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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
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TEXAS DEPARTMENT OF INSURANCE
(512) 676-6630 | F: (512) 490-1017 | (800) 578-4677 | TDI.texas.gov | @TexasTDI333 Guadalupe, Austin, Texas 78701 PO Box 149104, Austin, Texas 78714-9104Regulatory Policy Division - Accident and Health Program (106-1D)
INDIVIDUAL HEALTH FIRST DIAGNOSIS OR CRITICAL ILLNESS AND SPECIFIED DISEASE CHECKLIST
Every effort has been made to ensure the accuracy of the information in this document. All parties should consult the Texas Insurance Code, the Texas Administrative Code, and other applicable laws. Important Note A policy being reviewed against this checklist must also satisfy the “Individual Health Product Requirements” checklist. Form Use - For each listed item, complete the following: Page No. field - enter a form page number reference, or N/A if not applicable. First comment box - enter general comments or form objections. In the drop down box select: No Comments, Comments, or Objection. Text size: 1200 characters. When you print the form, only the visible text (first three lines) will print. To view the full text in a comment box, click on the + icon in the lower right corner of the box and then use the up or down scroll buttons. Second comment box labeled Company Response - enter a response if the first box is marked Objection (optional) Use the last two pages of this form for additional comments, objections and responses (text size: 4000 characters).
REQUIREMENTS FOR FIRST DIAGNOSIS OR CRITICAL ILLNESS PRODUCTS
Page No. Waiting periods may not be applied to any loss resulting from accidental injuries as defined in the policy - 28 TAC §3.3055(1)
Page No.
Company Response
PROHIBITED EXCLUSIONS AND LIMITATIONS
http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15751&p_tloc=&p_ploc=&pg=1&p_tac=15751&ti=28&pt=1&ch=3&rl=3055&dt=&z_chk=&z_contains=
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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
2/12
Exclusion of expenses of non-indigent patient in a government facility if charges are customarily charged (non-indigent patients) and collected by that facility - §1204.002, TIC
Page No.
Company Response
Page No.
Page No.
Requiring services by particular hospital or person - §1251.006, TIC
Prohibiting or limiting assignment to physician or other provider - §1204.053, TIC
Company Response
Company Response
Page No. Limiting or excluding benefits covered by Medicaid - §1204.201, TIC
Company Response
Page No. Limiting or excluding benefits for services by a provider acting within the scope of licensure - §1451.104, TIC
Company Response
Page No. Unfair Discrimination - refuse to enroll or renew due to exposure to asbestos or silica - §544.453, TIC
Company Response
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1204.htm#1204.002http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1251.htm#1251.006http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1204.htm#1204.053http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1204.htm#1204.201http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1451.htm#1451.104http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.544.htm#544.453
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Texas Department of Insurance | www.tdi.texas.gov
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Page No.
Page No.
Must clearly disclose applicability or non-applicability of coverage to pre-existing condition limitations - 28 TAC §3.3054
If simplified application is used (defined in 28 TAC §3.3002(20)), losses due to pre-existing conditions (not excluded from coverage) must be covered after twelve months - §1201.152, TIC and 28 TAC §3.3054(b)(1)
Company Response
Company Response
Page No. A policy issued to person 65 or older may not limit the coverage of a pre-existing condition for more than six months - §1201.153(a), TIC and 28 TAC §3.3054(b)(2)
Company Response
Page No. A family policy shall specify the age or event under which coverage terminates for each insured -28 TAC §3.3052(a)
Company Response
Page No. A noncancellable and guaranteed renewable or guaranteed renewable policy must continue to provide coverage for spouse after primary insured dies or reaches limiting age - 28 TAC §3.3052(c)
Company Response
PRE-EXISTING CONDITIONS
TERMINATION OF INSURANCE
http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15752&p_tloc=&p_ploc=&pg=1&p_tac=15752&ti=28&pt=1&ch=3&rl=3054&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32792&p_tloc=&p_ploc=&pg=1&p_tac=32792&ti=28&pt=1&ch=3&rl=3002&dt=&z_chk=&z_contains=http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.152http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15752&p_tloc=&p_ploc=&pg=1&p_tac=15752&ti=28&pt=1&ch=3&rl=3054&dt=&z_chk=&z_contains=http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.153http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15752&p_tloc=&p_ploc=&pg=1&p_tac=15752&ti=28&pt=1&ch=3&rl=3054&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=
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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
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Coverage continues for premium period without limitation for age or date; misstatement of age - §1201.011, TIC and 28 TAC §3.3052(d)
Page No.
Company Response
Page No.
Page No.
