28 Tex. Admin. Code § 3.1

Current through Reg. 49, No. 44; November 1, 2024

Section 3.1 - Scope

This subchapter applies to all contracts, policies, applications, certificates of insurance, insert pages, riders, limited partial refilings, matrix filings, disclosure forms, rates, outline of coverage, and other documents subject to be filed with the Texas Department of Insurance pertaining to the following:

(1) individual and group life insurance;

(2) individual and group annuities;

(3) individual and group accident and health insurance (including long-term care and Medicare supplement under Insurance Code Chapters 1651 and 1652);

(4) individual and group combination life and accident and health insurance;

(5) individual and group combination annuity and accident and health insurance;

(6) point of service products as described in Insurance Code Chapter 1273 and § 21.2901 of this title (relating to Definitions);

(7) individual and group credit life and individual and group credit accident and health insurance under Insurance Code Chapters 1131, 1153, and 1251;

(8) rates, subject to review and approval by the department including, but not limited to:

(A) individual and group credit life;

(B) individual and group credit accident and health insurance;

(C) Medicare supplement; and

(D) changes in rating methodologies for small employer plans;

(9) Medicare SELECT plans of operation and amendments;

(10) miscellaneous documents and information necessary to make a filing complete or for a comprehensive review of the filing including, but not limited to:

(A) documents that must be accompanied by the transmittal checklist described in § 3.3(b) of this title (relating to Transmittal Information) as follows:

(i) articles of incorporation;

(ii) constitutions and bylaws and/or trust agreements;

(iii) disclosures;

(iv) outlines of coverage;

(v) rates, other than the rates listed in paragraph (8) of this section, including the following:

(I) individual accident and health;

(II) long-term care; and

(III) life; and

(vi) certifications related to form filings, readability scores, and actuarial memoranda.

(B) documents that must be accompanied by the transmittal form described in § 3.3(c) of this title as follows:

(i) life insurance illustration information;

(ii) Medicare supplement refund calculations;

(iii) preferred provider health benefit plan provider directories;

(iv) preferred provider service or geographic descriptions;

(v) certifications including those related to small or large employer health benefit plans; and

(vi) annual reports including:

(I) long-term care lapse and replacement reports;

(II) long-term care rescission reports;

(III) long-term care denial of claims reports;

(IV) long-term care report required by Insurance Code § 1651.053;

(V) Medicare supplement rate reports; and

(VI) Medicare SELECT grievance reports.

28 Tex. Admin. Code § 3.1

The provisions of this §3.1 adopted to be effective June 1, 2003, 28 TexReg 3954; Amended by Texas Register, Volume 46, Number 17, April 23, 2021, TexReg 2822, eff. 4/26/2021