Texas State Regulations & NAIC Insurance Law
Licensing
Any individual applying for a Texas resident producer’s license must be at least 18 years old and must be a resident of Texas before submitting an application.
Pre-licensing course and exam
Texas does not have specific pre-licensing requirements, but an individual applicant must have passed the licensing examination within the past 12 months (Tex. Ins. Code § 4001.105).
Fingerprints/background check
The Commissioner reviews an applicant’s background before issuing a license, and many states require applicants to submit fingerprints for a state and FBI criminal history check as part of the application.
Controlled business
Controlled business is insurance written on the producer’s own life, property or interests, or on those of the producer’s family, employer or a business the producer controls. A producer may insure themselves and their family, but a license exists to sell insurance to the public, so states generally restrict obtaining or using a license principally to write controlled business.
Non-resident license
A producer licensed in another state can obtain a Texas nonresident license without taking Texas’s examination. Under the NAIC’s Producer Licensing Model Act, which most states have adopted in some form, a nonresident receives the license if the person:
- Is currently licensed as a resident, and in good standing, in the home state
- Has applied (the home-state application or the Uniform Application) and paid the fees
- Lives in a home state that grants nonresident licenses to residents of this state on the same basis (reciprocity)
Under the same model, a producer who moves to another state files a change of address, with certification from the new home state, within 30 days. In Texas, an individual agent notifies the Department on a monthly basis of a change of mailing address, a felony conviction, or an administrative action taken by a financial or insurance regulator (Tex. Ins. Code § 4001.252(a)). A licensed producer who moves into a state applies for a resident license there within 90 days and does not repeat prelicensing education or the examination for lines already held.
Temporary license
Most states allow the insurance regulator to issue a temporary license, without an examination, when one is needed to keep an insurance business serviced. Typical cases are:
- The surviving spouse or personal representative of a producer who dies or becomes disabled, to allow time to sell the business or train new people
- A member or employee of a business entity producer, on the death or disability of its designated producer
- The designee of a producer entering active military service
The regulator may limit what a temporary licensee may do and may require a licensed sponsor who takes responsibility for the temporary licensee’s acts.
In Texas, a temporary license is valid for 180 days after the date it is issued, and may not be issued to a person who does not intend to apply for a license to sell insurance to the general public (Tex. Ins. Code §§ 4001.155, 4001.156(b)). The temporary license goes to an applicant being considered for appointment as an agent (Tex. Ins. Code § 4001.151); when a property and casualty agent dies or becomes disabled, Texas instead issues an emergency license, valid for 90 days in any 12 consecutive months (Tex. Ins. Code § 4051.054).
Military service
Under the NAIC’s model act, a producer who cannot meet license renewal requirements because of military service, or because of another extenuating circumstance such as a long-term medical disability, may request a waiver of those requirements and of any examination, fine or sanction for missing them.
Renewal and reinstatement
A producer license stays in effect only while the producer renews it on schedule: paying the renewal fee and completing continuing education by the due date.
Each state sets its own renewal cycle.
A producer who misses the deadline and lets the license lapse may be able to reinstate it without retaking the examination.
Under the NAIC’s model act, a lapsed license may be reinstated within 12 months of the renewal due date, for a penalty of double the unpaid renewal fee. Each state sets its own window and fee, and after the window closes the person must qualify for a new license. Texas uses its own steps: a license expired 90 days or less may be renewed for the renewal fee plus half again; after more than 90 days but less than a year, the person may obtain a new license without the examination for the license fee plus half again; after a year or more, the person must qualify again, including any examination (Tex. Ins. Code § 4003.007).
Continuing education
All states, including Texas, have continuing education (CE) requirements that must be met to renew any major lines (life, health, property, liability) insurance license. Individuals licensed in Texas must complete continuing education before renewing their license. The number of hours required is set by state law and published by the state insurance department. In Texas, a general lines or personal lines agent completes 24 hours of continuing education each license period, including 3 hours of ethics (Tex. Ins. Code §§ 4004.053(a), 4004.054).
