Section 3.4004 - Exempt Forms(a) Group and individual life forms. The group and individual life insurance forms specified in this subsection are exempt from the review and approval requirements of Insurance Code Chapter 1701, unless the forms are required by the laws of Texas, another state, or the United States, to be specifically approved or are otherwise excepted in subsection (b) of this section: (1) group life insurance master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto, issued under the authority of Insurance Code §§ 1131.003, 1131.051 - 1131.058, 1131.060, and 1131.064(b), listed in subparagraphs (A) and (B) of this paragraph: (A) term policies and riders; and(B) cash value and endowment policies with no more than five death benefit and/or premium changes;(2) any alternate face pages filed subsequent to the original approval of a policy for use with multiple employer trusteed arrangements as defined in Insurance Code § 1131.053;(3) individual, joint life, and last survivor insurance forms, including applications, listed in subparagraphs (A)-(Q) of this paragraph: (B) limited pay life with no more than five death benefit and/or premium changes;(C) life paid up at specified ages with no more than five death benefit and/or premium changes;(D) single premium life with no more than five death benefit changes;(E) modified premium level death benefit life with no more than five premium changes;(F) level premium life with no more than five death benefit changes;(G) retirement income policies;(H) level or decreasing term policies and riders;(I) increasing term policies and riders;(L) family plan riders, including but not limited to children's term riders, dependent term riders, and spouse term riders;(M) limited pay endowment with no more than five death benefit and/or premium changes;(N) level premium endowment with no more than five death benefit changes;(O) single premium endowment with no more than five death benefit changes;(P) indeterminate premium policies with no more than five death benefit changes; and(Q) variable life policies with a separate account only;(4) rider forms listed in subparagraphs (A)-(K) of this paragraph: (A) accidental death benefit riders;(B) waiver of premium riders;(C) guaranteed insurability riders;(D) individual retirement accounts (IRA) (to include Roth and Simple IRA) riders;(E) preliminary term riders;(H) waiver of cost riders, including waiver of cost and monthly expense charge, and waiver of cost and premium payment;(I) dividend option riders;(J) additional insured riders; and(K) additional insurance on base insured riders;(5) endorsement forms listed in subparagraphs (A)-(K) of this paragraph: (B) nontransferability endorsements;(D) tax sheltered annuity endorsements;(E) nonassignability endorsements;(F) settlement option endorsements;(G) individual retirement account endorsements (to include Roth and Simple IRA endorsements);(J) waiver of surrender charges on disability or confinement in a hospital or nursing home endorsements; and(K) step-up or roll-up death benefit endorsements;(6) limited refilings for life insurance which indicate only a change in the mortality table or interest rates for new issues under the policy form, or changes to the separate account for variable products.(b) Exceptions. The provisions of subsection (a)(1) and (2) of this section do not apply to any group or individual life insurance forms providing the types of coverages set out in paragraphs (1) - (12) of this subsection: (2) universal related life;(4) variable life with a fixed account;(6) any forms containing a market value adjustment;(8) forms subject to Insurance Code Chapter 1153;(9) any life insurance product used to fund prepaid funeral contracts;(10) any form containing a persistency bonus provision, no-lapse premium provision, or other additional interest credit to the policy value provision (guaranteed or non-guaranteed), equity indexed provision, residual death benefit provision, accelerated death benefit provision, long-term care or other accident and health related benefit provision;(11) applications for use with variable life or equity indexed life, or forms that contain a market value adjustment provision, a long-term care or other accident and health related benefit provision; or(12) group life master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto, issued under the authority of Insurance Code § 1131.064, relating to discretionary groups.(c) Group and individual annuity forms. The group and individual annuity forms, including applications, specified in paragraphs (1) - (7) of this subsection are exempt from the review and approval requirements of Insurance Code Chapter 1701, unless the forms are required by the laws of Texas, another state, or of the United States to be specifically approved or are otherwise excepted in subsection (d) of this section: (1) single premium immediate annuities (including variable immediate annuities);(2) deferred annuities used as structured settlement options;(3) individual deferred annuities that do not include persistency bonuses or additional interest credits of any type, waiver of surrender charges (except for death, disability or confinement in a hospital or nursing home); two-tier values; or a market value adjustment: (A) for purposes of this paragraph, and paragraph (4) of this subsection, "waiver of surrender charges" means a waiver of surrender charges which is applied to any amount greater than 10% of the surrender value;(B) for purposes of this paragraph, and paragraph (4) of this subsection, "two-tier values" means values on an annuity available at the maturity date of the contract which are different, depending on whether the value is taken from the contract in a lump sum or left with the issuer for periodic payments, regardless of whether the different values are available at issue or later;(4) group annuities that do not include persistency bonuses or additional interest credits of any type, waiver of surrender charges (except for death, disability or confinement in a hospital or nursing home), two-tier values, or a market value adjustment; group annuities that are guaranteed investment contracts (GICs), synthetic GICs, funding agreements, and unallocated group annuities funding pension plans;(5) limited refilings for annuity products which indicate only a change in the mortality table or interest rates for new issues under the policy form, or changes to the separate account for variable products;(6) variable annuities with a separate account only, which do not include a provision for guaranteed living benefits; and(7) reversionary annuities.(d) Exceptions. The provisions of subsection (c) of this section do not include any of the following annuity forms: (1) annuities used to fund prepaid funeral contracts;(2) variable annuities that contain guaranteed living benefit provisions;(3) annuities that contain an equity indexed provision, long-term care or other accident- and health-related benefit provision;(4) applications for use with variable annuities, equity indexed annuities, annuities that contain a market value adjustment provision, long-term care or other accident- and health-related provision;(5) group annuity master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto, issued under the authority of Insurance Code § 1131.064, relating to discretionary groups.