28 Tex. Admin. Code § 3.2 - Definitions
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Amendment or
endorsement--A form that is not a rider that changes or modifies the provisions
of an issued policy, certificate, contract, or evidence of coverage.
(2) Blanket policy or contract--A policy or
contract authorized by Insurance Code Chapter 1251, Subchapter H, concerning
Blanket Accident and Health Insurance: Eligible Policyholders, and issued to a
master group policyholder or contract holder that covers all or nearly all
individuals within a described group or class of individuals without individual
application and without individual underwriting.
(3) Commissioner--The commissioner of
insurance.
(4) Department--The
Texas Department of Insurance.
(5)
Disposition--The final status of a filing, which is issued in writing by the
department and communicated to the issuer upon closing the filing. A
disposition status may include approved, disapproved, exempt, failed audit,
informational, noncompliant, rejected, reviewed, substitution approval, or
withdrawn.
(6) Disposition
date--The date the department issues a disposition on a filing.
(7) Evidence of coverage--Any certificate,
agreement, or contract, including a blended contract, that is issued by an HMO
to an enrollee and states the coverage to which the enrollee is entitled,
consistent with Insurance Code §
1271.051, concerning
Evidence of Coverage: Contract and Certificate Requirements.
(8) Exact copy--A filing that, except for the
issuer's name, address, telephone number, or other similar identification
information, is identical to a form that was previously approved by the
department and is still compliant with current statutes and regulations. A
braille or non-English-language copy of a form that is a direct translation
from the English version of the form is also an exact copy.
(9) Failed audit--A finding made by the
department, consistent with §
3.4008 of this title (relating to
Procedures for Corrections to Non-Compliant Exempt Forms) that a form filed in
an exempt filing mode includes one or more compliance deficiencies.
(10) Filing--A document filed with the
department under this subchapter, including a form filing, rate filing,
advertising filing, group eligibility filing, network filing, or informational
filing.
(11) Filing ID--A unique
identifier assigned to a filing by SERFF (for example, SERFF ID).
(12) Filing types--A designation used to
describe the purpose and contents of a filing, which includes form filings,
rate filings, advertising filings, network filings, group eligibility filings,
and informational filings and the associated categories identified in §
3.1 of this title (relating to
Applicability and Scope).
(13)
Form--A document required to be filed under Insurance Code §
1111A.005, concerning
Requirements for Contract Forms, Disclosure Forms, and Advertisements;
Insurance Code §
1153.051, concerning
Filing of Form; Insurance Code §
1271.101, concerning
Approval of Form of Evidence of Coverage or Group Contract; or Insurance Code §
1701.051, concerning
Filing Required;
(14) Form
number--A unique identifier printed at the lower left-hand corner composed of
numbers or letters that is assigned to a unique form.
(15) General use--A filing classification
that indicates that the filed forms will be used with other forms submitted in
the filing or with previously approved or exempted forms for a certain product
or products or a subset of a product or type (for example, an application that
will be used with all life products, an application that will be used with all
universal life products, an application that will be used with group life and
accident and health products, or an application that will be used with major
medical and dental products).
(16)
HMO--A health maintenance organization as defined in Insurance Code §
843.002, concerning
Definitions.
(17) Insert page--A
form consisting of a page or section of a contract that has a unique
identifiable form number and is used in combination with other forms to create
a complete contract.
(18)
Issuer--An insurance company or HMO that makes a filing under this
subchapter.
(19) Limited, partial
refiling--A change to a previously approved or exempted life or annuity form
that meets one or more of the criteria set forth in subparagraphs (A) - (D) of
this paragraph:
(A) a change in the text,
interest rate, guaranteed charges, or mortality table used to compute
nonforfeiture for life insurance or annuities;
(B) a change in the current interest rate,
where such rates are guaranteed and shown in the policy or contract;
(C) a change in the reserves (if the change
in reserves affects the text of the policy); or
(D) a change to the separate account for
variable products when the separate account is bracketed as variable text on
the initial filing.
(20)
Matrix filing--A filing consisting of individual provisions, each with its own
unique identifiable form number, allowing the flexibility to create multiple
policies, evidences of coverage, certificates, contracts, or applications by
using numerous combinations of the individual provisions.
(21) NAIC--National Association of Insurance
Commissioners.
(22) New
submission--A filing submission type that is applicable to all filings other
than a resubmission subject to Insurance Code §
1701.058, concerning
Reconsideration of Form.
(23)
Personally identifiable information--Facts or details about an individual that
can be used either alone or in combination to distinguish the individual's
identity, such as:
(A) any individual
policyholder's, certificate holder's, or insured's identification, including
name, address, phone number, or email;
(B) social security numbers;
(C) insurance policy, contract, or plan
numbers;
(D) identification
cards;
(E) debit, credit card, bank
account, or routing numbers; or
(F)
health information about an individual.
