Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter Y - STANDARDS FOR LONG-TERM CARE INSURANCE, NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE COVERAGE UNDER INDIVIDUAL AND GROUP POLICIES AND ANNUITY CONTRACTS, AND LIFE INSURANCE POLICIES THAT PROVIDE LONG-TERM CARE BENEFITS WITHIN THE POLICY
Division 2 - NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE
Section 3.3806 - Initial and Subsequent Conditions of Eligibility

Universal Citation: 28 TX Admin Code § 3.3806

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

A long-term care insurance policy and/or certificate shall contain a provision which sets forth the individuals eligible to be covered under the policy and/or certificate and which specifies the conditions applicable to an individual who may become covered under the policy and/or certificate by subsequent addition.

(1) Eligible individuals may include:

(A) for group coverage:
(i) the prospective certificate holder (the individual whose employment or other membership status, except for family dependency, is the basis for eligibility for enrollment under the group policy);

(ii) the certificate holder's spouse;

(iii) the certificate holder's children;

(iv) the certificate holder's spouse's children;

(v) the certificate holder's parents;

(vi) the certificate holder's spouse's parents; and

(vii) any other individual included as an eligible individual under a long-term care policy.

(B) For individual coverage:
(i) the prospective policyholder;

(ii) the policyholder's spouse;

(iii) the policyholder's children;

(iv) the policyholder's spouse's children;

(v) the policyholder's parents;

(vi) the policyholder's spouse's parents; and

(vii) any other individual included as an eligible individual under a long-term care policy.

(2) The provision shall state the conditions under which coverage will become effective for an individual who becomes insured subsequent to policy and/or certificate issuance. Such conditions shall include:

(A) any requirements relating to evidence of insurability;

(B) any requirements relating to the necessity of application or notice from the individual;

(C) any requirements relating to the payment of premiums as to such addition; and

(D) the time within which any action is to be taken by the individual.

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