Texas Insurance Code Title 8, Chapter 1201 - Accident And Health Insurance

SUBCHAPTER A GENERAL PROVISIONS

• Texas Section 1201.001 - Definitions
  In this chapter: (1) "Accident and health insurance policy" includes any policy or contract that provides insurance against loss resulting from: (A) accidental bodily injury;...
• Texas Section 1201.002 - Purpose
  The purpose of this chapter is to: (1) provide for reasonable standardization, readability, and simplification of terms and coverages in individual accident and health insurance...
• Texas Section 1201.003 - Applicability Of Chapter
  (a) This chapter applies only to an accident and health insurance policy delivered or issued for delivery in this state. (b) Except as otherwise provided...
• Texas Section 1201.004 - Construction Of Chapter
  This chapter does not enlarge the powers of an entity listed in Section 1201.003. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff....
• Texas Section 1201.005 - References To Chapter
  In this chapter, a reference to this chapter includes a reference to: (1) Section 1202.052; (2) Section 1271.005(a), to the extent that the subsection relates...
• Texas Section 1201.006 - Rulemaking Authority
  The commissioner may adopt reasonable rules as necessary to implement the purposes and provisions of this chapter. Added by Acts 2003, 78th Leg., ch. 1274,...
• Texas Section 1201.007 - Notice And Hearing
  The commissioner may adopt a general rule or order relating to a matter covered by this chapter only after a hearing held after the 10th...
• Texas Section 1201.008 - Judicial Review
  An insurer that is dissatisfied with an order, act, rule, administrative ruling, or decision of the commissioner under this chapter may, after failing to get...
• Texas Section 1201.009 - Nonconforming Policy
  (a) This chapter governs the rights, duties, and obligations of the insurer, the insured, and the beneficiary of an accident and health insurance policy regardless...
• Texas Section 1201.010 - Third-party Ownership Of Policy
  The use of "insured" in this chapter does not prevent a person with an insurable interest, other than the insured, from: (1) applying for and...
• Texas Section 1201.011 - Coverage For Premium Period With Limitations By Age Or Date; Misstatement Of Age Of Insured
  (a) Regardless of a provision in an individual accident and health insurance policy that specifies a date, by age limitation or otherwise, after which coverage...
• Texas Section 1201.012 - Defense Of Claim
  The following actions by an insurer do not operate as a waiver of the insurer's rights in defense of a claim that arises under an...

SUBCHAPTER B POLICY TERMS

• Texas Section 1201.013 - Programs Promoting Disease Prevention, Wellness, And Health
  (a) An insurer issuing an accident and health insurance policy may establish premium discounts, rebates, or a reduction in otherwise applicable copayments, coinsurance, or deductibles,...
• Texas Section 1201.051 - Entire Consideration
  An individual accident and health insurance policy must state the entire monetary and other consideration for the policy in the policy or in the application,...
• Texas Section 1201.052 - Time Of Effectiveness And Termination
  An individual accident and health insurance policy must state the time the insurance takes effect and the time the insurance terminates. Added by Acts 2003,...
• Texas Section 1201.053 - Persons Insured
  (a) Except as provided by this section, an individual accident and health insurance policy may not insure more than one individual. Text of subsection effective...
• Texas Section 1201.054 - Appearance Of Text
  (a) In this section, "text" includes all printed matter of an individual accident and health insurance policy except: (1) the name and address of the...
• Texas Section 1201.055 - Exceptions And Reductions Of Indemnity
  (a) An individual accident and health insurance policy must state each exception to or reduction of indemnity for the policy. (b) Except as provided by...
• Texas Section 1201.056 - Form Number
  Each form that constitutes a part of an individual accident and health insurance policy, including each rider or endorsement, must be identified by a form...
• Texas Section 1201.057 - Incorporation Of Or Reference To Other Documents
  (a) An individual accident and health insurance policy that provides that a portion of the charter, rules, constitution, or bylaws of the insurer are a...
• Texas Section 1201.058 - Notification That Policy Is Returnable; Effect Of Return
  (a) An individual accident and health insurance policy must include a notice that states in substance that the individual to whom the policy is issued...
• Texas Section 1201.059 - Termination Of Coverage Based On Age Of Child In Individual, Blanket, Or Group Policy
  (a) An accident and health insurance policy, including an individual, blanket, or group policy, and including a policy issued by a corporation operating under Chapter...
• Texas Section 1201.060 - Required Definition Of "Emergency Care" In Individual Or Group Policy
  An individual or group accident and health insurance policy that provides an emergency care benefit, including a policy issued by a corporation operating under Chapter...
• Texas Section 1201.0601 - Required Definitions: Specified Disease Policy
  An individual or group specified disease insurance policy that uses the term "actual charge" or "actual fee" must define the terms as follows: "Actual charge"...
• Texas Section 1201.061 - Coverage For Adopted Child
  (a) An individual accident and health insurance policy that provides coverage for an insured's immediate family or children may not, solely because the insured's child...
• Texas Section 1201.062 - Coverage For Certain Children In Individual Or Group Policy Or In Plan Or Program
  Sec. 1201.062. COVERAGE FOR CERTAIN CHILDREN IN INDIVIDUAL OR GROUP POLICY OR IN PLAN OR PROGRAM. Text of subsection effective until September 01, 2018 (a)...
• Texas Section 1201.063 - Prohibition Of Certain Criteria Relating To Child's Coverage In Individual Or Group Policy
  Regarding a natural or adopted child of an insured or group member or a child for whom the insured or group member must provide medical...
• Texas Section 1201.063 - Prohibition Of Certain Criteria Relating To Child's Coverage In Individual Or Group Policy
  Regarding a natural or adopted child of an insured or group member or a child for whom the insured or group member must provide medical...
• Texas Section 1201.064 - Coverage For Child Of Spouse In Individual Or Group Policy
  An individual or group accident and health insurance policy that provides coverage for a child of an insured or group member may not: (1) set...