(24) Product--A package of benefits with a
discrete set of rating and pricing methodologies that will be offered to a
consumer within a single policy, group agreement, evidence of coverage,
certificate, or contract. In the case of health coverage, a product also
includes a particular network type (such as HMO, point of service, preferred
provider, exclusive provider, or indemnity).
(25) Qualified actuary--An actuary who is
certified by the American Academy of Actuaries to meet the U.S. Qualification
Standards.
(26) Resubmission--A
filing submission type that contains corrections made to a form that was
previously disapproved or for which approval has been withdrawn.
(27) Rider--A form that adds or expands
benefits and becomes a part of the policy, group agreement, evidence of
coverage, certificate, or contract.
(28) SERFF--The System for Electronic Rates
& Forms Filing established by the NAIC.
(29) Submission guide--Documentation provided
by the department that includes technical guidance concerning how to submit and
classify filings. The submission guide is available on SERFF and on the
department's website: www.tdi.texas.gov.
(30) Substantially similar--A form that,
except for minor changes that are clearly identified and described in an
accompanying document, is identical to a form that the department previously
approved and is still compliant with current statutes and
regulations.
(31) Substitution--A
new submission that includes a form that replaces a previously approved or
exempted form that has not been and will not be issued or otherwise used in
Texas at any time by the issuer and that has a form number that is the same as
the form it is replacing.
(32)
Supplemental--A type of product that is specifically designed and issued to
supplement other in-force coverage.
(33) Withdrawn filing--A filing that is not
pending the department's review and is not considered approved or exempted,
including a filing that was submitted and subsequently removed from the
department's review for any reason, including at the issuer's request, or by
the department because of an issuer's failure to respond to a request for
information or request for revision.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
The following words and terms, when used in this subchapter, have the following meanings, unless the context clearly indicates otherwise.
(1) Alternate face page --A face page of a group policy, certificate, or contract, which may be used in place of the face page of a previously approved or exempted group policy, certificate, or contract when the group policy, certificate, or contract will be issued to a different or specific group (e.g., a policy that was filed as an "ABC Multiple Employer Trust (MET)" that is later issued to a specific MET).
(2) Department --The Texas Department of Insurance.
(3) Filing --A submission, made to the department by a company, that is accompanied by either a transmittal checklist or a transmittal form, and which may include policies, certificates, contracts, applications, certifications, informational materials, insert pages, riders, limited partial refilings, matrix filings, and rates.
(4) General use --A filing that will be used with other forms submitted in the filing or with previously approved and exempted forms for a certain product or products or a subset of a product or type (e.g., an application that will be used with all life products; an application that will be used with all universal life products; an application that will be used with group life and accident and health products; an application that will be used with major medical and hospital surgical products).
(5) Insert page --A page used to replace an existing page of a previously approved or exempted contract.
(6) Limited, partial refilings --A change to a previously approved or exempted life or annuity form that meets one or more of the criteria set forth in subparagraphs (A) - (D) of this paragraph as follows:
(A) a change in the text, interest rate, guaranteed charges, or mortality table used to compute nonforfeiture values for life insurance or annuities;
(B) a change in the current interest rate, where such rates are guaranteed and shown in the policy or contract;
(C) a change in the reserves (if the change in reserves impacts the text of the policy);
(D) a change to the separate account for variable products when the separate account is bracketed as variable text on the initial filing .
(7) Matrix filing --A filing consisting of individual provisions, each with its own unique identifiable form number, allowing the flexibility to create multiple policies, certificates, contracts or applications by using numerous combinations of the individual provisions approved or exempted.
(8) New filing --A filing that has not been previously reviewed, approved, or disapproved by the department , or a filing that has been previously withdrawn and is being resubmitted as a new filing (not to include the withdrawal of a filing containing corrections to a form subsequent to the company receiving a disapproval from the department );
(9) Purpose and use --For each submitted form, the purpose and use will be a brief description to include at least the following:
(A) how a form will be used (e.g., the application will be used on a general use basis; or used with specific policy(ies) or contract form(s) previously approved or exempted);
(B) the type of coverage provided by the form (e.g., whole life, term life, universal life, variable annuity, major medical, specified disease, accident only, or hospital indemnity);
(C) any key or unique provisions contained in the form (e.g., for life and annuities--bonus interest, additional interest credits, two-tier values, bail-out, market value adjustments, and long term care; for accident and health--preferred provider benefits, prescription drugs, and innovative benefit in a Medicare supplement policy);
(D) if applicable, how the form will be marketed (e.g., direct, agent, or electronic);
(E) if applicable, to whom the form is to be marketed (e.g., specific groups such as an annuity contract marketed to issue ages 25 - 60, or a health benefit plan issued to children only, including Insurance Code Chapter 1502).
(10) Rider --An amendment or endorsement that changes a policy, certificate, or contract to add, expand, limit, or remove provisions and/or benefits, which may be optional or mandatory, and when used, becomes a part of the policy, certificate, or contract.