CHAPTER 1201. ACCIDENT AND HEALTH INSURANCE

State Codes and Statutes

Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1201-accident-and-health-insurance

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE A. HEALTH COVERAGE IN GENERAL

CHAPTER 1201. ACCIDENT AND HEALTH INSURANCE

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 1201.001. DEFINITIONS. In this chapter:

(1) "Accident and health insurance policy" includes any policy

or contract that provides insurance against loss resulting from:

(A) accidental bodily injury;

(B) accidental death; or

(2) "Policy" means the entire contract between an insurer and an

insured and includes riders, endorsements, and the application,

if attached.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.002. PURPOSE. The purpose of this chapter is to:

(1) provide for reasonable standardization, readability, and

simplification of terms and coverages in individual accident and

health insurance policies;

(2) promote public understanding of coverages;

(3) eliminate provisions in individual accident and health

insurance policies that may be unjust, unfair, misleading, or

unreasonably confusing in connection with:

(A) the purchase of coverage; or

(B) the settlement of claims; and

(4) provide for full and fair disclosure in sales of accident

and health coverage.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.003. APPLICABILITY OF CHAPTER. (a) This chapter

applies only to an accident and health insurance policy delivered

or issued for delivery in this state.

(b) Except as otherwise provided by this chapter, this chapter

applies only to an individual accident and health insurance

policy delivered or issued for delivery by:

(1) a life, health, and accident insurance company;

(2) a mutual insurance company, including:

(A) a mutual life insurance company; and

(B) a mutual assessment life insurance company;

(3) a local mutual aid association;

(4) a mutual or natural premium life or casualty insurance

company;

(5) a general casualty company;

(6) a Lloyd's plan;

(7) a reciprocal or interinsurance exchange;

(8) a nonprofit hospital, medical, or dental service

corporation, including a corporation operating under Chapter 842;

(9) another insurer required by law to be authorized by the

department.

policy issued by a stipulated premium company subject to Chapter

884.

(d) This chapter does not apply to:

(1) any society, company, or other insurer whose activities are

exempt by statute from the control of the department and that is

entitled by statute to a certificate from the department that

shows the entity's exempt status;

(2) a credit accident and health insurance policy issued under

Chapter 1153;

(3) a workers' compensation insurance policy;

(4) a liability insurance policy, with or without supplementary

expense coverage;

(5) a reinsurance policy or contract;

(6) a blanket or group insurance policy, except as otherwise

provided by this chapter; or

(7) a life insurance endowment or annuity contract or a contract

supplemental to a life insurance endowment or annuity contract if

the contract or supplemental contract contains only provisions

relating to accident and health insurance that:

(A) provide additional benefits in case of accidental death,

accidental dismemberment, or accidental loss of sight; or

(B) operate to:

(i) safeguard the contract or supplemental contract against

lapse; or

(ii) give a special surrender value, a special benefit, or an

annuity if the insured or annuitant becomes totally and

permanently disabled, as defined by the contract or supplemental

contract.

(e) Subchapters C and D do not apply to a conversion policy

issued under a contractual conversion privilege under a group

accident and health insurance policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.004. CONSTRUCTION OF CHAPTER. This chapter does not

enlarge the powers of an entity listed in Section 1201.003.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a

reference to this chapter includes a reference to:

(1) Section 1202.052;

(2) Section 1271.005(a), to the extent that the subsection

relates to the applicability of Section 1201.105, and Sections

1271.005(d) and (e);

(3) Chapter 1351;

(4) Subchapters C and E, Chapter 1355;

(5) Chapter 1356;

(6) Chapter 1365;

(7) Subchapter A, Chapter 1367; and

(8) Subchapters A, B, and G, Chapter 1451.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.006. RULEMAKING AUTHORITY. The commissioner may adopt

reasonable rules as necessary to implement the purposes and

provisions of this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.007. NOTICE AND HEARING. The commissioner may adopt a

general rule or order relating to a matter covered by this

chapter only after a hearing held after the 10th day following

the date the department by mail notifies each insurer to which

this chapter applies.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.008. JUDICIAL REVIEW. An insurer that is dissatisfied

with an order, act, rule, administrative ruling, or decision of

the commissioner under this chapter may, after failing to get

relief from the commissioner, file a petition seeking judicial

review of the order, act, rule, ruling, or decision in accordance

with Subchapter D, Chapter 36. The action has precedence over all

other causes on the docket of a different nature.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.009. NONCONFORMING POLICY. (a) This chapter governs

the rights, duties, and obligations of the insurer, the insured,

and the beneficiary of an accident and health insurance policy

regardless of a provision in the policy that conflicts with this

chapter.

(b) An accident and health insurance policy that violates this

chapter is a valid policy, but the policy shall be construed in a

manner to make the policy consistent with this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.010. THIRD-PARTY OWNERSHIP OF POLICY. The use of

"insured" in this chapter does not prevent a person with an

insurable interest, other than the insured, from:

(1) applying for and owning an individual accident and health

insurance policy covering the insured; or

(2) being entitled to an indemnity, right, or benefit provided

for in an individual accident and health insurance policy

covering the insured.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.011. COVERAGE FOR PREMIUM PERIOD WITH LIMITATIONS BY

AGE OR DATE; MISSTATEMENT OF AGE OF INSURED. (a) Regardless of

a provision in an individual accident and health insurance policy

that specifies a date, by age limitation or otherwise, after

which coverage under the policy is not effective, coverage

continues in force, subject to any right of cancellation, until

the end of the period for which the insurer accepts a premium if:

(1) the insurer accepts the premium after the specified date; or

(2) the specified date falls before the end of the period for

which the insurer accepts the premium.

