28 Tex. Admin. Code § 3.3090 - Outline of Coverage Generally
(a) In
order to facilitate public understanding of coverages and to provide full and
fair disclosure in the sale of individual accident and sickness insurance
policies, no such policy may be delivered or issued for delivery in this state
unless an appropriate outline of coverage, as prescribed in these sections is
delivered.
(1) in the case of a direct
response insurance product, the outline of coverage shall be delivered with the
policy; and
(2) in all other cases,
the outline of coverage shall be delivered to the applicant at the time
application is made and acknowledgment of receipt or certificate of delivery of
such outline of coverage is provided to the insurer. The insurer may secure
acknowledgment of delivery of the outline of coverage by an acknowledgment
receipt attached to or made a part of the application; or by a certificate of
delivery signed by the insured.
(b) In the event that a policy is issued on a
basis other than that applied for which would require revision of the outline
of coverage, a substitute, properly describing the policy, must be delivered
with the policy and contain the following statement, in no less than 14-point
type, at the top of the page: "NOTICE: READ THIS OUTLINE OF COVERAGE CAREFULLY.
It is not the same as the outline of coverage given to you upon application
because you have not been issued the coverage for which you first
applied."
(c) Insurers issuing
individual accident and sickness policies that contain preferred provider
benefits are not required to deliver the outline of coverage prescribed in
subsection (a) of this section if the written description prescribed in §
3.3704(7) of
this title (relating to Freedom of Choice) is delivered at the time of
application, or no more than 14 days prior to application. If the insurer does
deliver the written description prescribed in §3.3704(7), it must be modified
to include the information required by §
3.3092(b)(5) and
(6) of this title (relating to Format,
Content, and Readability for Outline of Coverage). Modifications may be
achieved by providing a supplemental attachment.
Notes
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