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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER YSTANDARDS 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 2NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE
RULE §3.3806Initial and Subsequent Conditions of Eligibility

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.


Source Note: The provisions of this §3.3806 adopted to be effective August 10, 2000, 25 TexReg 7354

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