(b) Notwithstanding Subsection (a), if the age of the insured is

misstated and, because of the insured's correct age, coverage of

the insured would not have become effective or would have

terminated before the insurer's acceptance of a premium, the

liability of the insurer is limited to the refund, on request, of

the premiums paid for the period not covered by the policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.012. DEFENSE OF CLAIM. The following actions by an

insurer do not operate as a waiver of the insurer's rights in

defense of a claim that arises under an individual accident and

health insurance policy:

(1) acknowledgment of the receipt of notice given under the

policy;

(2) provision of a form for filing a proof of loss;

(3) acceptance of a proof of loss; or

(4) investigation of a claim under the policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.013. PROGRAMS PROMOTING DISEASE PREVENTION, WELLNESS,

AND HEALTH. (a) An insurer issuing an accident and health

insurance policy may establish premium discounts, rebates, or a

reduction in otherwise applicable copayments, coinsurance, or

deductibles, or any combination of these incentives, for an

insured who participates in programs promoting disease

prevention, wellness, and health.

(b) A discount, rebate, or reduction established under this

section does not violate Section 541.056(a).

Added by Acts 2007, 80th Leg., R.S., Ch.

112, Sec. 2, eff. May 17, 2007.

SUBCHAPTER B. POLICY TERMS

Sec. 1201.051. ENTIRE CONSIDERATION. An individual accident and

health insurance policy must state the entire monetary and other

consideration for the policy in the policy or in the application,

if the application is made a part of the policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.052. TIME OF EFFECTIVENESS AND TERMINATION. An

individual accident and health insurance policy must state the

time the insurance takes effect and the time the insurance

terminates.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.053. PERSONS INSURED. (a) Except as provided by this

section, an individual accident and health insurance policy may

not insure more than one individual.

(b) On the application of an adult member of a family, an

individual accident and health insurance policy may, at the time

of original issuance or by subsequent amendment, insure two or

more eligible members of the adult's family, including a spouse,

unmarried children younger than 25 years of age, including a

grandchild of the adult as described by Section 1201.062(a)(1), a

child the adult is required to insure under a medical support

order issued under Chapter 154, Family Code, or enforceable by a

court in this state, and any other individual dependent on the

adult.

insurance policy is considered the policyholder.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.054. APPEARANCE OF TEXT. (a) In this section, "text"

includes all printed matter of an individual accident and health

insurance policy except:

(1) the name and address of the insurer;

(2) the name or title of the policy;

(3) the brief description, if any; and

(4) captions and subcaptions.

(b) An individual accident and health insurance policy must

have:

(1) a style, arrangement, or overall appearance that does not

give undue prominence to any portion of the text; and

(2) every printed portion of its text and of any endorsements or

attached papers printed plainly in a lightfaced type:

(A) of a style in general use; and

(B) in a uniform size not less than 10-point with a lowercase

unspaced alphabet length not less than 120-point.

or identification card.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.055. EXCEPTIONS AND REDUCTIONS OF INDEMNITY. (a) An

individual accident and health insurance policy must state each

exception to or reduction of indemnity for the policy.

(b) Except as provided by Subchapter E, each exception to or

reduction of indemnity for the policy must be printed, at the

insurer's option:

(1) with the benefit provision to which the exception or

reduction applies; or

(2) under an appropriate caption such as:

(A) "Exceptions"; or

(B) "Exceptions and Reductions."

specifically applies only to a particular benefit of an

individual accident and health insurance policy, the statement of

the exception or reduction must be included with the benefit

provision to which the exception or reduction applies.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.056. FORM NUMBER. Each form that constitutes a part

of an individual accident and health insurance policy, including

each rider or endorsement, must be identified by a form number

placed in the lower left corner of the first page of the form.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.057. INCORPORATION OF OR REFERENCE TO OTHER DOCUMENTS.

(a) An individual accident and health insurance policy that

provides that a portion of the charter, rules, constitution, or

bylaws of the insurer are a part of the policy must state that

portion fully in the policy.

(b) An individual accident and health insurance policy may

incorporate or refer to:

(1) a statement of rates or classification of risks; or

(2) a short-rate table filed with the department.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.058. NOTIFICATION THAT POLICY IS RETURNABLE; EFFECT OF

RETURN. (a) An individual accident and health insurance policy

must include a notice that states in substance that the

individual to whom the policy is issued is entitled to have the

premium paid refunded if, after the individual examines the

policy, the individual is not satisfied with the policy for any

reason and returns the policy not later than the 10th day after

the date the policy is delivered to the individual.

(b) An individual accident and health insurance policy returned

to the insurer at the insurer's home or branch office or to the

agent through whom the policy was purchased within the time

provided by the notice is void from the date the policy was

issued, and the parties are in the same position as if the policy

had not been issued.

policy or attached to the policy.

(d) This section does not apply to a single premium nonrenewable

policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.059. TERMINATION OF COVERAGE BASED ON AGE OF CHILD IN

INDIVIDUAL, BLANKET, OR GROUP POLICY. (a) An accident and

health insurance policy, including an individual, blanket, or

group policy, and including a policy issued by a corporation

operating under Chapter 842, that provides that coverage of a

child terminates when the child attains a limiting age specified

in the policy must provide in substance that the child's

attainment of that age does not terminate coverage while the

child is:

(1) incapable of self-sustaining employment because of mental

retardation or physical disability; and

(2) chiefly dependent on the insured or group member for support

and maintenance.

