Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter E - GROUP LIFE, AND/OR GROUP ACCIDENT AND HEALTH INSURANCE POLICIES AND CERTIFICATES
Section 3.408 - Mandatory Policy Provisions

Universal Citation: 28 TX Admin Code § 3.408

Current through Reg. 50, No. 13; March 28, 2025

(a) Each group policy of accident and sickness insurance that is delivered, issued for delivery, or renewed in Texas on or after January 1, 1988, including a policy issued by a company subject to Insurance Code Chapter 842, must contain a benefit provision which states, "All benefits paid on behalf of the child or children under the policy must be paid to the Texas Health and Human Services Commission" whenever:

(1) the Texas Health and Human Services Commission is paying benefits under Human Resources Code Chapter 31 or Chapter 32, i.e., financial and medical assistance service programs administered pursuant to the Human Resources Code; and

(2) the parent who is covered by the group policy has possession or access to the child pursuant to a court order, or is not entitled to access or possession of the child and is required by the court to pay child support.

(b) The insurer or group nonprofit hospital service company must receive at its home office, written notice affixed to the insurance claim that when the claim is first submitted, and the notice must state that all benefits paid pursuant to this section must be paid directly to the Texas Health and Human Services Commission.

(c) With respect to any policy forms approved by the Texas Department of Insurance prior to the effective date of this section, an insurer is authorized to achieve compliance with this section by the use of endorsements or riders, provided such endorsements or riders are approved by the Texas Department of Insurance as being in compliance with this section and the provisions of the Insurance Code.

(d) All policies issued or renewed on and after January 1, 1988, will be considered in compliance with this section if they contain the language prescribed within subsection (a) of this section.

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