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, concerning Policy Forms, 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 and individual term life
insurance forms;
(2) individual
variable life policies with a separate account only;
(3) 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 account (IRA) riders (to include Roth and Simple IRAs);
(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;
(4) endorsement forms listed in subparagraphs
(A) - (K) of this paragraph:
(A) optional
retirement program (ORP) endorsements;
(B) nontransferability
endorsements;
(C) H.R. 10 (Keogh
plan) endorsements;
(D) tax
sheltered annuity endorsements;
(E)
nonassignability endorsements;
(F)
settlement option endorsements;
(G)
individual retirement account endorsements (to include Roth and Simple
IRAs);
(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; and
(5) limited refilings for changes to the
separate account for variable products.
(b) Exceptions. A filing identified in
subsection (a)(1) of this section is not permitted to be filed as exempt for
any group or individual life insurance forms providing the types of coverages
set out in paragraphs (1) - (13) of this subsection:
(1) universal life, including flexible
premium adjustable life;
(2) whole
life;
(3) endowment 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, concerning Credit Life Insurance and Credit
Accident and Health Insurance;
(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), index-linked
crediting 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 index-linked life, or forms that contain a market
value adjustment provision, a long-term care or other accident- and
health-related benefit provision;
(12) forms issued under the authority of
Insurance Code §
1131.064, concerning
Other Groups, that are related to discretionary groups; or
(13) limited refilings for life insurance
that indicate a change in the mortality table or interest rates for new issues
under the policy form.
(c) Group and individual annuity forms. The
group and individual annuity forms 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 that 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 that 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 that 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. A filing identified in
subsection (c) of this section may not be filed as exempt for 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 index-linked
crediting, long-term care, or other accident- and health-related benefit
provision;
(4) applications for use
with variable annuities, index-linked crediting annuities, annuities that
contain a market-value-adjustment, or that contain a long-term care or other
accident- and health-related provision;
(5) group annuity forms issued under the
authority of Insurance Code §
1131.064, relating to
discretionary groups; or
(6)
contingent deferred annuities.
(e) Group and individual accident and health
forms. The group and individual accident and health insurance forms specified
in paragraphs (1) and (2) 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 accident and health
forms set out in subparagraphs (A) - (C) of this paragraph:
(A) a group accident and health form issued
to employers under Insurance Code §
1251.051, concerning
Employers, or to a labor union or association of labor unions under Insurance
Code §
1251.052, concerning
Associations;
(B) group forms
issued under Insurance Code §§
1251.051; 1251.052; or
1251.053, concerning Funds Established by Employers, Labor Unions, or
Associations, respectively, that provide Medicare Supplement coverage to an
employer, multiple employer arrangement, or a labor union and that are exempt
from regulation under Insurance Code §
1652.002(b)(1),
concerning Medicare Supplement Benefit Plan;
(C) group forms issued under Insurance Code §
1251.051 and §
1251.052 that provide
long-term care coverage to a single employer, a labor union, or an association
of labor unions through a policy that is delivered or issued for delivery
outside of Texas;
(2)
group and individual accident and health forms that provide the following
coverages:
(A) accident only (including
occupational accident and other specified accident);
(B) accidental death and
dismemberment;
(C) hospital
indemnity;
(D) vision;
(E) specified disease (including cancer,
heart attack, stroke, and other specifically named diseases);
(F) disability coverages (including income
replacement, key-man, buy/sell, and overhead expense);
(G) policies designed to provide conversion
coverages;
(H) other permitted
coverages that are designed to supplement other in-force health insurance;
and
(I) group stop loss/excess loss
policies containing an attachment point of $5,000 or more.
(f) Exceptions. A filing
identified in subsection (e) of this section is not permitted to be filed as
exempt for any of the following insurance forms or rates:
(1) a group or individual health insurance
policy that provides, on a comprehensive basis for illness and injury, a
combination of hospital, medical, and surgical coverages, including any
guaranteed renewable or short-term limited-duration major medical
policies;
(2) a Medicare supplement
policy as defined in Insurance Code Chapter 1652, concerning Medicare
Supplement Benefit Plans, except as specifically provided in subsection
(e)(1)(C) of this section;
(3) a
long-term care policy as defined in Insurance Code Chapter 1651, concerning
Long-Term Care Benefit Plans, (including any policies providing nursing home or
home health care coverages), except as specifically provided in subsection
(e)(1)(D) of this section;
(4) a
form containing preferred provider or exclusive provider benefit plan
provisions as defined in Insurance Code Chapter 1301, concerning Preferred
Provider Benefit Plans;
(5) a group
form that is issued under Insurance Code §
1251.056, concerning
Other Groups;
(6) a conversion
policy subject to the provisions of Chapter 21, Subchapter SS of this title,
(relating to Continuation and Conversion Provisions), except for policies
providing conversion from a policy included as an exempt form in this
section;
(7) a policy that provides
fixed indemnity coverage for more than hospital confinement, including a policy
that provides limited long-term care coverage for a period of less than 12
months;
(8) rate or actuarial
information that is required to be filed, even if the form is filed exempt as
permitted by this section; and
(9)
a dental policy.
(g)
Copies of previously approved forms. Except for filings not eligible to be
filed exempt under subsection (f)(4) of this section, a form not otherwise
exempted under this subchapter that is an exact copy of a form is exempt from
the review and approval requirements of Insurance Code Chapter 1701. These
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).
(h) Copies of previously
approved forms subsequently submitted in braille or a non-English language. 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 non-English language from its previously approved English
version, is exempt from the review and approval requirements of Insurance Code
Chapter 1701. These forms must be filed in accordance with and accompanied by
the required certification as prescribed in Subchapter A of this
chapter.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
(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.