Sec. 1251.103. INCONTESTABILITY OF POLICY. (a) A group accident and health insurance policy must provide that:
(1) the validity of the policy may not be contested after the policy has been in force for two years after its date of issue; and
(2) in the absence of fraud, a statement made by any individual covered by the policy relating to the individual's insurability may not be used in contesting the validity of the insurance with respect to which the statement was made:
(A) after the insurance has been in force before the contest for two years during the individual's lifetime; and
(B) unless the statement is contained in a written instrument signed by the individual making the statement.
(b) Subsection (a)(1) does not apply to a contest based on nonpayment of premiums.
(c) The provisions required by this section do not preclude the assertion at any time of a defense based on:
(1) a provision in the policy that relates to eligibility for coverage;
(2) a provision in a group accident and health insurance policy or disability insurance policy that relates to overinsurance;
(3) a provision in a disability policy that relates to the relation of earnings to insurance; or
(4) another similar provision in a group accident and health insurance policy or disability insurance policy that limits the amounts of recovery from all sources to not more than 100 percent of the total actual losses or expenses incurred.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Structure Texas Statutes
Title 8 - Health Insurance and Other Health Coverages
Subtitle B - Group Health Coverage
Chapter 1251 - Group and Blanket Health Insurance
Subchapter C. Group Accident and Health Insurance: Required Provisions
Section 1251.101. Required Provisions
Section 1251.102. Payment of Premiums
Section 1251.103. Incontestability of Policy
Section 1251.104. Entire Contract
Section 1251.105. Statement Made by Policyholder or Insured
Section 1251.106. Distinction Based on Marital Status Prohibited
Section 1251.107. Evidence of Insurability
Section 1251.108. Exclusion or Limitation of Coverage for Preexisting Conditions
Section 1251.109. Adjustment of Premiums or Benefits if Age of Insured Is Misstated
Section 1251.110. Deadline for Notice of Claim
Section 1251.112. Deadline for Claim
Section 1251.113. Prompt Payment of Benefits Required
Section 1251.114. Payment of Benefits
Section 1251.115. Right to Conduct Physical Examination or Autopsy