Notice of change of name or address
Under the NAIC’s model act, the licensee reports a change of address to the regulator within 30 days of the change.
The model also requires a producer to report to the regulator within 30 days any administrative action taken against the producer in another state or by another government agency, counted from the final disposition, and any criminal prosecution in any jurisdiction, counted from the initial pretrial hearing date. A producer who does business under any name other than their legal name must notify the regulator before using it.
Company regulations
An insurance company must be authorized by the Department of Insurance to conduct business in Texas. To receive a certificate of authority, the company applies to the Commissioner and files its charter or articles of incorporation, financial statements showing that it meets the state’s capital and surplus requirements, and the other documents and fees the state requires.
Capital and surplus requirement
A company authorized to conduct insurance business in Texas must meet minimum corporate standards. The certificate of authority allows the insurer to conduct business in the state only if it maintains the minimum capital or permanent surplus required. In Texas, when an insurer’s surplus is impaired beyond the statutory level, the Commissioner must order it to bring the surplus to an acceptable level or to cease engaging in business in Texas, and then begin proceedings to decide further action (Tex. Ins. Code § 404.053).
Medigap policies
To reduce confusion about the many types of Medicare supplement policies available, federal law mandates national standardization of Medigap policies. The law requires insurers to offer a limited number of standardized Medigap plans developed by the NAIC.
Currently, the available plans are A, B, C, D, F, G, K, L, M, and N. Plans E, H, I, and J have been eliminated. In addition, Plans C and F are not available to individuals who became newly eligible for Medicare on or after January 1, 2020.
Plan A includes the “core” benefits (Parts A and B co-payments, 365 additional days of hospitalization, and the first 3 pints of blood). If an insurer sells any Medigap policies in the state, it must offer Plan A.
A Buyer’s Guide and an Outline of Coverage are delivered at the time of application, before accepting any premium payment.
Duties of the Commissioner of Insurance
The Texas Commissioner of Insurance is a state executive position in the Texas government. The Commissioner is the chief executive of the Texas Department of Insurance, which regulates insurance companies operating in Texas. The Commissioner of Insurance is appointed by the Governor for a term of 2 years.
The Commissioner is responsible for establishing and enforcing regulations in the Texas insurance market in a manner that protects consumers and encourages economic development.
Duties of the Commissioner include:
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Investigate all claims and complaints of legal violations relating to insurance.
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If the Commissioner finds that laws have been violated, the findings and supporting documents may be referred for criminal prosecution. In Texas, when the Commissioner believes a fraudulent insurance act has occurred, the Commissioner shall take disciplinary action and shall report it to an authorized governmental agency (Tex. Ins. Code § 701.103(a)).
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Monitor transactions of all companies, including domestic, foreign, and alien insurance companies.
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Audit the books and records of any resident producer as frequently as necessary.
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Collect all fees associated with producers and insurers.
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Determine and administer fines associated with violations for insurers and producers.
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Issue reports pertaining to the suspension and revocation of licenses of producers and certificates of authority for insurers.
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Approve documentation used by insurance companies, such as forms and rates.
Suspend, revoke or non-renew
The Commissioner has the authority to suspend, revoke, or refuse to renew a license for:
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Providing false information on the application for an insurance license.
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Omitting any relevant information on an application that would have disqualified the individual from being eligible to receive a license.
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Being found guilty of a violation or noncompliance with insurance regulations and laws.
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Committing fraud while attempting to obtain an insurance license.
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Improperly withholding, misappropriating or converting any money or property received in the course of doing insurance business.
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Providing false information in reference to the terms and conditions of an insurance contract.
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Having been convicted of a felony.
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Having admitted or been found to have committed any insurance unfair trade practice or fraud.
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Having engaged in fraudulent activities that allowed the person to involve themselves in dishonest, coercive, untrustworthy, and financially irresponsible practices.
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Having offered or given a rebate of an insurance premium or commission to an insured (Tex. Ins. Code § 4005.101(b)(9)).
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Using another person’s identity and forging their name on an insurance application.
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Being found guilty of using unethical practices or cheating on an examination for an insurance license.
