28 Tex. Admin. Code § 3.4004 - Exempt Forms
(a) Group and
individual life forms. The group and individual life insurance forms specified
in this subsection are exempt from the review and approval requirements of
Insurance Code Chapter 1701, unless the forms are required by the laws of
Texas, another state, or the United States, to be specifically approved or are
otherwise excepted in subsection (b) of this section:
(1) group life insurance master policies,
contracts, certificates, applications, enrollment forms, riders, amendments,
and endorsements applicable thereto, issued under the authority of Insurance
Code §§
1131.003,
1131.051 -
1131.058,
1131.060, and 1131.064(b), listed in subparagraphs (A) and (B) of this
paragraph:
(A) term policies and riders;
and
(B) cash value and endowment
policies with no more than five death benefit and/or premium changes;
(2) any alternate face pages filed
subsequent to the original approval of a policy for use with multiple employer
trusteed arrangements as defined in Insurance Code §
1131.053;
(3) individual, joint life, and last survivor
insurance forms, including applications, listed in subparagraphs (A)-(Q) of
this paragraph:
(A) ordinary life;
(B) limited pay life with no more than five
death benefit and/or premium changes;
(C) life paid up at specified ages with no
more than five death benefit and/or premium changes;
(D) single premium life with no more than
five death benefit changes;
(E)
modified premium level death benefit life with no more than five premium
changes;
(F) level premium life
with no more than five death benefit changes;
(G) retirement income policies;
(H) level or decreasing term policies and
riders;
(I) increasing term
policies and riders;
(J) family
plans;
(K) family income;
(L) family plan riders, including but not
limited to children's term riders, dependent term riders, and spouse term
riders;
(M) limited pay endowment
with no more than five death benefit and/or premium changes;
(N) level premium endowment with no more than
five death benefit changes;
(O)
single premium endowment with no more than five death benefit
changes;
(P) indeterminate premium
policies with no more than five death benefit changes; and
(Q) variable life policies with a separate
account only;
(4) rider
forms listed in subparagraphs (A)-(K) of this paragraph:
(A) accidental death benefit
riders;
(B) waiver of premium
riders;
(C) guaranteed insurability
riders;
(D) individual retirement
accounts (IRA) (to include Roth and Simple IRA) riders;
(E) preliminary term riders;
(F) conversion riders;
(G) exchange riders;
(H) waiver of cost riders, including waiver
of cost and monthly expense charge, and waiver of cost and premium
payment;
(I) dividend option
riders;
(J) additional insured
riders; and
(K) additional
insurance on base insured riders;
(5) endorsement forms listed in subparagraphs
(A)-(K) of this paragraph:
(A) ORP
endorsements;
(B)
nontransferability endorsements;
(C) H.R.10 endorsements;
(D) tax sheltered annuity
endorsements;
(E) nonassignability
endorsements;
(F) settlement option
endorsements;
(G) individual
retirement account endorsements (to include Roth and Simple IRA
endorsements);
(H) unisex
endorsements;
(I) loan
endorsements;
(J) waiver of
surrender charges on disability or confinement in a hospital or nursing home
endorsements; and
(K) step-up or
roll-up death benefit endorsements;
(6) limited refilings for life insurance
which indicate only a change in the mortality table or interest rates for new
issues under the policy form, or changes to the separate account for variable
products.
(b)
Exceptions. The provisions of subsection (a)(1) and (2) of this section do not
apply to any group or individual life insurance forms providing the types of
coverages set out in paragraphs (1) - (12) of this subsection:
(1) universal life;
(2) universal related life;
(3) adjustable life;
(4) variable life with a fixed
account;
(5) business
value;
(6) any forms containing a
market value adjustment;
(7)
deposit term;
(8) forms subject to
Insurance Code Chapter 1153;
(9)
any life insurance product used to fund prepaid funeral contracts;
(10) any form containing a persistency bonus
provision, no-lapse premium provision, or other additional interest credit to
the policy value provision (guaranteed or non-guaranteed), equity indexed
provision, residual death benefit provision, accelerated death benefit
provision, long-term care or other accident and health related benefit
provision;
(11) applications for
use with variable life or equity indexed life, or forms that contain a market
value adjustment provision, a long-term care or other accident and health
related benefit provision; or
(12)
group life master policies, contracts, certificates, applications, enrollment
forms, riders, amendments, and endorsements applicable thereto, issued under
the authority of Insurance Code §
1131.064, relating
to discretionary groups.