(b) To obtain coverage for a child as described by Subsection

(a), the insured or group member must provide to the insurer

proof of the child's incapacity and dependency:

(1) not later than the 31st day after the date the child attains

the limiting age; and

(2) subsequently as the insurer requires, except that the

insurer may not require proof more frequently than annually after

the second anniversary of the date the child attains the limiting

age.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.060. REQUIRED DEFINITION OF "EMERGENCY CARE" IN

INDIVIDUAL OR GROUP POLICY. An individual or group accident and

health insurance policy that provides an emergency care benefit,

including a policy issued by a corporation operating under

Chapter 842, must define "emergency care" as follows:

"Emergency care" means bona fide emergency services provided

after the sudden onset of a medical condition manifesting itself

by acute symptoms of sufficient severity, including severe pain,

such that the absence of immediate medical attention could

reasonably be expected to result in:

(1) placing the patient's health in serious jeopardy;

(2) serious impairment to bodily functions; or

(3) serious dysfunction of any bodily organ or part.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.0601. REQUIRED DEFINITIONS: SPECIFIED DISEASE POLICY.

An individual or group specified disease insurance policy that

uses the term "actual charge" or "actual fee" must define the

terms as follows:

"Actual charge" or "actual fee" means the amount actually paid by

or on behalf of the insured and accepted by a provider for

services provided.

Added by Acts 2005, 79th Leg., Ch.

974, Sec. 1, eff. September 1, 2005.

Sec. 1201.061. COVERAGE FOR ADOPTED CHILD. (a) An individual

accident and health insurance policy that provides coverage for

an insured's immediate family or children may not, solely because

the insured's child is adopted:

(1) exclude the child from coverage; or

(2) limit coverage for the child.

(b) For the purposes of this section, a child is an insured's

child if the insured is a party to a suit in which the insured

seeks to adopt the child.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.062. COVERAGE FOR CERTAIN CHILDREN IN INDIVIDUAL OR

GROUP POLICY OR IN PLAN OR PROGRAM. (a) An individual or group

accident and health insurance policy that is delivered, issued

for delivery, or renewed in this state, including a policy issued

by a corporation operating under Chapter 842, or a self-funded or

self-insured welfare or benefit plan or program, to the extent

that regulation of the plan or program is not preempted by

federal law, that provides coverage for a child of an insured or

group member, on payment of a premium, must provide coverage for:

(1) each grandchild of the insured or group member if the

grandchild is:

(A) unmarried;

(B) younger than 25 years of age; and

income tax purposes at the time application for coverage of the

grandchild is made; and

(2) each child for whom the insured or group member must provide

medical support under an order issued under Chapter 154, Family

Code, or enforceable by a court in this state.

(b) Coverage for a grandchild of the insured or group member may

not be terminated solely because the grandchild is no longer a

dependent of the insured or group member for federal income tax

purposes.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.063. PROHIBITION OF CERTAIN CRITERIA RELATING TO

CHILD'S COVERAGE IN INDIVIDUAL OR GROUP POLICY. Regarding a

natural or adopted child of an insured or group member or a child

for whom the insured or group member must provide medical support

under an order issued under Chapter 154, Family Code, or

enforceable by a court in this state, an individual or group

accident and health insurance policy that provides coverage for a

child of an insured or group member may not set a different

premium for the child, exclude the child from coverage, or

discontinue coverage of the child because:

(1) the child does not reside with the insured or group member;

(2) the insured or group member does not claim the child as an

exemption for federal income tax purposes under Section

151(c)(1)(B), Internal Revenue Code of 1986.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.064. COVERAGE FOR CHILD OF SPOUSE IN INDIVIDUAL OR

GROUP POLICY. An individual or group accident and health

insurance policy that provides coverage for a child of an insured

or group member may not:

(1) set a premium for a child that is different from the premium

for other children because the child is the natural or adopted

child of the spouse of the insured or group member;

(2) exclude a child described by Subdivision (1) from coverage;

(3) discontinue coverage of a child described by Subdivision

(1).

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.065. AGE AND SCHOOL ENROLLMENT ELIGIBILITY CRITERIA

FOR DEPENDENT CHILDREN IN INDIVIDUAL OR GROUP POLICY; LATE

ENROLLMENT. (a) An individual or group accident and health

insurance policy may contain criteria relating to a maximum age

or enrollment in school to establish continued eligibility for

coverage of a child 25 years of age or older.

(b) In the case of a late enrollment, an insurer may require

evidence of insurability that is satisfactory to the insurer

before a child is included for coverage under the policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.023(a), eff. September 1, 2005.

SUBCHAPTER C. GENERAL POLICY STANDARDS AND PROVISIONS

Sec. 1201.101. STANDARDS FOR POLICY PROVISIONS. (a) The

commissioner shall adopt reasonable rules establishing specific

standards for:

(1) the content of an individual accident and health insurance

policy; and

(2) the manner of sale of an individual accident and health

insurance policy, including disclosures required to be made in

connection with the sale.

(b) Rules adopted under this section must establish standards

for:

(1) policy readability; and

(2) full and fair policy disclosures.

standards that address:

(1) terms of policy renewability;

(2) initial and subsequent conditions of eligibility;

(3) nonduplication of coverage;

(4) coverage of dependents;

(5) preexisting conditions;

(6) termination of insurance;

(7) probationary periods;

(8) limitations;

(9) exceptions;

(10) reductions;

(11) elimination periods;

(12) requirements for replacement;

(13) recurrent conditions; and

(14) definitions of terms, including definitions of:

(A) "accident";

(B) "accidental means";

(D) "hospital";

(E) "injury";

(F) "nervous disorder";

(G) "partial disability";

(H) "physician";

(I) "sickness"; and

(J) "total disability."