Cease and desist
If the Commissioner finds that a producer has violated the state’s insurance laws, the Commissioner may order the producer to cease and desist. A cease and desist order does not suspend or revoke the recipient’s registration, but it does require the recipient to stop or limit the activity addressed in the order.
Hearing and penalties
A person facing action by the Commissioner is entitled to notice and an opportunity for a hearing, within time limits set by Texas law, and may ask a court to review the final order. In Texas, unfair practice charges come with a notice of hearing, the hearing may not be held before the sixth day after the notice is served, and a cease and desist order follows a finding of a violation (Tex. Ins. Code §§ 541.102, 541.108). A license holder facing denial, suspension or revocation is entitled to a hearing before the State Office of Administrative Hearings on at least 10 days’ notice (Tex. Ins. Code § 4005.104(a); Tex. Gov’t Code § 2001.051). The Commissioner may also issue an emergency cease and desist order without a hearing for fraudulent, hazardous or immediately harmful conduct, requiring the person to stop immediately, with a hearing if the person requests one within 60 days (Tex. Ins. Code §§ 83.051-83.053). The emergency order stays in effect while a hearing is pending unless the Commissioner stays it (Tex. Ins. Code § 83.055).
A violation of the insurance laws can bring a civil penalty in addition to action against a license. State law sets the maximum, usually per violation and often with a cap on the total, and a higher tier commonly applies to a violation that was knowing or flagrant. Some violations are also crimes. In Texas, an administrative penalty may not exceed $25,000 for each violation unless another insurance law sets a different amount (Tex. Ins. Code § 84.022(a)).
Unfair claims settlement practices
Under the NAIC’s model act, these practices are violations when committed flagrantly and in conscious disregard of the law, or often enough to indicate a general business practice.
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The intentional obstruction and delay of claims payment, or the delay of a claims investigation, is a violation of regulation.
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Neglecting to provide a prompt response and written explanation of insurance policy terms, conditions, and laws related to the contract are examples of unfair claims settlement practices.
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Failure to provide claims without launching a thorough investigation is a violation of regulation.
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Making settlement claims based on information contained on an application that has been altered without the insured’s consent is a violation of regulation.
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Denying a claim without conducting a thorough investigation.
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Attempting to settle a claim for less than fair market value.
Policy forms
Insurers file their policy forms with the Commissioner.
Depending on the line of insurance and the form, a state may require approval before a form is used, often with a period after which a filing that has not been acted on is deemed approved, or may allow the form to be used as soon as it is filed (“file and use”). In Texas, a property and casualty policy form must be filed with and approved by the Commissioner at least 60 days before use and is approved at the end of that period unless the Commissioner acts, with one extension of up to 10 days (Tex. Ins. Code § 2301.006); a life, annuity, accident or health insurance form is filed at least 60 days before use and is considered approved on the 61st day unless the Commissioner acts, or may be used as soon as it is filed if it carries a certification that it complies with the law (Tex. Ins. Code §§ 1701.051, 1701.052, 1701.054(a)).
If a policy provision conflicts with Texas law, the policy is read as amended to conform to the law.
Record maintenance
A producer keeps records of each transaction (the policies placed, the insureds, the premiums received and any changes) and makes them available for the Commissioner’s inspection.
Fraudulent producer representation
An insurance producer who represents to the public that they are licensed to conduct insurance business in Texas, but has not passed the appropriate licensing examination, is in violation of regulation. This includes any public communication, such as advertisements, letterheads, circulars, business cards, and other methods of representation, that implies the person is a licensed producer.
A producer found guilty of conducting business in Texas in any line of insurance for which they are not properly licensed may have any other insurance license suspended or revoked.
Misrepresentation
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Misrepresentation involving the creation or distribution of policies, quotes, and illustrations designed to provide inaccurate information about the terms and conditions of a policy is prohibited.
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Providing inaccurate or incomplete information or comparisons regarding the benefits of a policy is an example of misrepresentation.
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Providing inaccurate or incomplete information for the purpose of inducing, or tending to induce, the lapse, exchange, conversion, forfeiture, or surrender of a policy is also a violation (twisting).