Extension of benefits during pregnancy - 28 TAC §3.3052(e)
Extension of benefits beyond termination provision - 28 TAC §3.3052(f)
Company Response
Company Response
Page No. May provide for termination or suspension of family members who become eligible for federal coverage - 28 TAC §3.3052(g)
Company Response
Page No. Cannot terminate dependent child at limiting age if that child is incapable of self-sustaining employment due to mental retardation or physical handicap and chiefly dependent upon insured for support and maintenance - §1201.059, TIC and 28 TAC §3.3052(h)
Company Response
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.011http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.059http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=
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Page No.
Page No.
Use of genetic information - §§546.051 - 546.053, TIC
May not consider a determination that the applicant has or has not previously been denied health benefit plan coverage in underwriting the coverage for which the applicant has applied - §544.502, TIC
Company Response
Company Response
Page No. Actual charge/Actual fee - §1201.0601, TIC
Company Response
Page No. Guaranteed renewable, limited guarantee of renewability - 28 TAC §3.3020
Company Response
PROHIBITED PRACTICES
DEFINITIONS
REQUIREMENTS FOR SPECIFIED DISEASE PRODUCTS
This definition section provides a reference to general terms that may be included in a form filing. The section is not intended to limit or require the inclusion of certain terms in a form filing. A form filing containing any of the referenced terms shall not define the terms more restrictively than the referenced statute or rule.
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.546.htm#546.051http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.544.htm#544.502http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.0601http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15754&p_tloc=&p_ploc=&pg=1&p_tac=15754&ti=28&pt=1&ch=3&rl=3020&dt=&z_chk=&z_contains=
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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
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Hospital - 28 TAC §3.3006Page No.
Company Response
Page No. Noncancellable - 28 TAC §3.3019
Company Response
Page No. Policy renewability guarantees and limitations - 28 TAC §3.3050(b)(3) and (4)
Company Response
Page No. Specified disease coverage - 28 TAC §3.3077
Company Response
Page No. Policy may contain a “return of premium” or “cash value benefit” if policy meets all nine requirements in rule - 28 TAC §3.3040(c)
Company Response
MINIMUM STANDARDS - SPECIFIED DISEASE COVERAGE
OPTIONAL BENEFITS
http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15771&p_tloc=&p_ploc=&pg=1&p_tac=15771&ti=28&pt=1&ch=3&rl=3006&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15760&p_tloc=&p_ploc=&pg=1&p_tac=15760&ti=28&pt=1&ch=3&rl=3019&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32798&p_tloc=&p_ploc=&pg=1&p_tac=32798&ti=28&pt=1&ch=3&rl=3050&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15745&p_tloc=&p_ploc=&pg=1&p_tac=15745&ti=28&pt=1&ch=3&rl=3077&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32797&p_tloc=&p_ploc=&pg=1&p_tac=32797&ti=28&pt=1&ch=3&rl=3040&dt=&z_chk=&z_contains=
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Page No.
Page No.
Prohibiting or restricting assignment of benefits to physician or other provider - §1204.053, TIC
Excluding or limiting payment of benefits covered by Medicaid - §1204.201, TIC
Company Response
Company Response
Page No. Cannot require admission to a convalescent facility in less than 14 days after discharge from hospital - 28 TAC §3.3040(f)
Company Response
Page No. A waiting period may not exceed 120 days - 28 TAC §3.3055(1)(C)
Company Response
Page No. Exclusion of expenses of non-indigent patient in a government facility if charges are customarily charged (non-indigent patients) and collected by that facility - §1204.002, TIC
Company Response
PROHIBITED EXCLUSIONS AND LIMITATIONS
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1204.htm#1204.053http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1204.htm#1204.201http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32797&p_tloc=&p_ploc=&pg=1&p_tac=32797&ti=28&pt=1&ch=3&rl=3040&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15751&p_tloc=&p_ploc=&pg=1&p_tac=15751&ti=28&pt=1&ch=3&rl=3055&dt=&z_chk=&z_contains=http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1204.htm#1204.002
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Texas Department of Insurance | www.tdi.texas.gov
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May not consider a determination that the applicant has or has not previously been denied health benefit plan coverage in underwriting the coverage for which the applicant has applied - §544.502, TIC
Page No.
Company Response
Page No. Unfair Discrimination - refuse to enroll or renew due to exposure to asbestos or silica - §544.453, TIC
Company Response
Page No. Policy provision must indicate persons eligible for conversion and circumstances/limitations applicable to the conversion privilege - 28 TAC §3.3060(a)
Company Response
Page No. A person who loses coverage due to a change in marital status shall be issued a policy that approximates the coverage lost, without evidence of insurability - 28 TAC §21.407
Company Response
Page No. A family policy shall specify the age or event under which coverage terminates for each insured -28 TAC §3.3052(a)
Company Response
CONVERSION
TERMINATION OF INSURANCE
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.544.htm#544.502http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.544.htm#544.453http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15730&p_tloc=&p_ploc=&pg=1&p_tac=15730&ti=28&pt=1&ch=3&rl=3060&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=15224&p_tloc=&p_ploc=&pg=1&p_tac=15224&ti=28&pt=1&ch=21&rl=407&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=
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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
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A noncancellable and guaranteed renewable or guaranteed renewable policy must continue to provide coverage for spouse after primary insured dies or reaches limiting age - 28 TAC §3.3052(c)
Page No.
