Current through Reg. 50, No. 13; March 28, 2025
(a) The purpose of this section is to define
short-term limited-duration insurance and address requirements for short-term
limited-duration coverage. This section applies to any individual or group
accident and health insurance policy or certificate issued under Insurance Code
Chapters 1201 or 1251.
(b) For the
purposes of Chapters 3, 21, and 26 of this title, "short-term limited-duration
insurance" has the meaning given in Insurance Code §
1509.001.
(c) An individual policy or group certificate
of short-term limited-duration insurance must provide benefits consistent with
the minimum standards for the type of coverage offered.
(d) Short-term limited-duration coverage,
including individual policies and group certificates:
(1) may not be marketed as guaranteed
renewable;
(2) must be marketed
either as nonrenewable, or renewable (without new underwriting) at the option
of the policyholder or enrollee, if the enrollee contributes to the
premium;
(3) must clearly state the
duration of the initial term and the total maximum duration including any
renewal options;
(4) may not be
modified after the date of issue, except by signed acceptance of the
policyholder or the enrollee, if the enrollee contributes to the premium;
and
(5) if coverage is renewable, a
short-term limited-duration individual policy or group certificate must:
(A) include a statement that the enrollee has
a right to continue the coverage in force by timely payment of premiums for the
number of terms listed;
(B) include
a statement that the issuer will not increase premium rates or make changes in
provisions in the policy, or certificate, on renewal based on individual health
status;
(C) if applicable, include
a statement that the issuer retains the right, at the time of policy renewal,
to make changes to premium rates by class; and
(D) include a statement that the issuer, at
the time of renewal, may not deny renewal based on individual health
status.
(e)
An issuer offering short-term limited-duration insurance must include an
accurate written disclosure form that is consistent with the form and
instructions prescribed in Figure: 28 TAC §
3.3602(e) and
the requirements of this section.
Attached
Graphic
(f) In
creating a disclosure form, issuers must follow all instructions provided in
this subsection:
(1) The disclosure must be
produced for each plan option that the issuer makes available and reflect the
specific terms of the plan.
(2) The
disclosure form must accurately represent the short-term limited-duration
coverage being provided.
(3) If the
disclosure form provided in Figure 28 TAC §
3.3602(e) does
not accurately represent the plan being offered, the issuer may modify the form
as necessary. When filing the form with the department, the issuer must clearly
identify any changes made and explain the reason for modifying the
form.
(4) The chart under
disclosure form paragraph (9) may be supplemented to include cost-sharing
information for each benefit.
(5)
The disclosure form provided in Figure 28 TAC §
3.3602(e) (the
disclosure form) may be combined with the outline of coverage required under
§
3.3093(4) of
this title (the outline of coverage) only if the combined disclosure form and
outline of coverage is assembled and combined in the following order:
(A) "Is this short-term health insurance plan
right for me?" followed by the plan marketing name, name of issuer, and
paragraph (1) of the outline of coverage;
(B) paragraph (2) of the outline of coverage
is replaced with paragraphs (1) through (8) of the disclosure form;
(C) paragraph (3) of the outline of coverage
is combined with paragraph (9) of the disclosure form, using as a minimum, the
information contained in the chart in paragraph (9) of the disclosure
form;
(D) paragraph (4) of the
outline of coverage;
(E) paragraph
(5) of the outline of coverage may be removed, as it is addressed in paragraph
(3) of the disclosure form;
(F)
paragraph (6) of the outline of coverage; and
(G) paragraphs (10), (11), and (12) of the
disclosure form.
(g) A disclosure form under this section must
be:
(1) filed with the department for review
before use, consistent with filing procedures in Subchapter A of this
chapter;
(2) provided in writing to
a prospective enrollee:
(A) before the
individual completes an application or makes an initial premium payment,
application fee, or other fee; and
(B) at the time the policy or certificate is
issued; and
(3) signed
by the enrollee to acknowledge receipt at the time of application. An
electronic signature is acceptable if the issuer's procedures comply with
Insurance Code Chapter 35.