(c) Group and individual annuity forms. The
group and individual annuity forms, including applications, specified in
paragraphs (1) - (7) of this subsection are exempt from the review and approval
requirements of Insurance Code Chapter 1701, unless the forms are required by
the laws of Texas, another state, or of the United States to be specifically
approved or are otherwise excepted in subsection (d) of this section:
(1) single premium immediate annuities
(including variable immediate annuities);
(2) deferred annuities used as structured
settlement options;
(3) individual
deferred annuities that do not include persistency bonuses or additional
interest credits of any type, waiver of surrender charges (except for death,
disability or confinement in a hospital or nursing home); two-tier values; or a
market value adjustment:
(A) for purposes of
this paragraph, and paragraph (4) of this subsection, "waiver of surrender
charges" means a waiver of surrender charges which is applied to any amount
greater than 10% of the surrender value;
(B) for purposes of this paragraph, and
paragraph (4) of this subsection, "two-tier values" means values on an annuity
available at the maturity date of the contract which are different, depending
on whether the value is taken from the contract in a lump sum or left with the
issuer for periodic payments, regardless of whether the different values are
available at issue or later;
(4) group annuities that do not include
persistency bonuses or additional interest credits of any type, waiver of
surrender charges (except for death, disability or confinement in a hospital or
nursing home), two-tier values, or a market value adjustment; group annuities
that are guaranteed investment contracts (GICs), synthetic GICs, funding
agreements, and unallocated group annuities funding pension plans;
(5) limited refilings for annuity products
which indicate only a change in the mortality table or interest rates for new
issues under the policy form, or changes to the separate account for variable
products;
(6) variable annuities
with a separate account only, which do not include a provision for guaranteed
living benefits; and
(7)
reversionary annuities.
(d) Exceptions. The provisions of subsection
(c) of this section do not include any of the following annuity forms:
(1) annuities used to fund prepaid funeral
contracts;
(2) variable annuities
that contain guaranteed living benefit provisions;
(3) annuities that contain an equity indexed
provision, long-term care or other accident- and health-related benefit
provision;
(4) applications for use
with variable annuities, equity indexed annuities, annuities that contain a
market value adjustment provision, long-term care or other accident- and
health-related provision;
(5) group
annuity master policies, contracts, certificates, applications, enrollment
forms, riders, amendments, and endorsements applicable thereto, issued under
the authority of Insurance Code §
1131.064, relating
to discretionary groups.
(e) Group and individual accident and health
forms. The group and individual accident and health insurance forms specified
in paragraphs (1) - (3) of this subsection are exempt from the review and
approval requirements of Insurance Code Chapter 1701, unless the forms are
required by the laws of Texas, another state, or the United States, to be
specifically approved or are otherwise excepted in subsection (f) of this
section:
(1) the group and blanket accident
and health forms set out in subparagraphs (A) - (D) of this paragraph:
(A) any group accident and health master
policies, contracts, certificates, applications, enrollment forms, riders,
amendments, and endorsements applicable thereto issued under authority of
Insurance Code §
1251.051 and §
1251.052; provided
the forms issued under authority of Insurance Code §
1251.052 are exempt
only if delivered or issued for delivery to a labor union or organization of
labor unions;
(B) any blanket
accident and health master policies, contracts, certificates, applications,
enrollment forms, riders, amendments, and endorsements applicable thereto,
issued under authority of Insurance Code §§
1251.351
-
1251.358;
(C) any group master policies, contracts,
certificates, applications, enrollment forms, riders, amendments, and
endorsements applicable thereto, issued under the authority of Insurance Code
§§
1251.051,
1251.052, or
1251.053
providing Medicare Supplement coverage to an employer, multiple employer
arrangement, or a labor union;
(D)
any group master policies, contracts, certificates, applications, enrollment
forms, riders, amendments, and endorsements applicable thereto, issued under
the authority of Insurance Code §
1251.051 and §
1251.052 providing
long-term care coverage to a single employer or a labor union through a policy
which is delivered or issued for delivery outside of Texas;
(2) group and individual accident
and/or health policies, contracts, certificates, applications, enrollment
forms, riders, amendments, endorsements, and related forms (including but not
limited to outlines of coverage, notices, rates, and conditional receipts)
applicable thereto, providing coverages set forth in subparagraphs (A)-(K) of
this paragraph:
(A) accident only (including
occupational accident and other specified accident);
(B) accidental death and
dismemberment;
(C)
dental;
(D) in-patient confinement
and basic hospital expense coverages (including policies with coverage on an
indemnity or expense-incurred basis)
(E) vision;
(F) specified disease (including cancer,
heart attack, stroke, and other specifically named diseases);
(G) disability coverages (including but not
limited to income replacement, key-man, buy/sell, and overhead
expense);
(H) policies designed to
provide conversion coverages;
(I)
other permitted coverages which are designed to supplement other in-force
health insurance, including Champus supplements;
(J) group stop loss/excess loss policies
containing an attachment point of $5,000 or more; and
(K) prescription drug policies; and
(3) any alternate face pages filed
subsequent to the original approval of a policy for use with multiple employer
trusteed arrangements as defined in Insurance Code §
1251.053.