(e) Group and individual accident and health forms. The group and individual accident and health insurance forms specified in paragraphs (1) - (3) of this subsection are exempt from the review and approval requirements of Insurance Code Chapter 1701, unless the forms are required by the laws of Texas, another state, or the United States, to be specifically approved or are otherwise excepted in subsection (f) of this section: (1) the group and blanket accident and health forms set out in subparagraphs (A) - (D) of this paragraph: (A) any group accident and health master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto issued under authority of Insurance Code § 1251.051 and § 1251.052; provided the forms issued under authority of Insurance Code § 1251.052 are exempt only if delivered or issued for delivery to a labor union or organization of labor unions;(B) any blanket accident and health master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto, issued under authority of Insurance Code §§ 1251.351 - 1251.358;(C) any group master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto, issued under the authority of Insurance Code §§ 1251.051, 1251.052, or 1251.053 providing Medicare Supplement coverage to an employer, multiple employer arrangement, or a labor union;(D) any group master policies, contracts, certificates, applications, enrollment forms, riders, amendments, and endorsements applicable thereto, issued under the authority of Insurance Code § 1251.051 and § 1251.052 providing long-term care coverage to a single employer or a labor union through a policy which is delivered or issued for delivery outside of Texas;(2) group and individual accident and/or health policies, contracts, certificates, applications, enrollment forms, riders, amendments, endorsements, and related forms (including but not limited to outlines of coverage, notices, rates, and conditional receipts) applicable thereto, providing coverages set forth in subparagraphs (A)-(K) of this paragraph: (A) accident only (including occupational accident and other specified accident);(B) accidental death and dismemberment;(D) in-patient confinement and basic hospital expense coverages (including policies with coverage on an indemnity or expense-incurred basis)(F) specified disease (including cancer, heart attack, stroke, and other specifically named diseases);(G) disability coverages (including but not limited to income replacement, key-man, buy/sell, and overhead expense);(H) policies designed to provide conversion coverages;(I) other permitted coverages which are designed to supplement other in-force health insurance, including Champus supplements;(J) group stop loss/excess loss policies containing an attachment point of $5,000 or more; and(K) prescription drug policies; and(3) any alternate face pages filed subsequent to the original approval of a policy for use with multiple employer trusteed arrangements as defined in Insurance Code § 1251.053.(f) Exceptions. The provisions of subsection (e) of this section do not apply to any of the insurance forms set out in paragraphs (1) - (6) of this section. (1) The provisions of subsection (e)(2) of this section do not apply to any group or individual health insurance policy which provides, on a comprehensive basis for illness and injury, a combination of hospital, medical, and surgical coverages, including but not limited to any major medical policies and any limited benefit hospital, medical, and surgical policies as defined in § 3.3079 of this title (relating to Minimum Standards for Limited Benefit Coverage).(2) The provisions of subsection (e)(1) and (2) of this section do not apply to any Medicare supplement policies as defined in Insurance Code Chapter 1652, except as specifically provided in subsection (e)(1)(C) of this section.(3) The provisions of subsection (e)(1) and (2) of this section do not apply to any long-term care policies as defined in Insurance Code Chapter 1651 (including but not limited to any policies providing nursing home or home health care coverages), except as specifically provided in subsection (e)(1)(D) of this section.(4) The provisions of subsection (e)(1) and (2) of this section do not apply to any forms which contain preferred provider benefit plan provisions as defined in §§ 3.3701- 3.3706 of this title (relating to Preferred Provider Plans).(5) The provisions of subsection (e)(1) and (2) of this section do not apply to any group forms which are issued under the authority of Insurance Code § 1251.056 (discretionary groups).(6) The provisions of subsection (e)(2)(H) of this section do not apply to any policy subject to the provisions of Subchapter F of this chapter (relating to Group Health Insurance Conversion Privilege), except for policies providing conversion from a policy included as an exempt form in this section.(g) Copies of previously approved forms. Any form not otherwise exempted under this subchapter that is an exact copy of a previously approved form is exempt from the review and approval requirements of Insurance Code Chapter 1701. Such forms must be filed in accordance with and accompanied by the required certification as prescribed in Subchapter A of this chapter (relating to Submission Requirements for Filings and Departmental Actions Related to Such Filings). The certification form required to be used in filing the certification is "TEXAS POLICY FORM CERTIFICATIONS, Multi-Use Form," which also is to be utilized for filing certifications for file-and-use under Insurance Code § 1701.052, as well as for corrections, resubmissions, substitutions, and filings for forms exempted from review and official action by this subchapter. Form "TEXAS POLICY FORM CERTIFICATIONS" is available from the Life and Health Division, has been filed with the Texas Register Division of the Secretary of State for public inspection, and is adopted by reference in this subchapter. The form also is reproduced in full as Figure 1 in § 3.4020 of this title (relating to Appendix).(h) Copies of previously approved forms subsequently submitted in foreign language (non-English). Any form not otherwise exempted under this subchapter that is submitted in Braille as an exact copy of a previously approved form, or any form that has been translated into a foreign language from its previously approved English version, is exempt from the review and approval requirements of Insurance Code Chapter 1701. Such forms must be filed in accordance with and accompanied by the required certification as prescribed in Subchapter A of this chapter. The certification form required to be used in filing the certification is the same as that described in subsection (g) of this section.28 Tex. Admin. Code § 3.4004
The provisions of this §3.4004 adopted to be effective April 14, 1983, 8 TexReg 1067; amended to be effective March 12, 1996, 21 TexReg 1673; amended to be effective January 9, 2000, 25 TexReg 124; Amended by Texas Register, Volume 47, Number 18, May 6, 2022, TexReg 2766, eff. 5/11/2022