Accident and health insurance policy provisions

What this document is

Tex. Ins. Code ch. 1201: Accident and health insurance policy provisions is a state statute published by Texas Legislature (statutes.capitol.texas.gov). It is one of the Texas documents that insurance license exam questions are written from, including texas life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• Tex. Ins. Code § 1201.207 (Entirety of Contract; Policy Changes)

  “A change in this policy is not valid until the change is approved by an executive officer of the insurer and unless the approval is endorsed on or attached to the policy.”

• Tex. Ins. Code § 1201.211 (Notice of Claim)

  “A written notice of claim must be given to the insurer before the 21st day after the date of the occurrence or beginning of any loss covered by the policy, or as soon after that date as is reasonably possible.”

• Tex. Ins. Code § 1201.213 (Proof of Loss)

  “Failure to provide the proof within the required time does not invalidate or reduce any claim if it was not reasonably possible to give proof within the required time. In that case, the proof must be provided as soon as reasonably possible but not later than one year after the time proof is...”

• Tex. Ins. Code § 1201.210 (Reinstatement)

  “The reinstated policy covers only loss resulting from an accidental injury sustained after the date of reinstatement and loss due to sickness that begins more than 10 days after the date of reinstatement.”

• Tex. Ins. Code § 1201.208 (Time Limit on Certain Defenses / Incontestability)

  “After the second anniversary of the date this policy is issued, a misstatement, other than a fraudulent misstatement, made by the applicant in the application for the policy may not be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) beginning after that anniversary.”

• Tex. Ins. Code § 1201.214 (Time of Payment of Claims)

  “Indemnities payable under this policy for any loss, other than a loss for which this policy provides any periodic payment, will be paid immediately on receipt of due written proof of the loss.”

• Tex. Ins. Code § 1201.209 (Policy Provision: Grace Period)

  “Grace Period: A grace period of __________ (insert appropriate number) days will be granted for the payment of each premium due after the first premium. During the grace period, the policy continues in force.”

• Tex. Ins. Code § 1201.057 (Incorporation of or Reference to Other Documents)

  “An individual accident and health insurance policy that provides that a portion of the charter, rules, constitution, or bylaws of the insurer are a part of the policy must state that portion fully in the policy. (b) An individual accident and health insurance policy may incorporate or refer to: (1)...”

• Tex. Ins. Code § 1201.202(b)-(c) (Order of Required Policy Provisions)

  “(b) An insurer may print a policy provision required by this subchapter or a corresponding substitute provision as a unit in any part of the policy with other provisions to which the provision is logically related. (c) A policy printed under Subsection (b) may not be wholly or partly...”

• Tex. Ins. Code § 1201.210 (Policy Provision: Reinstatement)

  “Reinstatement: If a renewal premium is not paid before the expiration of the period granted for the insured to make the payment, a subsequent acceptance of the premium by the insurer or any agent authorized by the insurer to accept the premium, without requiring in connection with the acceptance an...”

• Tex. Ins. Code § 1201.201(b) (Substitute Wording for Required Policy Provisions)

  “An insurer may substitute for a policy provision required by this subchapter a provision with different wording approved by the commissioner in accordance with reasonable rules adopted by the commissioner. A substituted provision may not be less favorable to an insured or a beneficiary of the...”

• Tex. Ins. Code § 1201.212 (Policy Provision: Claim Forms)

  “The insurer, on receipt of a notice of claim, will provide to the claimant the forms usually provided by the insurer for filing proof of loss. If the forms are not provided before the 16th day after the date of the notice, the claimant shall be considered to have complied with the requirements of...”

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