Sec. 1651.051. MINIMUM STANDARDS. (a) The commissioner by rule shall establish:
(1) specific standards for provisions of long-term care benefit plans; and
(2) standards for full and fair disclosure setting forth the manner, content, and required disclosures for the marketing and sale of those benefit plans.
(b) The standards are in addition to and must be in accordance with:
(1) applicable laws of this state, including Chapter 1201;
(2) applicable federal law; and
(3) any rules, regulations, and standards required by federal law.
(c) The standards must address:
(1) terms of renewability;
(2) initial and subsequent conditions of eligibility;
(3) nonduplication of coverage;
(4) coverage of dependents;
(5) coverage of parents of the insured or enrollee and parents of the spouse of the insured or enrollee;
(6) preexisting conditions;
(7) termination of insurance;
(8) continuation or conversion;
(9) probationary periods;
(10) benefit limitations, exceptions, and reductions;
(11) elimination periods;
(12) requirements for replacement;
(13) recurrent conditions;
(14) definitions of terms; and
(15) inflation protection.
(d) The standards may:
(1) establish standard claim forms;
(2) establish standard benefits for:
(A) skilled nursing care;
(B) intermediate nursing care;
(C) custodial care; and
(D) home health care;
(3) require coverage for skilled nursing care, intermediate nursing care, and custodial care to facilitate comparison among long-term care products;
(4) require long-term care benefit plan issuers to offer coverage for home health care benefits;
(5) require that rates may not be increased for a covered individual unless:
(A) the covered individual requests and receives a change of benefits; or
(B) the increase applies to all members of the class to which the individual has been assigned by the benefit plan issuer; or
(6) require a benefit plan issuer to pay for a service covered by the benefit plan that is provided by an institution licensed to provide that service under Chapter 242, Health and Safety Code.
(e) Rules adopted under this section must include requirements no less favorable than the minimum standards of benefits for long-term care benefit plans adopted in any model laws or regulations relating to minimum standards for benefits for long-term care benefit plans and required by federal law.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
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