Sec. 1701.057. WITHDRAWAL OF INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICY FORM APPROVAL. (a) Except as provided by Subsection (b), the commissioner may, after notice and hearing, withdraw approval of an individual accident and health insurance policy form if, after consideration of all relevant facts, the commissioner determines that:
(1) the benefits provided under the form are unreasonable in relation to the premium charged; or
(2) the reserve required by Section 862.102 is not maintained by the insurer on the policies issued on the form.
(b) If an individual accident and health insurance policy form has been on file with the department for at least 360 days and has been affirmatively approved by the commissioner, been considered approved under this chapter, or been exempted from the approval requirements of this chapter, the commissioner may withdraw the approval or exemption only if:
(1) the form violates this code or a rule adopted under this code; or
(2) the commissioner finds proof of gross misrepresentation or fraud to a policyholder.
(c) To enable the department to determine compliance with Subsection (b), the commissioner:
(1) shall require an insurer to file the rates charged by that insurer for individual accident and health insurance policies; and
(2) may adopt and require an insurer to file in conjunction with the annual statement required under Section 841.255, 982.101, or 982.103 a form for reporting the insurer's experience on individual accident and health insurance policy forms issued by the insurer.
(d) The commissioner shall, in accordance with Section 1201.007, adopt reasonable rules necessary to establish standards under which the approval of an individual accident and health insurance policy form may be withdrawn.
(e) This section does not grant the commissioner the authority to determine, fix, prescribe, or promulgate rates to be charged for an individual accident and health insurance policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 5, eff. April 1, 2005.
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