SECTION 3.3090. Outline of Coverage Generally

(a) In order to facilitate public understanding of coverages and to provide full and fair disclosure in the sale of individual accident and sickness insurance policies, no such policy may be delivered or issued for delivery in this state unless an appropriate outline of coverage, as prescribed in these sections is delivered.

(1) in the case of a direct response insurance product, the outline of coverage shall be delivered with the policy; and

(2) in all other cases, the outline of coverage shall be delivered to the applicant at the time application is made and acknowledgment of receipt or certificate of delivery of such outline of coverage is provided to the insurer. The insurer may secure acknowledgment of delivery of the outline of coverage by an acknowledgment receipt attached to or made a part of the application; or by a certificate of delivery signed by the insured.

(b) In the event that a policy is issued on a basis other than that applied for which would require revision of the outline of coverage, a substitute, properly describing the policy, must be delivered with the policy and contain the following statement, in no less than 14-point type, at the top of the page: "NOTICE: READ THIS OUTLINE OF COVERAGE CAREFULLY. It is not the same as the outline of coverage given to you upon application because you have not been issued the coverage for which you first applied."

(c) Insurers issuing individual accident and sickness policies that contain preferred provider benefits are not required to deliver the outline of coverage prescribed in subsection (a) of this section if the written description prescribed in §3.3704(7) of this title (relating to Freedom of Choice) is delivered at the time of application, or no more than 14 days prior to application. If the insurer does deliver the written description prescribed in §3.3704(7), it must be modified to include the information required by §3.3092(b)(5) and (6) of this title (relating to Format, Content, and Readability for Outline of Coverage). Modifications may be achieved by providing a supplemental attachment.

Source Note: The provisions of this §3.3090 adopted to be effective January 26, 1977, 2 TexReg 159; amended to be effective December 7, 1983, 8 TexReg 4858; amended to be effective May 13, 1997, 22 TexReg 3990.