SUBCHAPTER C GENERAL POLICY STANDARDS AND PROVISIONS

• Texas Section 1201.065 - Age And School Enrollment Eligibility Criteria For Dependent Children In Individual Or Group Policy; Late Enrollment
  (a) An individual or group accident and health insurance policy may contain criteria relating to a maximum age or enrollment in school to establish continued...
• Texas Section 1201.101 - Standards For Policy Provisions
  (a) The commissioner shall adopt reasonable rules establishing specific standards for: (1) the content of an individual accident and health insurance policy; and (2) the...
• Texas Section 1201.102 - Prohibition Of Policy Provisions
  The commissioner may adopt rules prohibiting specific individual accident and health insurance policy provisions not specifically authorized by statute that the commissioner determines are unjust,...
• Texas Section 1201.103 - Compliance With Minimum Standards For Benefits
  (a) An individual accident and health insurance policy must meet the minimum standards for benefits established under Section 1201.104 for each category of coverage provided...
• Texas Section 1201.104 - Minimum Standards For Benefits
  (a) For individual accident and health insurance policies, the commissioner shall adopt rules establishing minimum standards for benefits under each of the following categories of...
• Texas Section 1201.105 - Minimum Standards For Benefits For Long-term Care In Individual, Group, Or Blanket Policy
  (a) The commissioner shall adopt rules establishing minimum standards for benefits for long-term care coverage under individual, group, and blanket accident and health insurance policies...
• Texas Section 1201.106 - Identification Of Policies According To Coverage Provided
  The commissioner shall prescribe the method to identify an individual accident and health insurance policy according to the coverages the policy provides. Added by Acts...
• Texas Section 1201.107 - Outline Of Coverage Required
  (a) An outline of coverage for an individual accident and health insurance policy must be delivered to the applicant at the time application is made,...
• Texas Section 1201.108 - Format And Content Of Outline Of Coverage
  (a) In this section, "format" means style, arrangement, and overall appearance, including: (1) the size, color, and prominence of type; and (2) the arrangement of...

SUBCHAPTER D PREEXISTING CONDITIONS

• Texas Section 1201.109 - Notice Of Rate Increase For Major Medical Expense Insurance Policy
  (a) Not less than 60 days before the date on which a premium rate increase takes effect on an individual accident and health insurance policy...
• Texas Section 1201.151 - Compliance With Subchapter; Prohibition Of Defense
  Except as provided by this subchapter, an individual accident and health insurance policy may not include a provision that permits a defense based on a...
• Texas Section 1201.152 - Coverage Under Simplified Application Form
  (a) Notwithstanding Clause (b) of the provision required by Section 1201.208(a), an individual accident and health insurance policy must cover any loss that occurs after...
• Texas Section 1201.153 - Coverage For Individuals Age 65 Or Older
  (a) Notwithstanding Section 1201.152 or Clause (b) of the provision required by Section 1201.208(a), an individual accident and health insurance policy delivered or issued for...

