28 Tex. Admin. Code § 3.3062 - Conditional Receipts
The following provisions shall apply to conditional receipts.
(1) A conditional receipt
which requires a determination of insurability as a condition precedent to
coverage shall include an agreement to provide:
(A) coverage subject to any limit regarding
the amount of insurance specified in the receipt, contingent upon insurability;
and
(B) that such insurability be
determined as of a date no later than the date of completion of all parts of
the application, including completion of the first medical examination if one
is required by the company's underwriting rules, and the required premium has
been paid. Completion of a second medical examination may be required as a
condition precedent to coverage if initially required by the company's
underwriting rules because of the amount of insurance applied for or the age of
the proposed insured.
(2) A determination of insurability means a
determination by the company as to whether the proposed insured is insurable
under its underwriting rules and practices for the plan and amount of insurance
applied for and at the company's standard premium rate.
(3) If the proposed insured is insurable as
of the date provided for in paragraph (1)(B) of this section, coverage shall
begin not later than such date, except as provided in paragraph (5) of this
section.
(4) A company must
determine the insurability of the proposed insured as of the date specified in
paragraph (1) of this section, even though the proposed insured dies or
undergoes a change in health after the date provided for in paragraph (1) of
this section but before the application is approved or rejected, and before the
expiration of any time limit specified in the receipt.
(5) A company may honor a written request
from the applicant that coverage is to commence as of a specified date later
than the date provided for in paragraph (1) of this section.
(6) Only in mail order cases, and in cases
where a premium is paid in advance and certain participation requirements must
be met, is it permissible for a company to postpone the effective date of
coverage to the date of issuance of the policy.
Notes
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