| (5) group annuity master policies, contracts, certificates,
applications, enrollment forms, riders, amendments, and endorsements
applicable thereto, issued under the authority of Insurance Code §1131.064,
relating to discretionary groups.
(e) Group and individual accident and health forms.
The group and individual accident and health insurance forms specified
in paragraphs (1) - (3) of this subsection are exempt from the review
and approval requirements of Insurance Code Chapter 1701, unless the
forms are required by the laws of Texas, another state, or the United
States, to be specifically approved or are otherwise excepted in subsection
(f) of this section:
(1) the group and blanket accident and health forms
set out in subparagraphs (A) - (D) of this paragraph:
(A) any group accident and health master policies,
contracts, certificates, applications, enrollment forms, riders, amendments,
and endorsements applicable thereto issued under authority of Insurance
Code §1251.051 and §1251.052; provided the forms issued
under authority of Insurance Code §1251.052 are exempt only if
delivered or issued for delivery to a labor union or organization
of labor unions;
(B) any blanket accident and health master policies,
contracts, certificates, applications, enrollment forms, riders, amendments,
and endorsements applicable thereto, issued under authority of Insurance
Code §§1251.351 - 1251.358;
(C) any group master policies, contracts, certificates,
applications, enrollment forms, riders, amendments, and endorsements
applicable thereto, issued under the authority of Insurance Code §§1251.051,
1251.052, or 1251.053 providing Medicare Supplement coverage to an
employer, multiple employer arrangement, or a labor union;
(D) any group master policies, contracts, certificates,
applications, enrollment forms, riders, amendments, and endorsements
applicable thereto, issued under the authority of Insurance Code §1251.051
and §1251.052 providing long-term care coverage to a single employer
or a labor union through a policy which is delivered or issued for
delivery outside of Texas;
(2) group and individual accident and/or health policies,
contracts, certificates, applications, enrollment forms, riders, amendments,
endorsements, and related forms (including but not limited to outlines
of coverage, notices, rates, and conditional receipts) applicable
thereto, providing coverages set forth in subparagraphs (A) - (K)
of this paragraph:
(A) accident only (including occupational accident
and other specified accident);
(B) accidental death and dismemberment;
(C) dental;
(D) in-patient confinement and basic hospital expense
coverages (including policies with coverage on an indemnity or expense-incurred
basis);
(E) vision;
(F) specified disease (including cancer, heart attack,
stroke, and other specifically named diseases);
(G) disability coverages (including but not limited
to income replacement, key-man, buy/sell, and overhead expense);
(H) policies designed to provide conversion coverages;
(I) other permitted coverages which are designed to
supplement other in-force health insurance, including Champus supplements;
(J) group stop loss/excess loss policies containing
an attachment point of $5,000 or more; and
(K) prescription drug policies; and
(3) any alternate face pages filed subsequent to the
original approval of a policy for use with multiple employer trusteed
arrangements as defined in Insurance Code §1251.053.
(f) Exceptions. The provisions of subsection (e) of
this section do not apply to any of the insurance forms set out in
paragraphs (1) - (6) of this section.
(1) The provisions of subsection (e)(2) of this section
do not apply to any group or individual health insurance policy which
provides, on a comprehensive basis for illness and injury, a combination
of hospital, medical, and surgical coverages, including but not limited
to any major medical policies and any limited benefit hospital, medical,
and surgical policies as defined in §3.3079 of this title (relating
to Minimum Standards for Limited Benefit Coverage).
(2) The provisions of subsection (e)(1) and (2) of
this section do not apply to any Medicare supplement policies as defined
in Insurance Code Chapter 1652, except as specifically provided in
subsection (e)(1)(C) of this section.
(3) The provisions of subsection (e)(1) and (2) of
this section do not apply to any long-term care policies as defined
in Insurance Code Chapter 1651 (including but not limited to any policies
providing nursing home or home health care coverages), except as specifically
provided in subsection (e)(1)(D) of this section.
(4) The provisions of subsection (e)(1) and (2) of
this section do not apply to any forms which contain preferred provider
benefit plan provisions as defined in §§3.3701 - 3.3706
of this title (relating to Preferred Provider Plans).
(5) The provisions of subsection (e)(1) and (2) of
this section do not apply to any group forms which are issued under
the authority of Insurance Code §1251.056 (discretionary groups).
(6) The provisions of subsection (e)(2)(H) of this
section do not apply to any policy subject to the provisions of Subchapter
F of this chapter (relating to Group Health Insurance Conversion Privilege),
except for policies providing conversion from a policy included as
an exempt form in this section.
(g) Copies of previously approved forms. Any form not
otherwise exempted under this subchapter that is an exact copy of
a previously approved form is exempt from the review and approval
requirements of Insurance Code Chapter 1701. Such forms must be filed
in accordance with and accompanied by the required certification as
prescribed in Subchapter A of this chapter (relating to Submission
Requirements for Filings and Departmental Actions Related to Such
Filings). The certification form required to be used in filing the
certification is "TEXAS POLICY FORM CERTIFICATIONS, Multi-Use Form,"
which also is to be utilized for filing certifications for file-and-use
under Insurance Code §1701.052, as well as for corrections, resubmissions,
substitutions, and filings for forms exempted from review and official
action by this subchapter. Form "TEXAS POLICY FORM CERTIFICATIONS"
is available from the Life and Health Division, has been filed with
the Texas Register Division of the Secretary of State for public inspection,
and is adopted by reference in this subchapter. The form also is reproduced
in full as Figure 1 in §3.4020 of this title (relating to Appendix).
(h) Copies of previously approved forms subsequently
submitted in foreign language (non-English). Any form not otherwise
exempted under this subchapter that is submitted in Braille as an
exact copy of a previously approved form, or any form that has been
translated into a foreign language from its previously approved English
version, is exempt from the review and approval requirements of Insurance
Code Chapter 1701. Such forms must be filed in accordance with and
accompanied by the required certification as prescribed in Subchapter
A of this chapter. The certification form required to be used in filing
the certification is the same as that described in subsection (g)
of this section.
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