28 Tex. Admin. Code § 21.4805 - Disclosure Requirements for Form Filings that Include Noninsurance Benefits

A policy, contract or certificate form filing that includes a noninsurance benefit shall also include the items set out in paragraphs (1) - (3) of this section:

(1) A description of the noninsurance benefit must be provided. The description must be sufficiently specific to provide information about the nature, character, purpose and scope of the benefit.

(2) A notice fully disclosing the noninsurance benefit to the policyholder, contract holder or certificate holder must be provided. Full disclosure includes the following:

(A) an explanation of how the noninsurance benefit may be obtained;

(B) a statement disclosing:

(i) whether acceptance or declination of the noninsurance benefit is optional to the policyholder, contract holder, certificate holder or, as applicable, other individual covered person;

(ii) the identifiable charge and amount, if any, for a noninsurance benefit that an individual covered person has the option to accept or decline;

(iii) the means by which the policyholder, contract holder, certificate holder or other person entitled to the benefit may obtain the benefit in the event the provider of the benefit, if other than the insurer, fails to provide or to continue to provide the benefit as set out in the policy, contract or certificate; and

(C) a statement providing information about the nature, character and purpose of the benefit, as well as any limitations associated with or applicable to the benefit.

(3) A statement explaining any condition on which termination of the noninsurance benefit will occur must be provided. The statement must include a reasonable notice and pre-termination period in circumstances where the condition triggering termination is the insurer's decision to discontinue offering or providing the benefit.

Notes

28 Tex. Admin. Code § 21.4805

The provisions of this §21.4805 adopted to be effective January 4, 2010, 35 TexReg 99