28 Tex. Admin. Code § 11.507
Additional Mandatory Contractual Provisions: Conversion and Individual Agreements
Effective Nov 2, 199823 TexReg 11347Source Note: The provisions of this §11.507 adopted to be effective January 1, 1980, 4 TexReg 4622; amended to be effective December 6, 1984, 9 TexReg 6011; amended to be effective November 2, 1998, 23 TexReg 11347.Texas Secretary of State
Conversion and individual agreements must contain the following additional mandatory provisions.
- (1) Reinstatement--A provision that clearly sets forth the requirements for reinstatement and discloses how reinstatement changes or affects the rights and coverages originally provided. New evidence of insurability may be required.
- (2) Ten days to examine agreement--A provision stating that the contract holder to whom the contract is issued shall be permitted to return the contract within 10 days of receiving it and to have the premium paid refunded if, after examination of the contract, such contract holder is not satisfied with it for any reason. If such contract holder, pursuant to such provision, returns the contract to the issuing HMO or to the agent through whom it was purchased, it is considered void from the beginning and the parties are in the same position as if no contract had been issued. If services are rendered or claims paid by the HMO during the 10 days, the subscriber is responsible for repaying the HMO for such services or claims.
- (3) Consideration--The original consideration including premiums, application fee, and any other amounts to be paid for coverage must be expressed in the agreement or in the application.
- (4) Continuance of coverage due to change in marital status--A provision stating that if a person loses coverage due to a change in marital status, that person shall be issued coverage in accordance with §21.407 of this title (relating to Continuance of Coverage).
Source Note:The provisions of this §11.507 adopted to be effective January 1, 1980, 4 TexReg 4622; amended to be effective December 6, 1984, 9 TexReg 6011; amended to be effective November 2, 1998, 23 TexReg 11347.