SECTION 3.3051. Initial and Subsequent Conditions of Eligibility Provision

A family policy providing hospital, surgical, medical expense, hospital confinement indemnity, or accident only insurance shall include provisions which specify the indemnity and qualifications applicable to those family members who may become insured under the policy initially or by subsequent addition.

(1) Eligible family members may include:

(A) the insured;

(B) the insured's spouse;

(C) children of the insured or of the insured's spouse who are over a specified age and under a specified age not to exceed 25, unless a dependency test is specified; and

(D) any other person dependent upon the insured.

(2) The provisions concerning eligibility shall state the conditions under which coverage will become effective for persons who become insured subsequent to policy issuance. Such conditions include:

(A) qualifications for automatic coverage and the duration thereof;

(B) required evidence of insurability;

(C) the necessity of application or notice from the insured;

(D) any requirements as to the payment of premiums as to such addition; and

(E) the time within which action is to be taken by the insured.

(3) In family policies providing for the addition of newly eligible family members, the "Time Limit on Certain Defenses" provision may be modified to provide for a new contestable period for each new member so added, other than newborn children of the insured, but may not provide for a new contestable period for the policy.

Source Note: The provisions of this §3.3051 adopted to be effective January 26, 1977, 2 TexReg 159.