28 Tex. Admin. Code § 3.3061 - Standards for Requirements for Replacement Provision

(a) Application forms shall include a question relating to replacement designed to elicit information as to whether the insurance to be issued is intended to replace any other accident and sickness insurance presently in force. A supplementary application or other form to be signed by the applicant containing such a question or statement may be used.

(b) Upon determining that a sale will involve replacement, an insurer (other than a direct response insurer) or its agent shall furnish the applicant, prior to issuance or delivery of the policy, the notice described in subsection (c) of this section. One copy of such notice shall be provided to the applicant and an additional copy signed by the applicant shall be retained by the insurer. A direct response insurer shall deliver one copy of the notice described in subsection (d) of this section to the applicant upon issuance of the policy. In no event, however, will such a notice be required in the solicitation of the following types of policies:

(1) accident only;

(2) single premium nonrenewable;

(3) conversion to another policy in the same insurer with continuous coverage;

(4) conversion to an individual or family policy to replace group, blanket, or group type coverage.

(c) The notice required for an insurer, other than a direct response insurer is as follows: "NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing accident and sickness insurance and replace it with a policy to be issued by (Company Name) Insurance Company. For your own information and protection, you should be aware of and seriously consider certain facts which may affect the insurance protection available to you under the new policy.

(1) Health conditions which you may presently have may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy. (This subsection may be modified if pre-existing conditions are covered under a new policy.)

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on any application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, re-read it carefully to be certain that all information has been properly recorded. The above Notice to Applicant was delivered to me on: (Date) (Applicant's Signature)"

(d) The notice required for a direct response insurer is as follows: "NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE According to (your application) (information that you have furnished), you intend to lapse or otherwise terminate existing accident and sickness insurance and replace it with the policy delivered herewith issued by (Company Name) Insurance Company. You have a period of 10 days from receipt of the new policy within which you may decide without cost whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.

(1) Health conditions which you may presently have may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) (*To be included only if the application is attached to the policy.*) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (Company Name and Address) within 10 days if any information is not correct and complete or if any past medical history has been left out of the application. (Company Name)

Notes

28 Tex. Admin. Code § 3.3061

The provisions of this §3.3061 adopted to be effective January 26, 1977, 2 TexReg 159; amended to be effective December 7, 1983, 8 TexReg 4858; amended to be effective December 22, 1997, 22 TexReg 12503.