SUBCHAPTER E REQUIRED POLICY PROVISIONS

• Texas Section 1201.154 - Coverage For Certain Previously Covered Persons
  (a) In this section, "creditable coverage" has the meaning assigned by Section 1205.004(a). (b) A preexisting condition provision in an individual accident and health insurance...
• Texas Section 1201.201 - Policy Provisions Required
  (a) Except as provided by Subsections (b) and (c), an individual accident and health insurance policy must contain the provisions required by this subchapter in...
• Texas Section 1201.202 - Order Of Required Policy Provisions
  (a) Except as provided by Subsection (b), policy provisions required by this subchapter or corresponding substitute provisions must be printed in the same consecutive order...
• Texas Section 1201.203 - Other Policy Provisions
  A policy provision that is not otherwise subject to this subchapter may not make an individual accident and health insurance policy or any portion of...
• Texas Section 1201.204 - Policy Provisions Required By Other Jurisdiction
  An individual accident and health insurance policy of a foreign or alien insurer may contain any provision that is: (1) not less favorable to the...
• Texas Section 1201.205 - Policy Provisions For Policy Delivered Outside This State
  An individual accident and health insurance policy issued by a domestic insurer for delivery in another state or country may contain any provision permitted or...
• Texas Section 1201.206 - Filing Procedure
  (a) The commissioner may adopt reasonable rules regarding the procedure for submitting policies subject to this chapter that are necessary, proper, or advisable for the...
• Texas Section 1201.207 - Policy Provision: Entirety Of Contract; Policy Changes
  An individual accident and health insurance policy must contain the following provision: "Entire Contract; Changes: This policy, including the endorsements and the attached papers, if...
• Texas Section 1201.208 - Policy Provision: Incontestability
  (a) Except as provided by Subsection (c), an individual accident and health insurance policy must contain the following provision: "Time Limit on Certain Defenses: (a)...
• Texas Section 1201.209 - Policy Provision: Grace Period
  (a) An individual accident and health insurance policy must contain the following provision: "Grace Period: A grace period of __________ (insert appropriate number) days will...
• Texas Section 1201.210 - Policy Provision: Reinstatement
  (a) Except as provided by Subsection (b), an individual accident and health insurance policy must contain the following provision: "Reinstatement: If a renewal premium is...
• Texas Section 1201.211 - Policy Provision: Notice Of Claim
  (a) Except as provided by Subsection (b), an individual accident and health insurance policy must contain the following provision: "Notice of Claim: A written notice...
• Texas Section 1201.212 - Policy Provision: Claim Forms
  (a) Except as provided by Subsection (b), an individual accident and health insurance policy must contain the following provision: "Claim Forms: The insurer, on receipt...
• Texas Section 1201.213 - Policy Provision: Proof Of Loss
  An individual accident and health insurance policy must contain the following provision: "Proof of Loss: For a claim for loss for which this policy provides...
• Texas Section 1201.214 - Policy Provision: Time Of Payment Of Claims
  (a) Except as provided by Subsection (c), an individual accident and health insurance policy must contain the following provision: "Time of Payment of Claims: Indemnities...
• Texas Section 1201.215 - Policy Provision: Payment Of Claims
  (a) Except as provided by Subsection (d), an individual accident and health insurance policy must contain the following provision: "Payment of Claims: Indemnity for loss...
• Texas Section 1201.216 - Policy Provision: Physical Examinations And Autopsy
  An individual accident and health insurance policy must contain the following provision: "Physical Examinations and Autopsy: The insurer at its own expense has the right...
• Texas Section 1201.217 - Policy Provision: Legal Actions
  An individual accident and health insurance policy must contain the following provision: "Legal Actions: An action at law or in equity may not be brought...
• Texas Section 1201.218 - Policy Provision: Change Of Beneficiary
  (a) Except as provided by Subsection (b), an individual accident and health insurance policy must contain the following provision: "Change of Beneficiary: Unless the insured...
• Texas Section 1201.219 - Policy Provision: Change Of Occupation
  An individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision: "Change of Occupation:...
• Texas Section 1201.220 - Policy Provision: Misstatement Of Age
  An individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision: "Misstatement of Age:...
• Texas Section 1201.221 - Policy Provision: Excess Insurance
  An individual accident and health insurance policy must contain one of the following provisions if the policy addresses the subject matter of the provision: "Other...
• Texas Section 1201.222 - Policy Provision: Relation Of Earnings To Insurance
  (a) Subject to Subsection (b), an individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of...
• Texas Section 1201.223 - Policy Provision: Unpaid Premium
  An individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision: "Unpaid Premium: At...
• Texas Section 1201.224 - Policy Provision: Cancellation
  An individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision: "Cancellation: The insurer...
• Texas Section 1201.225 - Policy Provision: Conformity With State Statutes
  An individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision: "Conformity With State...

SUBCHAPTER F APPLICATION FOR POLICY

• Texas Section 1201.226 - Policy Provision: Illegal Occupation
  An individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision: "Illegal Occupation: The...
• Texas Section 1201.271 - Alteration Of Policy Application
  (a) A person may not alter a written application for an individual accident and health insurance policy unless the person has the written consent of...
• Texas Section 1201.272 - False Statements
  The falsity of a statement in an application for an individual accident and health insurance policy does not bar a right to recovery under the...
• Texas Section 1201.273 - Binding Statements
  An insured may not be bound by a statement made in an application for an individual accident and health insurance policy unless a copy of...

SUBCHAPTER O ENFORCEMENT

• Texas Section 1201.274 - Insurer's Evidentiary Use Of Application For Reinstatement Or Renewal
  (a) If an individual accident and health insurance policy is reinstated or renewed, and the insured or the beneficiary or assignee of the policy makes...
• Texas Section 1201.701 - Civil Penalty
  A person, partnership, or corporation that wilfully violates this chapter or an order of the commissioner made under this chapter is liable to the state...
• Texas Section 1201.702 - Action Against Certificate Of Authority Or License
  The commissioner may suspend or revoke the certificate of authority or license of an insurer or agent who wilfully violates this chapter or an order...

Last modified: September 28, 2016