SECTION 3.3077. Minimum Standards for Specified Disease and Specified Accident Coverage

(a) "Specified disease coverage" is a policy written on a guaranteed renewable basis as prescribed in §3.3050(b) of this title (relating to Standards for Renewability Provisions) which meets one of the following definitions.

(1) A policy which provides coverages for each person insured under the policy for a specifically named disease (or diseases) with a deductible amount not to exceed 5.0% of the aggregate maximum benefit and an overall aggregate benefit limit of no less than $5,000 per person and a benefit period of not less than two years. If the benefits are subject to be scheduled inside dollar limits, such limits shall meet the minimum requirements for major medical coverage as prescribed in §3.3074 of this title (relating to Minimum Standards for Major Medical Expense Coverage).

(2) A policy which provides coverage for each person insured under the policy for a specifically named disease (or diseases) with no deductible amount and an overall aggregate benefit limit of not less than $25,000 payable at the rate of not less than $50 a day while confined in a hospital and a benefit period of not less than 500 days.

(3) In lieu of the minimum benefits specified in paragraphs (1) and (2) of this subsection, a specified disease policy or rider, limited to cancer, may provide minimum benefits not less than the following:

(A) $50 a day for the first 10 days of hospitalization without any elimination period, deductible or coinsurance factor and $30 a day for each day of continuous hospitalization thereafter with no limit on the number of days of hospitalization;

(B) x-ray, radium, and cobalt therapy up to a total of $1,500;

(C) attending physician(s) charges in hospital (other than the operating surgeon) of $7.50 per day up to a total of $500;

(D) surgical charges in accordance with the 1969 California Relative Value Schedule or other acceptable relative value scale of surgical procedure, up to a maximum of at least $600;

(E) anesthetist services for an operation in an amount not less than:

(i) 80% of the usual, customary and reasonable charges; or

(ii) 15% of the surgical charges benefit;

(F) nursing expenses of $24 per shift for not less than one shift per day up to $750;

(G) blood transfusions and plasma up to $500;

(H) prescribed drugs and medicine up to $250. If an overall aggregate limit on all benefits is used, it shall be not less than $10,000 per person.

(b) "Specified accident coverage" is an accident insurance policy which provides coverage for a specifically identified kind of accident (or accidents) for each person insured under the policy for accidental death or accidental death and dismemberment combined, disability or hospital and medical care with a benefit amount not less than $1,000 for accidental death; $1,000 for double dismemberment and $500 for single dismemberment.

Source Note: The provisions of this §3.3077 adopted to be effective January 26, 1977, 2 TexReg 159.