(f) Exceptions. The provisions of
subsection (e) of this section do not apply to any of the insurance forms set
out in paragraphs (1) - (6) of this section.
(1) The provisions of subsection (e)(2) of
this section do not apply to any group or individual health insurance policy
which provides, on a comprehensive basis for illness and injury, a combination
of hospital, medical, and surgical coverages, including but not limited to any
major medical policies and any limited benefit hospital, medical, and surgical
policies as defined in §
3.3079
of this title (relating to Minimum Standards for Limited Benefit
Coverage).
(2) The provisions of
subsection (e)(1) and (2) of this section do not apply to any Medicare
supplement policies as defined in Insurance Code Chapter 1652, except as
specifically provided in subsection (e)(1)(C) of this section.
(3) The provisions of subsection (e)(1) and
(2) of this section do not apply to any long-term care policies as defined in
Insurance Code Chapter 1651 (including but not limited to any policies
providing nursing home or home health care coverages), except as specifically
provided in subsection (e)(1)(D) of this section.
(4) The provisions of subsection (e)(1) and
(2) of this section do not apply to any forms which contain preferred provider
benefit plan provisions as defined in §§
3.3701-
3.3706
of this title (relating to Preferred Provider Plans).
(5) The provisions of subsection (e)(1) and
(2) of this section do not apply to any group forms which are issued under the
authority of Insurance Code §
1251.056
(discretionary groups).
(6) The
provisions of subsection (e)(2)(H) of this section do not apply to any policy
subject to the provisions of Subchapter F of this chapter (relating to Group
Health Insurance Conversion Privilege), except for policies providing
conversion from a policy included as an exempt form in this section.
(g) Copies of previously approved
forms. Any form not otherwise exempted under this subchapter that is an exact
copy of a previously approved form is exempt from the review and approval
requirements of Insurance Code Chapter 1701. Such forms must be filed in
accordance with and accompanied by the required certification as prescribed in
Subchapter A of this chapter (relating to Submission Requirements for Filings
and Departmental Actions Related to Such Filings). The certification form
required to be used in filing the certification is "TEXAS POLICY FORM
CERTIFICATIONS, Multi-Use Form," which also is to be utilized for filing
certifications for file-and-use under Insurance Code §
1701.052, as well as
for corrections, resubmissions, substitutions, and filings for forms exempted
from review and official action by this subchapter. Form "TEXAS POLICY FORM
CERTIFICATIONS" is available from the Life and Health Division, has been filed
with the Texas Register Division of the Secretary of State for public
inspection, and is adopted by reference in this subchapter. The form also is
reproduced in full as Figure 1 in §
3.4020 of
this title (relating to Appendix).
(h) Copies of previously approved forms
subsequently submitted in foreign language (non-English). Any form not
otherwise exempted under this subchapter that is submitted in Braille as an
exact copy of a previously approved form, or any form that has been translated
into a foreign language from its previously approved English version, is exempt
from the review and approval requirements of Insurance Code Chapter 1701. Such
forms must be filed in accordance with and accompanied by the required
certification as prescribed in Subchapter A of this chapter. The certification
form required to be used in filing the certification is the same as that
described in subsection (g) of this section.
Notes
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