Section 3.3806 - Initial and Subsequent Conditions of EligibilityA 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.28 Tex. Admin. Code § 3.3806
The provisions of this §3.3806 adopted to be effective August 10, 2000, 25 TexReg 7354