(d) A definition of "hospital" adopted under Subsection (c) may

not apply to a corporation operating under Chapter 842.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.102. PROHIBITION OF POLICY PROVISIONS. The

commissioner may adopt rules prohibiting specific individual

accident and health insurance policy provisions not specifically

authorized by statute that the commissioner determines are

unjust, unfair, or unfairly discriminatory to:

(1) the policyholder;

(2) an insured under the policy; or

(3) a beneficiary.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.103. COMPLIANCE WITH MINIMUM STANDARDS FOR BENEFITS.

(a) An individual accident and health insurance policy must meet

the minimum standards for benefits established under Section

1201.104 for each category of coverage provided under the policy.

(b) Subsection (a) does not apply if the commissioner determines

that the policy is a supplemental policy or experimental policy

or determines that the policy will fulfill a reasonable public

need and the policy meets the requirements of Chapter 1701.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.104. MINIMUM STANDARDS FOR BENEFITS. (a) For

individual accident and health insurance policies, the

commissioner shall adopt rules establishing minimum standards for

benefits under each of the following categories of coverage:

(1) basic hospital expense;

(2) basic medical-surgical expense;

(3) hospital confinement indemnity;

(4) major medical expense;

(5) disability income protection;

(6) accident only;

(7) specified disease;

(8) specified accident; and

(9) limited benefit.

(b) This section does not prohibit the issuance of an individual

accident and health insurance policy that combines categories of

coverage listed by this section.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.105. MINIMUM STANDARDS FOR BENEFITS FOR LONG-TERM CARE

IN INDIVIDUAL, GROUP, OR BLANKET POLICY. (a) The commissioner

shall adopt rules establishing minimum standards for benefits for

long-term care coverage under individual, group, and blanket

accident and health insurance policies and certificates delivered

or issued for delivery in this state.

(b) Rules adopted under this section apply to group coverages

delivered or issued for delivery by a corporation operating under

Chapter 842.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.106. IDENTIFICATION OF POLICIES ACCORDING TO COVERAGE

PROVIDED. The commissioner shall prescribe the method to

identify an individual accident and health insurance policy

according to the coverages the policy provides.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.107. OUTLINE OF COVERAGE REQUIRED. (a) An outline of

coverage for an individual accident and health insurance policy

must be delivered to the applicant at the time application is

made, and an acknowledgment of receipt or certificate of delivery

of an outline of coverage must be provided to the insurer with

the application.

(b) If the policy issued differs from the policy for which the

applicant applied, an outline of coverage that properly describes

the policy must:

(1) accompany the policy when delivered; and

(2) clearly state that the policy is not the policy for which

the applicant applied.

product.

(d) An outline of coverage under a direct response insurance

product must accompany the policy.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.108. FORMAT AND CONTENT OF OUTLINE OF COVERAGE. (a)

In this section, "format" means style, arrangement, and overall

appearance, including:

(1) the size, color, and prominence of type; and

(2) the arrangement of text and captions.

(b) The commissioner shall prescribe the format and content of

an outline of coverage required by Section 1201.107.

(1) a statement that identifies the applicable categories of

coverage listed by Section 1201.104 and provided by the policy;

(2) a description of the principal benefits and coverage

provided by the policy;

(3) a statement of the exceptions, reductions, and limitations

in the policy;

(4) a statement of the renewal provision, including any

reservation of the insurer's right to change premiums;

(5) a statement that:

(A) the outline is a summary of the policy issued or applied

for; and

(B) the policy should be consulted to determine governing

contractual provisions;

(6) as the commissioner determines necessary to carry out the

purposes of this chapter, a summary of the provisions required by

Subchapter E to be in the policy; and

(7) any other statement, description, or outline that the

commissioner determines is reasonably necessary to carry out the

purposes of this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

SUBCHAPTER D. PREEXISTING CONDITIONS

Sec. 1201.151. COMPLIANCE WITH SUBCHAPTER; PROHIBITION OF

DEFENSE. Except as provided by this subchapter, an individual

accident and health insurance policy may not include a provision

that permits a defense based on a preexisting condition.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.152. COVERAGE UNDER SIMPLIFIED APPLICATION FORM. (a)

Notwithstanding Clause (b) of the provision required by Section

1201.208(a), an individual accident and health insurance policy

must cover any loss that occurs after 12 months from a

preexisting condition if the insurer uses a simplified

application form that does not include a question concerning the

applicant's health history or medical treatment history.

(b) This section applies regardless of whether the simplified

application form includes a question regarding the applicant's

health at the time of application.

from a condition that the policy specifically excludes from

coverage.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.153. COVERAGE FOR INDIVIDUALS AGE 65 OR OLDER. (a)

Notwithstanding Section 1201.152 or Clause (b) of the provision

required by Section 1201.208(a), an individual accident and

health insurance policy delivered or issued for delivery to an

individual who is 65 years of age or older may not include a

provision that excludes from coverage a loss that occurs from a

preexisting condition more than six months after the effective

date of coverage under the policy.