False advertising
Making, publishing or circulating an advertisement, announcement or statement about the business of insurance that is untrue, deceptive or misleading is an unfair trade practice under state law, based on the NAIC’s model act. The medium does not matter: the rule reaches newspapers, magazines, radio and television, and also notices, circulars, pamphlets, letters, posters and any other way of placing the statement before the public. The model act’s test is whether the statement is untrue, deceptive or misleading, not whether the person meant to deceive.
Defamation
Defamation of an insurer is an unfair trade practice under state law, based on the NAIC’s model act: making, publishing or circulating an oral or written statement that is false, or maliciously critical of or derogatory to the financial condition of an insurer, and that is calculated to injure that insurer or any other person engaged in the business of insurance. Spreading an untrue rumor that a competing insurer is about to fail is the classic example.
Boycott, coercion and intimidation
Entering into an agreement to commit, or by concerted action committing, any act of boycott, coercion or intimidation that results or tends to result in unreasonable restraint of, or monopoly in, the business of insurance is prohibited.
False financial statements
In Texas, filing with a public official, or making or circulating, a false statement of an insurer’s financial condition with intent to deceive is an unfair practice (Tex. Ins. Code § 541.055(a)), and a producer may be disciplined for fraudulent or dishonest acts or practices (Tex. Ins. Code § 4005.101(b)(5)).
Illegal inducements
Offering anything of value not specified in the policy (money, a service, a favor or a gift) as an inducement to buy insurance is prohibited unless state law expressly allows it, and any agreement made as part of the sale must be written into the policy.
States differ on promotional gifts. The NAIC’s model act lets producers and insurers give customers non-cash gifts, meals or charitable donations up to an amount the state considers reasonable, as long as the gift is not conditioned on buying or renewing a policy and is offered without unfair discrimination. Each state sets its own limit. In Texas, an agent may give, in connection with an offer or sale, a promotional advertising item, educational item or traditional courtesy commonly extended to consumers valued at $25 or less (Tex. Ins. Code § 4005.053(d)). For life, annuity and accident and health coverage, noncash gifts, items or services, including meals, are also allowed if their cost does not exceed an amount the Commissioner determines to be reasonable, they are offered without unfair discrimination and no purchase is required (Tex. Ins. Code § 1702.053(a)).
Unfair discrimination
Unfair discrimination is treating people or risks that present the same hazard differently. The NAIC’s model act, on which state unfair trade practices laws are based, prohibits:
- Unfair discrimination between individuals of the same class and equal expectation of life in life insurance and annuity rates, dividends, benefits or terms
- Unfair discrimination between individuals of the same class and essentially the same hazard in health insurance premiums, benefits or terms
- Refusing, limiting or canceling coverage because of a person’s sex, marital status, race, religion or national origin
- In property and casualty insurance, refusing or limiting coverage solely because of a risk’s geographic location, unless sound underwriting and actuarial principles justify it, or solely because the applicant or insured is physically or mentally impaired
Many states also expressly forbid refusing or limiting coverage solely because a person is blind or partially blind. Texas’s own rule: an insurer may not refuse, limit or charge a different rate because of race, color, religion or national origin; age, gender, marital status or geographic location; or disability or partial disability (Tex. Ins. Code § 544.002(a)), but the second and third groups may be used when the decision rests on sound underwriting or actuarial principles reasonably related to actual or anticipated loss experience (Tex. Ins. Code § 544.003(b)). A widowed person may never be charged a different rate than a married person (Tex. Ins. Code § 544.002(d)).
Errors & Omissions
Errors & Omissions (E&O) insurance is a type of professional liability insurance that protects insurance agents if they are sued for negligent performance of their duties. E&O covers negligence and unintentional mistakes that cause financial harm to clients. It does not cover intentional misconduct, criminal acts, or regulatory fines.
Children covered as dependents
Under the Affordable Care Act, a plan that offers dependent coverage must make it available to an adult child until age 26, whether or not the child is married, a student or financially dependent on the parent.
