SECTION 3.6. Certifications, Attachments, and Additional Information Requirements

(a) A company must include the certification(s), attachment(s), and additional information referred to in this section as follows:

(1) A filing must include the following certifications, as applicable:

(A) Specific certification. Filings submitted as file and use pursuant to §3.5(a)(2) of this title (relating to Filing Authorities and Categories) must certify that:

(i) the certification is on behalf of the company;

(ii) the company is bound thereby;

(iii) the company has reviewed, and is familiar with, all applicable statutes and regulations of this state and of the United States;

(iv) the company has reviewed the filing; and

(v) to the best of the company's knowledge, information, and belief, the filing complies in all respects with the applicable statutes and regulations of this state.

(B) General certification. Filings submitted other than file and use must certify that:

(i) the certification is on behalf of the company;

(ii) the company is bound thereby;

(iii) the company has reviewed the filing; and

(iv) to the best of the company's knowledge, information, and belief, the filing complies with the applicable statutes and regulations of this state.

(2) A company submitting a filing as file and use must, in addition to providing the certification specified in paragraph (1) of this subsection, complete the appropriate certification on the transmittal checklist certifying that:

(A) no corrections to the form have been requested by the department; and

(B) the form has not been previously disapproved by the department.

(3) A company submitting a form substantially similar to a previously approved form or an exact copy of a previously approved form must provide the certification specified in paragraph (1) of this subsection, and on the transmittal checklist must provide the following information and certification(s):

(A) the form number and approval date of the previously approved form, including the company's name if different from the submitting company;

(B) a summary of the difference(s) between the previously approved form and the new form, including a description of any deleted text, and a clear identification of all changes with new or modified text underlined; and

(C) a certification that no changes have been made to the form other than those identified.

(4) A company submitting a form as a substitution of a previously approved or exempted form must provide the certification specified in paragraph (1) of this subsection, and on the transmittal checklist must provide the following information and certification(s):

(A) the form number and approval or exemption date of the previously approved or exempted form;

(B) a summary of the difference(s) between the previously approved or exempted form and the new form, including a description of any deleted text, and a clear identification of all changes with new or modified text underlined;

(C) a certification that no changes have been made to the form other than those identified; and

(D) a certification that the original version of the form has not been issued or otherwise used in Texas, and will not be issued or used in Texas at any time.

(5) A company submitting a form as a correction to a pending form must provide the certification specified in paragraph (1) of this subsection, and on the transmittal checklist must provide the following information and certification(s):

(A) the form number of the pending form;

(B) the name of the department's form review specialist who reviewed the form;

(C) the date of notification of any form deficiencies;

(D) the tracking number of the pending form as assigned by the department;

(E) a summary of the difference(s) between the previously reviewed form and the corrected form, including a description of any deleted text, and a clear identification of all changes, with new or modified text underlined; and

(F) a certification that no changes have been made to the form other than those identified.

(6) A company submitting a form as a resubmission of a previously disapproved form must provide the certification specified in paragraph (1) of this subsection, and on the transmittal checklist must provide the following information and certification(s):

(A) the form number of the disapproved form;

(B) the name of the department's form review specialist who reviewed the form;

(C) the date of disapproval by the department;

(D) the tracking number of the disapproved form as assigned by the department;

(E) a summary of the difference(s) between the disapproved form and the new form, including a description of any deleted text, and a clear identification of all changes, with new or modified text underlined; and

(F) a certification that no changes have been made to the form other than those identified.

(7) A company submitting a supplemental coverage filing pursuant to §3.3080 of this title (relating to Supplemental Coverage) or Insurance Code §1131.051 or §1131.053 must complete the appropriate certification on the transmittal checklist certifying that the policy will be marketed only as supplemental coverage.

(8) A company submitting a filing as a matrix filing or as an insert page pursuant to §3.4(f) and (g) of this title (relating to General Submission Requirements) must, in addition to providing the certification specified in paragraph (1) of this subsection, complete the appropriate certification on the transmittal checklist certifying that, when issued, the policies, certificates, contracts, riders, or applications created from such forms comply in all respects with the applicable statutes and regulations of this state and of the United States with regard to the final product issued.