(b) Notwithstanding Subsection (a), the commissioner may

authorize a policy provision that excludes coverage for a

preexisting condition for a period of not more than one year if

the commissioner determines that the provision would serve the

public interest.

for a loss from a preexisting condition specifically excluded

from coverage by name or specific description in an exclusion

endorsement or rider that is effective on the date of the loss.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.154. COVERAGE FOR CERTAIN PREVIOUSLY COVERED PERSONS.

(a) In this section, "creditable coverage" has the meaning

assigned by Section 1205.004(a).

(b) A preexisting condition provision in an individual accident

and health insurance policy may not apply to an individual who

was continuously covered for an aggregate period of 18 months by

creditable coverage that was in effect up to a date not more than

63 days before the effective date of the individual coverage,

excluding any waiting period.

an individual accident and health insurance policy applies to an

individual, an insurer shall credit the time the individual

previously was covered under creditable coverage if the previous

coverage was in effect at any time during the 18 months preceding

the effective date of the individual coverage.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Amended by:

Acts 2005, 79th Leg., Ch.

728, Sec. 11.024, eff. September 1, 2005.

Acts 2007, 80th Leg., R.S., Ch.

1070, Sec. 1, eff. June 15, 2007.

SUBCHAPTER E. REQUIRED POLICY PROVISIONS

Sec. 1201.201. POLICY PROVISIONS REQUIRED. (a) Except as

provided by Subsections (b) and (c), an individual accident and

health insurance policy must contain the provisions required by

this subchapter in the words provided by this subchapter.

(b) An insurer may substitute for a policy provision required by

this subchapter a provision with different wording approved by

the commissioner in accordance with reasonable rules adopted by

the commissioner. A substituted provision may not be less

favorable to an insured or a beneficiary of the policy than the

provision required by this subchapter.

or partly inapplicable to or inconsistent with the coverage

provided by a particular form of policy, the insurer, with the

commissioner's approval, shall:

(1) omit from the policy each inapplicable provision or part of

a provision; and

(2) modify each inconsistent provision or part of a provision so

that the provision as contained in the policy is consistent with

the coverage provided by the policy.

(d) A policy provision required by this subchapter must be

preceded by the caption for the provision provided by this

subchapter or, at the option of the insurer, by an appropriate

individual or group caption or subcaption approved by the

commissioner.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.202. ORDER OF REQUIRED POLICY PROVISIONS. (a) Except

as provided by Subsection (b), policy provisions required by this

subchapter or corresponding substitute provisions must be printed

in the same consecutive order as provided by this subchapter.

(b) An insurer may print a policy provision required by this

subchapter or a corresponding substitute provision as a unit in

any part of the policy with other provisions to which the

provision is logically related.

partly unintelligible, uncertain, ambiguous, abstruse, or likely

to mislead a person to whom the policy is offered, delivered, or

issued.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.203. OTHER POLICY PROVISIONS. A policy provision that

is not otherwise subject to this subchapter may not make an

individual accident and health insurance policy or any portion of

the policy less favorable in any way to the insured or the

beneficiary than the policy provisions that are subject to this

chapter.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.204. POLICY PROVISIONS REQUIRED BY OTHER JURISDICTION.

An individual accident and health insurance policy of a foreign

or alien insurer may contain any provision that is:

(1) not less favorable to the insured or the beneficiary than

the provisions of this chapter; and

(2) prescribed or required by the law of the state under which

the insurer is organized.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.205. POLICY PROVISIONS FOR POLICY DELIVERED OUTSIDE

THIS STATE. An individual accident and health insurance policy

issued by a domestic insurer for delivery in another state or

country may contain any provision permitted or required by the

laws of that state or country.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.206. FILING PROCEDURE. (a) The commissioner may

adopt reasonable rules regarding the procedure for submitting

policies subject to this chapter that are necessary, proper, or

advisable for the administration of this chapter.

(b) This section does not limit any authority otherwise granted

by law to the commissioner or department.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.207. POLICY PROVISION: ENTIRETY OF CONTRACT; POLICY

CHANGES. An individual accident and health insurance policy must

contain the following provision:

"Entire Contract; Changes: This policy, including the

endorsements and the attached papers, if any, constitutes the

entire contract of insurance. A change in this policy is not

valid until the change is approved by an executive officer of the

insurer and unless the approval is endorsed on or attached to the

policy. An agent does not have authority to change this policy or

to waive any of its provisions."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.208. POLICY PROVISION: INCONTESTABILITY. (a) Except

as provided by Subsection (c), an individual accident and health

insurance policy must contain the following provision:

"Time Limit on Certain Defenses: (a) After the second anniversary

of the date this policy is issued, a misstatement, other than a

fraudulent misstatement, made by the applicant in the application

for the policy may not be used to void the policy or to deny a

claim for loss incurred or disability (as defined in the policy)

beginning after that anniversary.

"(b) A claim for loss incurred or disability (as defined in the

policy) beginning after the second anniversary of the date this

policy is issued may not be reduced or denied on the ground that

a disease or physical condition not excluded from coverage by

name or specific description effective on the date of loss

existed before the effective date of coverage of this policy."

(b) Clause (a) of the provision required by Subsection (a) does

not:

(1) affect any legal requirement for avoidance of a policy or

denial of a claim during the initial two-year period; or

(2) limit the application of Section 1201.219, 1201.220, or

1201.221 in a case of a misstatement regarding age, occupation,

or other insurance.

continue the policy in force by the timely payment of premiums

until the insured reaches at least 50 years of age or, if the

policy was issued after the insured reached 44 years of age,

until at least the fifth anniversary of the policy's date of

issuance, an insurer may use the following clause instead of

Clause (a) of the provision required by Subsection (a):

"After this policy has been in force for a period of two years

during the lifetime of the insured (excluding any period during

which the insured is disabled), it shall become incontestible as

to the statements contained in the application."

