Tex. Ins. Code Section 1201.222
Policy Provision: Relation of Earnings to Insurance


(a)

Subject to Subsection (b), an individual accident and health insurance policy must contain the following provision if the policy addresses the subject matter of the provision:
“Relation of Earnings to Insurance: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage on the insured, regardless of whether the benefits are payable on a weekly or monthly basis, exceeds the amount of monthly earnings of the insured at the time the insured’s disability began or the insured’s average amount of monthly earnings for the period of two years immediately preceding a disability for which claim is made, whichever amount is greater, the insurer will be liable only for the proportionate amount of loss of time benefits under this policy as the amount of the insured’s monthly earnings or average monthly earnings bears to the total amount of monthly benefits for the same loss under all loss of time coverage on the insured at the time the disability begins and for the return of the part of the premiums paid during the immediately preceding two years that exceeds the pro rata amount of the premiums for the benefits actually paid under this policy. This provision does not reduce the total monthly amount of benefits payable under all loss of time coverage on the insured to less than $200 or the sum of the monthly benefits specified in the loss of time coverages, whichever amount is less, and does not reduce benefits other than loss of time benefits.”

(b)

The provision described by Subsection (a) may be included only in a policy that provides that the insured is entitled to continue the policy in force subject to its terms by the timely payment of premiums until the insured reaches at least 50 years of age or, if the policy was issued after the insured reached 44 years of age, until at least the fifth anniversary of the policy’s date of issuance.

(c)

An insurer may include in the provision described by Subsection (a) a definition of “valid loss of time coverage.” The form of the definition must be approved by the commissioner. The subject matter of the definition must be limited to:

(1)

coverage provided by:

(A)

governmental agencies; or

(B)

organizations subject to regulation by insurance laws or by insurance authorities of this or any other state or any province of Canada;

(2)

any other coverage the inclusion of which is approved by the commissioner; or

(3)

any combination of coverages described by Subdivisions (1) and (2).

(d)

In the absence of a definition authorized under Subsection (c), “valid loss of time coverage” does not include:

(1)

coverage provided for the insured under a compulsory benefit statute, including a workers’ compensation or employer’s liability statute; or

(2)

benefits provided by:

(A)

a union welfare plan;

(B)

an employer benefit organization; or

(C)

an employee benefit organization.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1201.222 — Policy Provision: Relation of Earnings to Insurance, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1201.­htm#1201.­222 (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

Accessed:
Jun. 5, 2024

§ 1201.222’s source at texas​.gov