(a) A company must include the certification(s), attachment(s),
and additional information referred to in this section as follows:
(1) A filing must include the following certifications,
as applicable:
(A) Specific certification. Filings submitted as file
and use pursuant to §3.5(a)(2) of this title (relating to Filing
Authorities and Categories) must certify that:
(i) the certification is on behalf of the company;
(ii) the company is bound thereby;
(iii) the company has reviewed, and is familiar with,
all applicable statutes and regulations of this state and of the United
States;
(iv) the company has reviewed the filing; and
(v) to the best of the company's knowledge, information,
and belief, the filing complies in all respects with the applicable
statutes and regulations of this state.
(B) General certification. Filings submitted other
than file and use must certify that:
(i) the certification is on behalf of the company;
(ii) the company is bound thereby;
(iii) the company has reviewed the filing; and
(iv) to the best of the company's knowledge, information,
and belief, the filing complies with the applicable statutes and regulations
of this state.
(2) A company submitting a filing as file and use must,
in addition to providing the certification specified in paragraph
(1) of this subsection, complete the appropriate certification on
the transmittal checklist certifying that:
(A) no corrections to the form have been requested
by the department; and
(B) the form has not been previously disapproved by
the department.
(3) A company submitting a form substantially similar
to a previously approved form or an exact copy of a previously approved
form must provide the certification specified in paragraph (1) of
this subsection, and on the transmittal checklist must provide the
following information and certification(s):
(A) the form number and approval date of the previously
approved form, including the company's name if different from the
submitting company;
(B) a summary of the difference(s) between the previously
approved form and the new form, including a description of any deleted
text, and a clear identification of all changes with new or modified
text underlined; and
(C) a certification that no changes have been made
to the form other than those identified.
(4) A company submitting a form as a substitution of
a previously approved or exempted form must provide the certification
specified in paragraph (1) of this subsection, and on the transmittal
checklist must provide the following information and certification(s):
(A) the form number and approval or exemption date
of the previously approved or exempted form;
(B) a summary of the difference(s) between the previously
approved or exempted form and the new form, including a description
of any deleted text, and a clear identification of all changes with
new or modified text underlined;
(C) a certification that no changes have been made
to the form other than those identified; and
(D) a certification that the original version of the
form has not been issued or otherwise used in Texas, and will not
be issued or used in Texas at any time.
(5) A company submitting a form as a correction to
a pending form must provide the certification specified in paragraph
(1) of this subsection, and on the transmittal checklist must provide
the following information and certification(s):
(A) the form number of the pending form;
(B) the name of the department's form review specialist
who reviewed the form;
(C) the date of notification of any form deficiencies;
(D) the tracking number of the pending form as assigned
by the department;
(E) a summary of the difference(s) between the previously
reviewed form and the corrected form, including a description of any
deleted text, and a clear identification of all changes, with new
or modified text underlined; and
(F) a certification that no changes have been made
to the form other than those identified.
(6) A company submitting a form as a resubmission of
a previously disapproved form must provide the certification specified
in paragraph (1) of this subsection, and on the transmittal checklist
must provide the following information and certification(s):
(A) the form number of the disapproved form;
(B) the name of the department's form review specialist
who reviewed the form;
(C) the date of disapproval by the department;
(D) the tracking number of the disapproved form as
assigned by the department;
(E) a summary of the difference(s) between the disapproved
form and the new form, including a description of any deleted text,
and a clear identification of all changes, with new or modified text
underlined; and
(F) a certification that no changes have been made
to the form other than those identified.
(7) A company submitting a supplemental coverage filing
pursuant to §3.3080 of this title (relating to Supplemental Coverage)
or Insurance Code §1131.051 or §1131.053 must complete the
appropriate certification on the transmittal checklist certifying
that the policy will be marketed only as supplemental coverage.
(8) A company submitting a filing as a matrix filing
or as an insert page pursuant to §3.4(f) and (g) of this title
(relating to General Submission Requirements) must, in addition to
providing the certification specified in paragraph (1) of this subsection,
complete the appropriate certification on the transmittal checklist
certifying that, when issued, the policies, certificates, contracts,
riders, or applications created from such forms comply in all respects
with the applicable statutes and regulations of this state and of
the United States with regard to the final product issued.
(9) A company submitting a filing as exempt pursuant
to §3.5(a)(3) of this title (relating to Filing Authorities and
Categories) must, in addition to the certification specified in paragraph
(1) of this subsection, complete the appropriate certification on
the transmittal checklist certifying:
(A) the form filed is not deceptive or misleading;
(B) the form filed does not contain exceptions or conditions
that unreasonably or deceptively affect the risk purported to be assumed
in the general coverages of the policy;
(C) the form filed meets the criteria specified in §3.4004
of this title (relating to Exempt Forms);
(D) the form filed does not contain any new, uncommon,
or unusual provisions, conditions, or concepts as provided in §3.4006
of this title (relating to New, Uncommon, and Unusual Forms);
(E) the company submitting the filed form has had a
certificate of authority to do such business in Texas for a period
not less than two years as required in §3.4007 of this title
(relating to Newly Licensed Insurers); and
(F) the use of the form filed will be discontinued
in the event of future changes in laws or rules that would prohibit
the use of such forms.
(b) A company must include any applicable readability
certifications, in accordance with Subchapter G of this chapter (relating
to Plain Language Requirements for Health Benefit Policies), §3.3092(c)
of this title (relating to Format, Content, and Readability for Outline
of Coverage), §3.3102(g) of this title (relating to Language
Readability), or any other statutes and regulations of this state.
(c) A company submitting a filing for a group policy
or contract must:
(1) on the transmittal checklist, specify the specific
group type under which the form is being filed by indicating the appropriate
section as set forth in Insurance Code Chapter 1131 and Chapter 1251,
or §21.2702(1) and (2) of this title (relating to Definitions)
and for Chapter 26 filings, specify the size of the group. Any filing
submitted under an ineligible group type will not be accepted for
review by the department, and will be returned to the company as incomplete;
(2) submit a separate policy and certificate, each
with a unique identifying form number, for each group type that the
filing will be issued to; and
(3) submit the following required information for certain
group filings.
(A) Filings subject to Insurance Code Chapter 26 of
this title (relating to Employer-Related Health Benefit Plan Regulations)
must comply with all filing requirements set forth in Chapter 26 of
this title.
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