(d) The provision provided by Subsection (c) must be under the

caption "Incontestable." An insurer that uses the provision may

omit the parenthetical clause.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.209. POLICY PROVISION: GRACE PERIOD. (a) An

individual accident and health insurance policy must contain the

following provision:

"Grace Period: A grace period of __________ (insert appropriate

number) days will be granted for the payment of each premium due

after the first premium. During the grace period, the policy

continues in force."

(b) The number of days of the grace period may not be less than:

(1) 7 for a weekly premium policy;

(2) 10 for a monthly premium policy; or

(3) 31 for any other policy.

the end of the provision required by Subsection (a): "subject to

the right of the insurer to cancel the policy in accordance with

the policy's cancellation provision."

(d) A policy in which the insurer reserves the right to refuse

any renewal must include the following provision at the beginning

of the provision required by Subsection (a):

"Unless, not less than five days before the premium due date, the

insurer has delivered to the insured, or has mailed to the

insured's last address as shown by the insurer's records, a

written notice of the insurer's intention not to renew this

policy beyond the period for which the premium has been accepted,

...."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.210. POLICY PROVISION: REINSTATEMENT. (a) Except as

provided by Subsection (b), an individual accident and health

insurance policy must contain the following provision:

"Reinstatement: If a renewal premium is not paid before the

expiration of the period granted for the insured to make the

payment, a subsequent acceptance of the premium by the insurer or

any agent authorized by the insurer to accept the premium,

without requiring in connection with the acceptance an

application for reinstatement, reinstates the policy. However, if

the insurer or authorized agent requires an application for

reinstatement and issues a conditional receipt for the premium

tendered, the policy will be reinstated on approval of the

application by the insurer or, if the application is not

approved, on the 45th day after the date of the conditional

receipt unless the insurer before that date has notified the

insured in writing of the insurer's disapproval of the

application. The reinstated policy covers only loss resulting

from an accidental injury sustained after the date of

reinstatement and loss due to sickness that begins more than 10

days after the date of reinstatement. In all other respects the

insured and insurer have the same rights under the reinstated

policy as they had under the policy immediately before the due

date of the defaulted premium, subject to any provisions endorsed

in the policy or attached to the policy in connection with the

reinstatement. Any premium accepted in connection with a

reinstatement shall be applied to a period for which premium has

not been previously paid, but not to any period more than 60 days

before the date of reinstatement."

(b) The insurer may omit the last sentence of the provision

required by Subsection (a) in a policy that provides that the

insured is entitled to continue the policy in force by the timely

payment of premiums until the insured reaches at least 50 years

of age or, if the policy was issued after the insured reached 44

years of age, until at least the fifth anniversary of the

policy's date of issuance.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.211. POLICY PROVISION: NOTICE OF CLAIM. (a) Except

as provided by Subsection (b), an individual accident and health

insurance policy must contain the following provision:

"Notice of Claim: A written notice of claim must be given to the

insurer before the 21st day after the date of the occurrence or

beginning of any loss covered by the policy, or as soon after

that date as is reasonably possible. A notice given by or on

behalf of the insured or the beneficiary to the insurer at

__________ (insert the location of any office the insurer

designates for the purpose), or to any authorized agent of the

insurer, with information sufficient to identify the insured,

constitutes notice to the insurer."

(b) In a policy that provides a loss of time benefit that may be

payable for at least two years, an insurer may insert, between

the first and second sentences of the provision required by

Subsection (a), the following provision:

"Subject to the qualifications below, and except in the event of

a legal incapacity, if the insured suffers loss of time on

account of disability for which indemnity may be payable for at

least two years, the insured shall, at least once in every

__________ (insert appropriate number) months after having given

notice of claim, give to the insurer notice of continuance of the

disability. In applying this provision, the period of __________

(insert appropriate number) months following a filing of proof by

the insured or any payment by the insurer on account of the claim

or any denial of liability in whole or in part by the insurer

shall be excluded. Delay in giving the notice does not impair the

insured's right to any indemnity that would otherwise have

accrued during the period of __________ (insert appropriate

number) months preceding the date on which the notice is actually

given."

Subsection (b) may not be less than one or greater than six.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.212. POLICY PROVISION: CLAIM FORMS. (a) Except as

provided by Subsection (b), an individual accident and health

insurance policy must contain the following provision:

"Claim Forms: The insurer, on receipt of a notice of claim, will

provide to the claimant the forms usually provided by the insurer

for filing proof of loss. If the forms are not provided before

the 16th day after the date of the notice, the claimant shall be

considered to have complied with the requirements of this policy

as to proof of loss on submitting, within the time fixed in the

policy for filing proofs of loss, written proof covering the

occurrence, the character, and the extent of the loss for which

the claim is made."