Company Response
Page No.
Page No.
Coverage for premium period with limitation for age or date; misstatement of age - §1201.011, TIC and 28 TAC §3.3052(d)
Extension of pregnancy benefits - 28 TAC §3.3052(e)
Company Response
Company Response
Page No. Extension of benefits beyond termination provision - 28 TAC §3.3052(f)
Company Response
Page No. May provide for termination or suspension of family members who become eligible for federal coverage - 28 TAC §3.3052(g)
Company Response
http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.011http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=
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Texas Department of Insurance | www.tdi.texas.gov
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Page No. Cannot terminate dependent child at limiting age if that child is incapable of self-sustaining employment due to mental retardation or physical handicap and chiefly dependent upon insured for support and maintenance - §1201.059,TIC and 28 TAC §3.3052(h)
Company Response
See next pages for additional comments or objections and space for additional responses, if any.
http://www.statutes.legis.state.tx.us/Docs/IN/htm/IN.1201.htm#1201.059http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=2&p_dir=&p_rloc=32799&p_tloc=&p_ploc=&pg=1&p_tac=32799&ti=28&pt=1&ch=3&rl=3052&dt=&z_chk=&z_contains=
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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
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Additional Comments or Objections:
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Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
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Company Response
Additional Company Responses:
Texas Department of Insurance | www.tdi.texas.gov
AH020 | 0715
/
TEXAS DEPARTMENT OF INSURANCE
Texas Department of Insurance Seal
..\StateSeals\1x1 TDI Agency Seal with margin.jpg
(512) 676-6630 | F: (512) 490-1017 | (800) 578-4677 | TDI.texas.gov | @TexasTDI
333 Guadalupe, Austin, Texas 78701 PO Box 149104, Austin, Texas 78714-9104
Regulatory Policy Division - Accident and Health Program (106-1D)
INDIVIDUAL HEALTH FIRST DIAGNOSIS OR CRITICAL ILLNESS AND SPECIFIED DISEASE CHECKLIST
Every effort has been made to ensure the accuracy of the information in this document. All parties should consult the Texas Insurance Code, the Texas Administrative Code, and other applicable laws.
Important Note
A policy being reviewed against this checklist must also satisfy the “Individual Health Product Requirements” checklist.
Form Use - For each listed item, complete the following:
Page No. field - enter a form page number reference, or N/A if not applicable.
First comment box - enter general comments or form objections. In the drop down box select: No Comments,
Comments, or Objection.
Text size: 1200 characters. When you print the form, only the visible text (first three lines) will print.
To view the full text in a comment box, click on the + icon in the lower right corner of the box and then use
the up or down scroll buttons.
Second comment box labeled Company Response - enter a response if the first box is marked Objection (optional)
Use the last two pages of this form for additional comments, objections and responses (text size: 4000 characters).
REQUIREMENTS FOR FIRST DIAGNOSIS OR CRITICAL ILLNESS PRODUCTS
Waiting periods may not be applied to any loss resulting from accidental injuries as defined
in the policy - 28 TAC §3.3055(1)
Company Response
PROHIBITED EXCLUSIONS AND LIMITATIONS
Exclusion of expenses of non-indigent patient in a government facility if charges are
customarily charged (non-indigent patients) and collected by that facility - §1204.002, TIC
Company Response
Requiring services by particular hospital or person - §1251.006, TIC
Prohibiting or limiting assignment to physician or other provider - §1204.053, TIC
Company Response
Company Response
Limiting or excluding benefits covered by Medicaid - §1204.201, TIC
Company Response
Limiting or excluding benefits for services by a provider acting within the scope of licensure - §1451.104, TIC
Company Response
Unfair Discrimination - refuse to enroll or renew due to exposure to asbestos or silica - §544.453, TIC
Company Response
Must clearly disclose applicability or non-applicability of coverage to pre-existing condition
limitations - 28 TAC §3.3054
If simplified application is used (defined in 28 TAC §3.3002(20)), losses due to pre-existing conditions (not excluded from coverage) must be covered after twelve months - §1201.152, TIC and 28 TAC §3.3054(b)(1)
Company Response
Company Response
A policy issued to person 65 or older may not limit the coverage of a pre-existing condition for
more than six months - §1201.153(a), TIC and 28 TAC §3.3054(b)(2)
Company Response
A family policy shall specify the age or event under which coverage terminates for each insured - 28 TAC §3.3052(a)
Company Response
A noncancellable and guaranteed renewable or guaranteed renewable policy must continue to provide coverage for spouse after primary insured dies or reaches limiting age - 28 TAC §3.3052(c)
