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=

Texas Department of Insurance | www.tdi.texas.gov

AH020 | 0715

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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

Texas Department of Insurance | www.tdi.texas.gov

AH020 | 0715

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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=

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=

Texas Department of Insurance | www.tdi.texas.gov

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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=

Texas Department of Insurance | www.tdi.texas.gov

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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=

Texas Department of Insurance | www.tdi.texas.gov

AH020 | 0715

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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

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=

Texas Department of Insurance | www.tdi.texas.gov

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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=

Texas Department of Insurance | www.tdi.texas.gov

AH020 | 0715

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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=

Texas Department of Insurance | www.tdi.texas.gov

AH020 | 0715

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Additional Comments or Objections:

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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