(b) The provision required by this section is not required to be

contained in a policy issued by a corporation operating under

Chapter 842.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.213. POLICY PROVISION: PROOF OF LOSS. An individual

accident and health insurance policy must contain the following

provision:

"Proof of Loss: For a claim for loss for which this policy

provides any periodic payment contingent on continuing loss, a

written proof of loss must be provided to the insurer at the

insurer's designated office before the 91st day after the

termination of the period for which the insurer is liable. For a

claim for any other loss, a written proof of loss must be

provided to the insurer at the insurer's designated office before

the 91st day after the date of the loss. Failure to provide the

proof within the required time does not invalidate or reduce any

claim if it was not reasonably possible to give proof within the

required time. In that case, the proof must be provided as soon

as reasonably possible but not later than one year after the time

proof is otherwise required, except in the event of a legal

incapacity."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.214. POLICY PROVISION: TIME OF PAYMENT OF CLAIMS. (a)

Except as provided by Subsection (c), an individual accident and

health insurance policy must contain the following provision:

"Time of Payment of Claims: Indemnities payable under this policy

for any loss, other than a loss for which this policy provides

any periodic payment, will be paid immediately on receipt of due

written proof of the loss. Subject to due written proof of loss,

all accrued indemnities for a loss for which this policy provides

periodic payment will be paid __________ (insert period for

payment) and any balance remaining unpaid on termination of

liability will be paid immediately on receipt of due written

proof of loss."

(b) The period for payment to be inserted in the clause required

by Subsection (a) may not be less frequent than monthly.

contained in a policy issued by a corporation operating under

Chapter 842.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.215. POLICY PROVISION: PAYMENT OF CLAIMS. (a) Except

as provided by Subsection (d), an individual accident and health

insurance policy must contain the following provision:

"Payment of Claims: Indemnity for loss of life will be payable in

accordance with the beneficiary designation and the provisions

respecting indemnity payments that may be prescribed in this

policy and effective at the time of payment. If such a

designation or provision is not then effective, the indemnity

will be payable to the insured's estate. Any other accrued

indemnities unpaid at the insured's death may, at the option of

the insurer, be paid either in accordance with the beneficiary

designation or to the insured's estate. All other indemnities

will be payable to the insured."

(b) An insurer may include with the provision required by

Subsection (a) one or both of the following provisions:

"If any indemnity of this policy is payable to the insured's

estate, or to an insured or beneficiary who is a minor or is

otherwise not competent to give a valid release, the insurer may

pay the indemnity, up to an amount not exceeding $__________

(insert amount), to any relative by blood or connection by

marriage of the insured or beneficiary who is considered by the

insurer to be equitably entitled to the indemnity. Any payment

made by the insurer in good faith in accordance with this

provision fully discharges the insurer to the extent of the

payment."

"Subject to any written direction of the insured, in the

application or otherwise, all or a portion of any indemnity

provided by this policy on account of hospital, nursing, medical,

or surgical services may, at the insurer's option and unless the

insured requests otherwise in writing not later than the time of

filing proof of the loss, be paid directly to the hospital or

person providing the services. It is not required that the

service be provided by a particular hospital or person."

Subsection (b) may not exceed $1,000.

(d) The provision required by Subsection (a) is not required to

be contained in a policy issued by a corporation operating under

Chapter 842.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.216. POLICY PROVISION: PHYSICAL EXAMINATIONS AND

AUTOPSY. An individual accident and health insurance policy must

contain the following provision:

"Physical Examinations and Autopsy: The insurer at its own

expense has the right and opportunity to conduct a physical

examination of the insured when and as often as the insurer

reasonably requires while a claim under the policy is pending

and, in case of death, to require that an autopsy be conducted if

not forbidden by law."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.217. POLICY PROVISION: LEGAL ACTIONS. An individual

accident and health insurance policy must contain the following

provision:

"Legal Actions: An action at law or in equity may not be brought

to recover on this policy before the 61st day after the date

written proof of loss has been provided in accordance with the

requirements of this policy. An action at law or in equity may

not be brought after the expiration of three years after the time

written proof of loss is required to be provided."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.218. POLICY PROVISION: CHANGE OF BENEFICIARY. (a)

Except as provided by Subsection (b), an individual accident and

health insurance policy must contain the following provision:

"Change of Beneficiary: Unless the insured makes an irrevocable

designation of beneficiary, the right to change a beneficiary is

reserved for the insured, and the consent of the beneficiary or

beneficiaries is not required for the surrender or assignment of

this policy, for any change of beneficiary or beneficiaries, or

for any other changes in this policy."

(b) An insurer may omit the first clause of the provision

required by Subsection (a) relating to an irrevocable designation

of beneficiary.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.219. POLICY PROVISION: CHANGE OF OCCUPATION. An

individual accident and health insurance policy must contain the

following provision if the policy addresses the subject matter of

the provision:

"Change of Occupation: If the insured is injured or contracts a

sickness after the insured changes the insured's occupation to

one classified by the insurer as more hazardous than the

occupation stated in this policy or while doing for compensation

anything pertaining to an occupation so classified, the insurer

will pay only the portion of the indemnity provided in this

policy as the premium paid would have purchased at the rates and

within the limits fixed by the insurer for the more hazardous

occupation. If the insured changes the insured's occupation to

one classified by the insurer as less hazardous than the

occupation stated in this policy, the insurer, on receipt of

proof of the change of occupation, will reduce the premium rate

accordingly, and will return the excess pro rata unearned premium

from the date of change of occupation or from the policy

anniversary date immediately preceding the receipt of the proof,

whichever date is more recent. In applying this provision, the

classification of occupational risk and the premium rates are the

classification and rates that, before the occurrence of the loss

for which the insurer is liable or before the date of proof of

change in occupation, were:

(1) last filed by the insurer with the state official having

supervision of insurance in the state where the insured resided

at the time this policy was issued; or

(2) if filing was not required, last made effective by the

insurer in the state where the insured resided at the time this

policy was issued."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.220. POLICY PROVISION: MISSTATEMENT OF AGE. An

individual accident and health insurance policy must contain the

following provision if the policy addresses the subject matter of

the provision:

