SECTION 3.3806. Initial and Subsequent Conditions of Eligibility

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.

Source Note: The provisions of this §3.3806 adopted to be effective August 10, 2000, 25 TexReg 7354