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 3.3847 - Qualified Long-Term Care Insurance Contracts: Prohibited Representations
Universal Citation: 28 TX Admin Code § 3.3847
Current through Reg. 50, No. 13; March 28, 2025
(a) In marketing and issuing long-term care insurance contracts in Texas, no person shall state that any such contract is intended to be a "qualified long-term care insurance contract" as defined in § 3.3804 of this title (relating to Definitions) unless the contract:
(1)
provides insurance protection only for services which are "qualified long-term
care services," as defined in §
3.3804 of this title (relating to
Definitions);
(2) does not provide
for a cash surrender value or other money that can be paid, assigned or pledged
as collateral for a loan or borrowed, except on a complete surrender or
cancellation of the contract;
(3)
provides that all refunds of premium and all policyholder dividends or similar
amounts are applied as a reduction in future premiums or to increase future
benefits, except for any refund on the death of the insured, or on a complete
surrender or cancellation of the contract, which cannot exceed the aggregate
premiums paid under the contract;
(4) does not pay or reimburse expenses
incurred under Medicare or which would be reimbursable under Medicare but for
the application of a deductible or coinsurance amount, except expenses which
are reimbursable under Medicare only as a secondary payor; and
(5) otherwise meets the applicable
requirements of this subchapter.
(b) Neither this section, nor any other provision of law, shall be construed or applied so as to prohibit the offering of a long-term care insurance contract on the basis that the contract coordinates its benefits with those provided under Medicare.
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