"Misstatement of Age: If the age of the insured has been

misstated, the amounts payable under this policy are the amounts

the premium paid would have purchased at the correct age."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.221. POLICY PROVISION: EXCESS INSURANCE. An

individual accident and health insurance policy must contain one

of the following provisions if the policy addresses the subject

matter of the provision:

"Other Insurance With This Insurer: If an accident or health or

accident and health policy or policies previously issued by the

insurer to the insured is in force concurrently with this policy,

making the aggregate indemnity for __________ (insert types of

coverages) in excess of $__________ (insert maximum limit of

indemnity or indemnities), the excess insurance is void and all

premiums paid for the excess shall be returned to the insured or

to the insured's estate."

"Other Insurance With This Insurer: Insurance effective at any

one time on the insured under the same type of policy or policies

with this insurer is limited to the one policy elected by the

insured, the insured's beneficiary, or the insured's estate, as

the case may be, and the insurer will return all premiums paid

for all other policies of the same type."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.222. POLICY PROVISION: RELATION OF EARNINGS TO

INSURANCE. (a) Subject to Subsection (b), an individual

accident and health insurance policy must contain the following

provision if the policy addresses the subject matter of the

provision:

"Relation of Earnings to Insurance: If the total monthly amount

of loss of time benefits promised for the same loss under all

valid loss of time coverage on the insured, regardless of whether

the benefits are payable on a weekly or monthly basis, exceeds

the amount of monthly earnings of the insured at the time the

insured's disability began or the insured's average amount of

monthly earnings for the period of two years immediately

preceding a disability for which claim is made, whichever amount

is greater, the insurer will be liable only for the proportionate

amount of loss of time benefits under this policy as the amount

of the insured's monthly earnings or average monthly earnings

bears to the total amount of monthly benefits for the same loss

under all loss of time coverage on the insured at the time the

disability begins and for the return of the part of the premiums

paid during the immediately preceding two years that exceeds the

pro rata amount of the premiums for the benefits actually paid

under this policy. This provision does not reduce the total

monthly amount of benefits payable under all loss of time

coverage on the insured to less than $200 or the sum of the

monthly benefits specified in the loss of time coverages,

whichever amount is less, and does not reduce benefits other than

loss of time benefits."

(b) The provision described by Subsection (a) may be included

only in a policy that provides that the insured is entitled to

continue the policy in force subject to its terms by the timely

payment of premiums until the insured reaches at least 50 years

of age or, if the policy was issued after the insured reached 44

years of age, until at least the fifth anniversary of the

policy's date of issuance.

Subsection (a) a definition of "valid loss of time coverage." The

form of the definition must be approved by the commissioner. The

subject matter of the definition must be limited to:

(1) coverage provided by:

(A) governmental agencies; or

(B) organizations subject to regulation by insurance laws or by

insurance authorities of this or any other state or any province

of Canada;

(2) any other coverage the inclusion of which is approved by the

commissioner; or

(3) any combination of coverages described by Subdivisions (1)

and (2).

(d) In the absence of a definition authorized under Subsection

(c), "valid loss of time coverage" does not include:

(1) coverage provided for the insured under a compulsory benefit

statute, including a workers' compensation or employer's

liability statute; or

(2) benefits provided by:

(A) a union welfare plan;

(B) an employer benefit organization; or

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.223. POLICY PROVISION: UNPAID PREMIUM. An individual

accident and health insurance policy must contain the following

provision if the policy addresses the subject matter of the

provision:

"Unpaid Premium: At the time of payment of a claim under this

policy, any premium then due and unpaid or covered by any note or

written order may be deducted from the payment."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.224. POLICY PROVISION: CANCELLATION. An individual

accident and health insurance policy must contain the following

provision if the policy addresses the subject matter of the

provision:

"Cancellation: The insurer may cancel this policy at any time by

written notice delivered to the insured, or mailed to the

insured's last address as shown by the records of the insurer,

stating when the cancellation is effective, which may not be

earlier than five days after the date the notice is delivered or

mailed. After this policy has been continued beyond its original

term, the insured may cancel the policy at any time by written

notice delivered or mailed to the insurer, effective on receipt

or on a later date specified in the notice. In the event of

cancellation, the insurer will promptly return the unearned

portion of any premium paid. If the insured cancels, the earned

premium shall be computed by the use of the short-rate table last

filed with the state official having supervision of insurance in

the state where the insured resided when the policy was issued.

If the insurer cancels, the earned premium shall be computed pro

rata. Cancellation is without prejudice to any claim originating

before the effective date of cancellation."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.225. POLICY PROVISION: CONFORMITY WITH STATE STATUTES.

An individual accident and health insurance policy must contain

the following provision if the policy addresses the subject

matter of the provision:

"Conformity With State Statutes: Any provision of this policy

that, on its effective date, conflicts with the statutes of the

state in which the insured resides on the effective date is by

this clause effectively amended to conform to the minimum

requirements of that state's statutes."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1201.226. POLICY PROVISION: ILLEGAL OCCUPATION. An

individual accident and health insurance policy must contain the

following provision if the policy addresses the subject matter of

the provision:

"Illegal Occupation: The insurer is not liable for any loss to

which a contributing cause was the insured's commission of or

attempt to commit a felony or to which a contributing cause was

the insured's being engaged in an illegal occupation."

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

State Codes and Statutes

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