Tex. Ins. Code Section 1201.215
Policy Provision: Payment of Claims

(a)

Except as provided by Subsection (d), an individual accident and health insurance policy must contain the following provision:
“Payment of Claims: Indemnity for loss of life will be payable in accordance with the beneficiary designation and the provisions respecting indemnity payments that may be prescribed in this policy and effective at the time of payment. If such a designation or provision is not then effective, the indemnity will be payable to the insured’s estate. Any other accrued indemnities unpaid at the insured’s death may, at the option of the insurer, be paid either in accordance with the beneficiary designation or to the insured’s estate. All other indemnities will be payable to the insured.”

(b)

An insurer may include with the provision required by Subsection (a) one or both of the following provisions:
“If any indemnity of this policy is payable to the insured’s estate, or to an insured or beneficiary who is a minor or is otherwise not competent to give a valid release, the insurer may pay the indemnity, up to an amount not exceeding $__________ (insert amount), to any relative by blood or connection by marriage of the insured or beneficiary who is considered by the insurer to be equitably entitled to the indemnity. Any payment made by the insurer in good faith in accordance with this provision fully discharges the insurer to the extent of the payment.”
“Subject to any written direction of the insured, in the application or otherwise, all or a portion of any indemnity provided by this policy on account of hospital, nursing, medical, or surgical services may, at the insurer’s option and unless the insured requests otherwise in writing not later than the time of filing proof of the loss, be paid directly to the hospital or person providing the services. It is not required that the service be provided by a particular hospital or person.”

(c)

The amount to be inserted in the clause permitted by Subsection (b) may not exceed $1,000.

(d)

The provision required by Subsection (a) is not required to be contained in a policy issued by a corporation operating under Chapter 842 (Group Hospital Service Corporations).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1201.215 — Policy Provision: Payment of Claims, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1201.­htm#1201.­215 (accessed Jun. 5, 2024).

1201.001
Definitions 1201.002
Purpose 1201.003
Applicability of Chapter 1201.004
Construction of Chapter 1201.005
References to Chapter 1201.006
Rulemaking Authority 1201.007
Notice and Hearing 1201.008
Judicial Review 1201.009
Nonconforming Policy 1201.010
Third-party Ownership of Policy 1201.011
Coverage for Premium Period with Limitations by Age or Date 1201.012
Defense of Claim 1201.013
Programs Promoting Disease Prevention, Wellness, and Health 1201.051
Entire Consideration 1201.052
Time of Effectiveness and Termination 1201.053
Persons Insured 1201.054
Appearance of Text 1201.055
Exceptions and Reductions of Indemnity 1201.056
Form Number 1201.057
Incorporation of or Reference to Other Documents 1201.058
Notification that Policy Is Returnable 1201.059
Termination of Coverage Based on Age of Child in Individual, Blanket, or Group Policy 1201.061
Coverage for Adopted Child 1201.062
Coverage for Certain Children in Individual or Group Policy or in Plan or Program 1201.063
Prohibition of Certain Criteria Relating to Child’s Coverage in Individual or Group Policy 1201.064
Coverage for Child of Spouse in Individual or Group Policy 1201.065
Age and School Enrollment Eligibility Criteria for Dependent Children in Individual or Group Policy 1201.101
Standards for Policy Provisions 1201.102
Prohibition of Policy Provisions 1201.103
Compliance with Minimum Standards for Benefits 1201.104
Minimum Standards for Benefits 1201.105
Minimum Standards for Benefits for Long-term Care in Individual, Group, or Blanket Policy 1201.106
Identification of Policies According to Coverage Provided 1201.107
Outline of Coverage Required 1201.108
Format and Content of Outline of Coverage 1201.109
Notice of Rate Increase for Major Medical Expense Insurance Policy 1201.151
Compliance with Subchapter 1201.152
Coverage Under Simplified Application Form 1201.154
Coverage for Certain Previously Covered Persons 1201.201
Policy Provisions Required 1201.202
Order of Required Policy Provisions 1201.203
Other Policy Provisions 1201.204
Policy Provisions Required by Other Jurisdiction 1201.205
Policy Provisions for Policy Delivered Outside This State 1201.206
Filing Procedure 1201.207
Policy Provision: Entirety of Contract 1201.208
Policy Provision: Incontestability 1201.209
Policy Provision: Grace Period 1201.210
Policy Provision: Reinstatement 1201.211
Policy Provision: Notice of Claim 1201.212
Policy Provision: Claim Forms 1201.213
Policy Provision: Proof of Loss 1201.214
Policy Provision: Time of Payment of Claims 1201.215
Policy Provision: Payment of Claims 1201.216
Policy Provision: Physical Examinations and Autopsy 1201.217
Policy Provision: Legal Actions 1201.218
Policy Provision: Change of Beneficiary 1201.219
Policy Provision: Change of Occupation 1201.220
Policy Provision: Misstatement of Age 1201.221
Policy Provision: Excess Insurance 1201.222
Policy Provision: Relation of Earnings to Insurance 1201.223
Policy Provision: Unpaid Premium 1201.224
Policy Provision: Cancellation 1201.225
Policy Provision: Conformity with State Statutes 1201.226
Policy Provision: Illegal Occupation 1201.271
Alteration of Policy Application 1201.272
False Statements 1201.273
Binding Statements 1201.274
Insurer’s Evidentiary Use of Application for Reinstatement or Renewal 1201.0601
Required Definitions: Specified Disease Policy 1201.701
Civil Penalty 1201.702
Action Against Certificate of Authority or License
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 1201.215’s source at texas​.gov