| (iii) the insurer or HMO writes business only in Texas
and claims the exception based on receipt of gross first-year premiums
of less than $2 million for the prior calendar year, as reported on
its annual statement; or
(iv) the insurer or HMO claims the exception based
on receipt of gross initial first-year premiums of less than $2 million
for business written in Texas, as reported on its annual statement.
(B) Any insurer or HMO that is authorized to write
business in Texas, but that does not meet the criteria of subparagraph
(A) of this paragraph and that claims an exception based on receipt
of gross first-year premiums of less than $2 million for business
written in this state, must maintain a system by which information
about receipt of first-year premiums for Texas business is tracked
on a calendar-year basis. This information must include the following
information for each new policy written during a calendar year: the
policy number; effective date of the policy; and amount of the first-year
premium received, including any membership fees, assessments, dues,
and any other considerations for the insurance.
(d) Policies in force prior to May 1, 1992, and renewed
on or after May 1, 1992. The notice required to be provided by this
section must be provided with the first premium notice, or other communication
indicating renewal of the coverage mailed or delivered after May 1,
1992.
(1) For all policies, certificates or evidences of
coverage in force prior to May 1, 1992, and renewed by any insurer
or HMO on or after May 1, 1992, the notice required to be provided
by this section must either be mailed or be personally delivered to
the policyholder, certificate holder, or enrollee, except as provided
by paragraph (2) of this subsection.
(2) For all group policies in force prior to May 1,
1992, and renewed by any insurer or HMO on or after May 1, 1992, the
notice required to be provided by this section may be provided to
the group policyholder for delivery to each certificate holder or
enrollee under the group policy, or it may be mailed directly to each
certificate holder or enrollee by the insurer or HMO.
(e) Policies, bonds, annuity contracts, and certificates.
Policies, bonds, annuity contracts, and certificates subject to the
provisions of this section that required prior approval and were approved
or filed before June 1, 2015, may be delivered or issued for delivery
with the notice required by this section without refiling for approval.
(f) Additions to group coverage. When an individual
is added as a certificate holder, annuitant, or enrollee to a policy
or plan issued, delivered, or renewed on or after May 1, 1992, the
notice required by this section must be included as the first, second,
or third page of the certificate, annuity contract, or evidence of
coverage.
|
| Source Note: The provisions of this §1.601 adopted to be effective August 24, 1984, 9 TexReg 4340; amended to be effective June 12, 1990, 15 TexReg 3015; amended to be effective May 1, 1992, 17 TexReg 2776; amended to be effective October 28, 1992, 17 TexReg 7230; amended to be effective January 22, 2007, 32 TexReg 241; amended to be effective June 1, 2015, 40 TexReg 3174 |
