28 TAC §3.3502 — what it says, and how the exam tests it

28 TAC §3.3502. (a) This subchapter applies to: (1) group, blanket, or franchise accident and health insurance policies as described by Insurance Code Chapter 1251, concerning Group and Blanket Health Insurance; (2) individual and group health maintenance organization (HMO) evidences of coverage as defined by Insurance Code §843.002, concerning Definitions; (3) individual accident and health insurance policies as defined by Insurance Code §1201.001, concerning Definitions; (4) individual and group preferred provider benefit plans and exclusive provider benefit plans as described by Insurance Code Chapter 1301, concerning Preferred Provider Benefit Plans; (5) group insurance contracts, individual insurance contracts, and subscriber contracts that pay or reimburse for the cost of dental care; (6) individual and group health benefit plans or vision benefit plans, as described by Insurance Code Chapter 1203, Subchapter C, concerning Vision and Eye Care Benefits; and (7) the medical care components of individual and group long-term care contracts. (b) This subchapter does not apply to: (1) disability income protection coverage; (2) workers' compensation insurance coverage; (3) hospital indemnity coverage benefits or other fixed indemnity coverage; (4) accident only coverage; (5) specified disease or specified accident coverage; (6) school accident-type coverages that cover students for accidents only, including athletic injuries, either on a \"24-hour\" or a \"to and from school\" basis; (7) benefits provided in long-term care insurance policies for nonmedical services, for example, personal care, adult day care, homemaker services, assistance with activities of daily living, respite care, custodial care, or for contracts that pay a fixed daily benefit without regard to expenses incurred or the receipt of services; (8) Medicare supplement policies; (9) a state plan under Medicaid; (10) a governmental plan, which, by law, provides benefits that are in excess of those of any private insurance plan or other nongovernmental plan; or (11) an individual accident and health insurance policy that is designed to fully integrate with other policies through a variable deductible. (c) This subchapter does not apply to individual policies issued before March 25, 2014, that are noncancellable or guaranteed renewable. (Source Note: The provisions of this §3.3502 adopted to be…