(9) A company submitting a filing as exempt pursuant to §3.5(a)(3) of this title (relating to Filing Authorities and Categories) must, in addition to the certification specified in paragraph (1) of this subsection, complete the appropriate certification on the transmittal checklist certifying:

(A) the form filed is not deceptive or misleading;

(B) the form filed does not contain exceptions or conditions that unreasonably or deceptively affect the risk purported to be assumed in the general coverages of the policy;

(C) the form filed meets the criteria specified in §3.4004 of this title (relating to Exempt Forms);

(D) the form filed does not contain any new, uncommon, or unusual provisions, conditions, or concepts as provided in §3.4006 of this title (relating to New, Uncommon, and Unusual Forms);

(E) the company submitting the filed form has had a certificate of authority to do such business in Texas for a period not less than two years as required in §3.4007 of this title (relating to Newly Licensed Insurers); and

(F) the use of the form filed will be discontinued in the event of future changes in laws or rules that would prohibit the use of such forms.

(b) A company must include any applicable readability certifications, in accordance with Subchapter G of this chapter (relating to Plain Language Requirements for Health Benefit Policies), §3.3092(c) of this title (relating to Format, Content, and Readability for Outline of Coverage), §3.3102(g) of this title (relating to Language Readability), or any other statutes and regulations of this state.

(c) A company submitting a filing for a group policy or contract must:

(1) on the transmittal checklist, specify the specific group type under which the form is being filed by indicating the appropriate section as set forth in Insurance Code Chapter 1131 and Chapter 1251, or §21.2702(1) and (2) of this title (relating to Definitions) and for Chapter 26 filings, specify the size of the group. Any filing submitted under an ineligible group type will not be accepted for review by the department, and will be returned to the company as incomplete;

(2) submit a separate policy and certificate, each with a unique identifying form number, for each group type that the filing will be issued to; and

(3) submit the following required information for certain group filings.

(A) Filings subject to Insurance Code Chapter 26 of this title (relating to Employer-Related Health Benefit Plan Regulations) must comply with all filing requirements set forth in Chapter 26 of this title.

(B) Filings to be issued to an association must include a copy of the association's constitution, bylaws, and articles of incorporation that demonstrate that the association meets the requirements of Insurance Code §§1131.060, 1251.052, or 21.2702(1) or (2) of this title.

(C) Filings to be issued to an association may be submitted on an "ABC association" basis provided that, if approved, each time the form is issued to a different eligible association, the company submits:

(i) a copy of the eligible association's constitution, bylaws, and articles of incorporation; and

(ii) an alternate face page which identifies the association with either the policy number assigned or a unique form number;

(D) Accident and health filings to be issued to associations participating in a multiple association trusteed arrangement must be accompanied by:

(i) a listing of all the associations participating in the multiple association trusteed arrangement;

(ii) a copy of the trust agreement; and

(iii) a copy of each eligible association's constitution, bylaws, and articles of incorporation.

(E) A company that has received approval for a filing to be issued to associations participating in a multiple association trusteed arrangement must notify the department of any subsequent additions of participating associations upon enrollment and include the documentation required in subparagraph (D) of this paragraph for each association that joins the trust after approval of the initial filing.

(F) Filings to be issued to a multiple employer trusteed group:

(i) must be accompanied by a copy of the trust agreement;

(ii) must include an alternate face page for each related industry group, with a unique form number assigned; and

(iii) may be submitted on an "ABC Trust" basis provided that, if approved, each time the form is issued to a different eligible trust, the company submits:

(I) a copy of the individual trust agreement; and

(II) an alternate face page, identifying the policyholder, the industry, and the policy number assigned to each industry.

(d) The department may request any additional information necessary for a comprehensive review of any form.

Source Note: The provisions of this §3.6 adopted to be effective June 1, 2003, 28 TexReg 3954; amended to be effective May 11, 2022, 47 TexReg 2758