SECTION 11.507. Additional Mandatory Contractual Provisions: Conversion and Individual Agreements

Conversion and individual agreements must contain the following additional mandatory provisions:

(1) Reinstatement. A provision clearly setting forth the requirements for reinstatement and disclosing 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 may return the contract within 10 days of receiving it and have the premium paid refunded if, after examination of the contract, the contract holder is not satisfied with it for any reason. If the contract holder returns the contract to the issuing HMO or to the agent through whom it was purchased, then the contract 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 the 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 will be issued coverage in compliance with §21.407 of this title (relating to Continuance of Coverage).

Source Note: The provisions of this §11.507 adopted to be effective August 1, 2017, 42 TexReg 2169