Company Response
PRE-EXISTING CONDITIONS
TERMINATION OF INSURANCE
Coverage continues for premium period without limitation for age or date; misstatement
of age - §1201.011, TIC and 28 TAC §3.3052(d)
Company Response
Extension of benefits during pregnancy - 28 TAC §3.3052(e)
Extension of benefits beyond termination provision - 28 TAC §3.3052(f)
Company Response
Company Response
May provide for termination or suspension of family members who become eligible for federal coverage - 28 TAC §3.3052(g)
Company Response
Cannot terminate dependent child at limiting age if that child is incapable of self-sustaining employment due to mental retardation or physical handicap and chiefly dependent upon
insured for support and maintenance - §1201.059, TIC and 28 TAC §3.3052(h)
Company Response
Use of genetic information - §§546.051 - 546.053, TIC
May not consider a determination that the applicant has or has not previously been denied
health benefit plan coverage in underwriting the coverage for which the applicant has applied - §544.502, TIC
Company Response
Company Response
Actual charge/Actual fee - §1201.0601, TIC
Company Response
Guaranteed renewable, limited guarantee of renewability - 28 TAC §3.3020
Company Response
PROHIBITED PRACTICES
DEFINITIONS
REQUIREMENTS FOR SPECIFIED DISEASE PRODUCTS
This definition section provides a reference to general terms that may be included in a form filing. The section is
not intended to limit or require the inclusion of certain terms in a form filing. A form filing containing any of the referenced terms shall not define the terms more restrictively than the referenced statute or rule.
Hospital - 28 TAC §3.3006
Company Response
Noncancellable - 28 TAC §3.3019
Company Response
Policy renewability guarantees and limitations - 28 TAC §3.3050(b)(3) and (4)
Company Response
Specified disease coverage - 28 TAC §3.3077
Company Response
Policy may contain a “return of premium” or “cash value benefit” if policy meets all nine requirements in rule - 28 TAC §3.3040(c)
Company Response
MINIMUM STANDARDS - SPECIFIED DISEASE COVERAGE
OPTIONAL BENEFITS
Prohibiting or restricting assignment of benefits to physician or other provider - §1204.053, TIC
Excluding or limiting payment of benefits covered by Medicaid - §1204.201, TIC
Company Response
Company Response
Cannot require admission to a convalescent facility in less than 14 days after discharge from
hospital - 28 TAC §3.3040(f)
Company Response
A waiting period may not exceed 120 days - 28 TAC §3.3055(1)(C)
Company Response
Exclusion of expenses of non-indigent patient in a government facility if charges are customarily charged (non-indigent patients) and collected by that facility - §1204.002, TIC
Company Response
PROHIBITED EXCLUSIONS AND LIMITATIONS
May not consider a determination that the applicant has or has not previously been denied
health benefit plan coverage in underwriting the coverage for which the applicant has applied - §544.502, TIC
Company Response
Unfair Discrimination - refuse to enroll or renew due to exposure to asbestos or silica - §544.453, TIC
Company Response
Policy provision must indicate persons eligible for conversion and circumstances/limitations applicable to the conversion privilege - 28 TAC §3.3060(a)
Company Response
A person who loses coverage due to a change in marital status shall be issued a policy that approximates the coverage lost, without evidence of insurability - 28 TAC §21.407
Company Response
A family policy shall specify the age or event under which coverage terminates for each insured - 28 TAC §3.3052(a)
Company Response
CONVERSION
TERMINATION OF INSURANCE
A noncancellable and guaranteed renewable or guaranteed renewable policy must continue to provide coverage for spouse after primary insured dies or reaches limiting age - 28 TAC §3.3052(c)
Company Response
Coverage for premium period with limitation for age or date; misstatement of age -
§1201.011, TIC and 28 TAC §3.3052(d)
Extension of pregnancy benefits - 28 TAC §3.3052(e)
Company Response
Company Response
Extension of benefits beyond termination provision - 28 TAC §3.3052(f)
Company Response
May provide for termination or suspension of family members who become eligible for federal coverage - 28 TAC §3.3052(g)
Company Response
Cannot terminate dependent child at limiting age if that child is incapable of
self-sustaining employment due to mental retardation or physical handicap and chiefly
dependent upon insured for support and maintenance - §1201.059,TIC and 28 TAC §3.3052(h)
Company Response
See next pages for additional comments or objections and space for additional responses, if any.
Additional Comments or Objections:
Company Response
Additional Company Responses:
9.0.0.2.20120627.2.874785
Rate and Form Review Office
Used by companies to ensure compliance.
Rate and Form Review Office
Individual Health First Diagnosis or Critical Illness and Specified Disease Checklist
Rositta Kraml
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