain a claim denial provision which is appropriately
					 captioned. Such provision must clearly state that if a claim is denied, the
					 insurer will make available all information directly relating to such denial
					 within 60 days of the date of a written request by the policyholder or
					 certificate holder, unless such disclosure is prohibited under state or federal
					 law.
(9) A long-term care insurance
					 policy and certificate which includes benefit provisions under §
												3.3818(b)
					 of this title (relating to Standards for Eligibility for Benefits) must
					 disclose, within a common location and in equal prominence, a description of
					 all benefit levels payable for the coverage described in §
												3.3818(b)
					 of this subchapter. Criteria utilized to determine eligibility for benefits
					 must be disclosed in all long-term care insurance policies and certificates, in
					 the manner prescribed by §
												3.3818
					 of this subchapter.
(10) If the
					 insurer intends for a long-term care insurance policy or certificate to be a
					 qualified long-term care insurance contract as defined by the Internal Revenue
					 Code of 1986, §7702B(b), the policy or certificate must include disclosure
					 language substantially similar to the following: "This policy is intended to be
					 a qualified long-term care contract as defined by the Internal Revenue Code of
					 1986, §7702B(b)."
(11) If the
					 insurer does not intend for the policy to be a qualified long-term care
					 insurance contract as defined by the Internal Revenue Code of 1986,
					 §7702B(b), the policy or certificate must include disclosure language
					 substantially similar to the following: "This policy is not intended to be a
					 qualified long-term care insurance contract. This long-term care insurance
					 policy does not qualify the insured for the favorable tax treatment provided
					 for in the Internal Revenue Code of 1986, §7702B."
(12) A long-term care policy or certificate
					 which provides for increases in rates must include a provision disclosing that
					 notice of an upcoming premium rate increase will be provided no later than the
					 45th day preceding the date of the implementation of the rate
					 increase.