This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:48 GMT
A long-term care insurance policy and/or certificate shall contain a provision which sets forth the individuals eligible to be covered under the policy and/or certificate and which specifies the conditions applicable to an individual who may become covered under the policy and/or certificate by subsequent addition.(1) Eligible individuals may include:(A) for group coverage:(i) the prospective certificate holder (the individual whose employment or other membership status, except for family dependency, is the basis for eligibility for enrollment under the group policy);(ii) the certificate holder's spouse;(iii) the certificate holder's children;(iv) the certificate holder's spouse's children;(v) the certificate holder's parents;(vi) the certificate holder's spouse's parents; and(vii) any other individual included as an eligible individual under a long-term care policy.(B) For individual coverage:(i) the prospective policyholder;(ii) the policyholder's spouse;(iii) the policyholder's children;(iv) the policyholder's spouse's children;(v) the policyholder's parents;(vi) the policyholder's spouse's parents; and(vii) any other individual included as an eligible individual under a long-term care policy.(2) The provision shall state the conditions under which coverage will become effective for an individual who becomes insured subsequent to policy and/or certificate issuance. Such conditions shall include:(A) any requirements relating to evidence of insurability;(B) any requirements relating to the necessity of application or notice from the individual;(C) any requirements relating to the payment of premiums as to such addition; and(D) the time within which any action is to be taken by the individual.