Texas law · Section III · Life, Accident and Health only
Texas statutes and rules pertinent to accident and health insurance only
Texas rules that apply only to accident and health insurance: required policy provisions, Medicare supplement rules, AIDS testing requirements, long-term care, small employer health insurance and the Affordable Care Act.
Questions on the exam
- Life, Accident and Health: 7 questions
- Life Agent: Not on this exam
Life, Accident and Health exam
What the official outline lists
- Required group and individual policy provisions
- Medicare supplement
- AIDS testing requirements
- Long term care
- Small group health insurance
- Affordable Care Act
Practice questions
Choose your answer, then open “Show the answer” to see why each option is right or wrong and the exact source text.
1. Under the Texas Employees Group Benefits Act, a child related by blood or marriage generally must have been claimed as a dependent on a federal income tax return for the calendar year preceding enrollment. In which situation does that requirement not apply?
- The child is born in the year in which the child is first enrolled
- The child is younger than 26 years of age at first enrollment
- The child has lived with the participant for at least one full year
- The child is enrolled during the program's annual enrollment period
Show the answer
Correct answer: A. The child is born in the year in which the child is first enrolled
Under TIC §1551.004(c), the Subsection (b)(2) requirement that a child be claimed as a dependent on a federal income tax return in the calendar year preceding the child's enrollment does not apply if (1) the child is born in the year in which the child is first enrolled, or (2) the participant can demonstrate good cause for not claiming the child as a dependent in the preceding calendar year.
Why the other options are wrong
- B. Incorrect. Being younger than 26 years of age is not one of the two exceptions listed in TIC §1551.004(c) (birth in the year of first enrollment, or good cause).
- C. Incorrect. Living with the participant is not an exception in TIC §1551.004(c); only birth in the year of first enrollment or demonstrated good cause excuses the requirement.
- D. Incorrect. TIC §1551.004(c) does not excuse the tax-claim requirement based on the enrollment period; its only exceptions are birth in the year of first enrollment and good cause.
(c) The requirement in Subsection (b)(2) that a child must be claimed as a dependent on a federal income tax return in the calendar year preceding the child's enrollment does not apply if:
(1) the child is born in the year in which the child is first enrolled; or
(2) the participant can demonstrate good cause for not claiming the child as a dependent in the preceding calendar year.
2. Under 28 TAC §3.3306, a Medicare supplement policy must be guaranteed renewable. For which of the following reasons may the issuer cancel or nonrenew the policy?
- Nonpayment of the policy premium
- Deterioration of the insured's health
- A high number of claims filed by the insured
- The insured reaching a specified older age
Show the answer
Correct answer: A. Nonpayment of the policy premium
Under 28 TAC §3.3306(b)(1)(E), each Medicare supplement policy must be guaranteed renewable, and the issuer may not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation. Nonpayment of premium is therefore a permitted reason.
Why the other options are wrong
- B. Incorrect. §3.3306(b)(1)(E)(i) says the issuer may not cancel or nonrenew the policy solely on the ground of health status of the individual.
- C. Incorrect. Under §3.3306(b)(1)(E)(ii), the only permitted reasons are nonpayment of premium or material misrepresentation; claim volume is not one of them.
- D. Incorrect. Age is not a permitted reason; §3.3306(b)(1)(E)(ii) allows cancellation or nonrenewal only for nonpayment of premium or material misrepresentation.
Each Medicare supplement policy must be guaranteed renewable and must comply with the provisions of clauses (i) - (vi) of this subparagraph. (i) The issuer may not cancel or nonrenew the policy solely on the ground of health status of the individual. (ii) The issuer may not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation.
3. Under 28 TAC §21.705, the HIV tests and testing procedures an insurer uses for a proposed insured must have been approved by which agency?
- The United States Food and Drug Administration
- The Texas Department of Insurance
- The federal Centers for Disease Control and Prevention
- The National Association of Insurance Commissioners
Show the answer
Correct answer: A. The United States Food and Drug Administration
Under 28 TAC §21.705(3), the tests and testing procedures used must have been approved by the United States Food and Drug Administration (FDA) and must otherwise comply with applicable Texas and federal laws.
Why the other options are wrong
- B. Incorrect. 28 TAC §21.705(3) requires approval by the United States Food and Drug Administration (FDA), not by the Texas Department of Insurance.
- C. Incorrect. The approving agency named in 28 TAC §21.705(3) is the United States Food and Drug Administration (FDA), not the Centers for Disease Control and Prevention.
- D. Incorrect. The NAIC is not named in 28 TAC §21.705(3); the rule requires tests and procedures approved by the United States Food and Drug Administration (FDA).
(3) the tests and testing procedures used have been approved by the United States Food and Drug Administration (FDA) and otherwise comply with applicable Texas and federal laws.
4. Under the Affordable Care Act's essential health benefits requirements, the pediatric services category expressly includes which two types of care?
- Oral and vision care
- Hearing and speech care
- Orthodontic and cosmetic care
- Allergy and hearing aid care
Show the answer
Correct answer: A. Oral and vision care
According to 42 U.S.C. 18022(b)(1)(J) (ACA Sec. 1302), one of the general categories of essential health benefits is "Pediatric services, including oral and vision care." Oral and vision care are the two types of care the statute names in the pediatric category.
Why the other options are wrong
- B. Incorrect. 42 U.S.C. 18022(b)(1)(J) names oral and vision care in the pediatric services category; hearing and speech care are not the types of care it names.
- C. Incorrect. 42 U.S.C. 18022(b)(1)(J) names oral and vision care; it does not name orthodontic or cosmetic care in the pediatric services category.
- D. Incorrect. The pediatric services category in 42 U.S.C. 18022(b)(1)(J) names oral and vision care, not allergy care or hearing aids.
(J) Pediatric services, including oral and vision care.
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Key flashcards
Front and back, as in the app.
- Texas Employees Group Benefits Act: when is the prior-calendar-year tax-dependent claim for a blood- or marriage-related child not required?
- When (1) the child is born in the year in which the child is first enrolled, or (2) the participant can demonstrate good cause for not claiming the child as a dependent in the preceding calendar year (TIC §1551.004(c)). (Texas Insurance Code §1551.004, “Definition of dependent”)
- 28 TAC §21.705: tests required before a proposed insured may be denied coverage or rated a substandard risk on the basis of HIV testing
- An initial ELISA test showing HIV antibodies, a second ELISA test showing HIV antibodies, and a Western Blot test confirming the two ELISA results (28 TAC §21.705, “Nondiscriminatory Testing for Human Immunodeficiency Virus.”)
- ACA essential health benefits: what does the pediatric services category expressly include?
- Pediatric services, including oral and vision care (42 U.S.C. 18022(b)(1)(J), ACA Sec. 1302). (42 U.S.C. 18022(b)(1)(J), “Essential health benefits requirements”)
Terms on this topic
- Renewable — Renovable
- Guaranteed renewable — Renovación garantizada
- Misrepresentation — Representaciones falsas
- Affordable Care Act — Ley de Cuidado de Salud a Bajo Precio
- Essential health benefits — Beneficios de salud esenciales
- Enrollment — Inscripción
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