State law generally requires a policy that covers dependents to cover a newborn from the moment of birth and an adopted child from placement, and may let the insurer require notice and any added premium within a set period to continue the child’s coverage. In Texas, a plan that covers newborns may not exclude or limit a newborn’s initial coverage before the 61st day after birth, or coverage for congenital defects (Tex. Ins. Code § 1367.003). Policies also generally continue coverage past the age limit for a dependent child who cannot support themselves because of a mental or physical disability that began before that age.
Rebating
Texas licensed producers are prohibited from directly or indirectly giving any refund, discount, favor, or credit to reduce premiums to induce the purchase of insurance. Texas allows some exceptions: an accident and health insurer may offer premium discounts, rebates or reduced cost sharing to people who take part in disease-prevention or wellness programs, and that is not a prohibited rebate (Tex. Ins. Code § 1702.155); insurers and agents may also provide loss-control or value-added products and services of reasonable cost (Tex. Ins. Code § 1702.051).
Sharing commission
The splitting or sharing of commissions with a licensed producer is allowed. Both parties must be licensed in the line of business in which the proposed commission is to be split. Under the NAIC’s model act, a commission may also be paid to an insurance agency, or to a person who does not sell, solicit or negotiate insurance.
Twisting
Providing false information or expressing derogatory ideas about the financial conditions of a competitor company with the intent to lapse or surrender an existing policy is a violation of the law. Any written or oral statements used to induce the lapse, termination, exchange, or surrender of an insurance contract based on inaccurate information is prohibited.
Under the NAIC’s model act, twisting is a misrepresentation made to induce a policyholder to lapse, forfeit, surrender, exchange or convert a policy. A false or maliciously critical statement about a competing insurer’s finances, made to injure it, is defamation. In Texas, a misleading representation or misrepresentation about an insurer’s financial condition is also an unfair practice in its own right, whatever its purpose (Tex. Ins. Code § 541.051(3)(A)).
Unfair marketing practices
The Department of Insurance is responsible for establishing minimum standards for full and fair disclosure of policy content. The Department also requires standardization and simplification of the terms used to describe insurance coverage. Advertising may not involve the following:
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Any statement or implication that policies are approved, or that the financial condition of a company is endorsed, by any government agency or by any independent group, individual, organization or society, unless that is the fact.
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Any statements in advertising that are false or untrue in reference to the time frame in which claims are paid.
Gramm-Leach Bliley Act (GLBA)
This law repealed the Glass-Steagall Act of 1933, allowing consolidation of commercial banks, investment institutions, and insurance companies. GLBA established a framework of responsibilities for federal and state regulators for these financial industries. It permits financial services companies to merge and engage in a variety of new business activities, including insurance, while attempting to address the regulatory issues raised by such combinations.
McCarran-Ferguson Act
Federal law signed in 1945 in which Congress declared that the insurance industry would be regulated at the state level. Grants insurers a limited exemption from federal antitrust legislation. Since 2021 the exemption does not cover the business of health insurance, apart from narrow activities such as sharing historical loss data (15 U.S.C. § 1013©).
National Association of Insurance Commissioners (NAIC)
The U.S. standard-setting and regulatory support organization is created and governed by the chief insurance regulators from the 50 states, the District of Columbia, and five U.S. territories. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. NAIC staff supports these efforts and represents the collective views of state regulators domestically and internationally. NAIC members, together with the central resources of the NAIC, form the national system of state-based insurance regulation in the U.S.
Fair Credit Reporting Act
The Fair Credit Reporting Act (FCRA, 15 U.S.C. 1681) regulates consumer reporting agencies and the use of consumer reports, such as credit reports, MIB records and investigative reports, including in insurance underwriting.
- When an insurer requests an investigative consumer report, it must disclose that to the consumer within 3 days of the request
- When an insurer takes adverse action based on a consumer report, it must notify the consumer and identify the reporting agency. The consumer then has 60 days to request a free copy of the report and may dispute inaccurate information
Privacy Act of 1974
The federal Privacy Act of 1974 governs how federal agencies handle personal information. It does not apply to private insurers. An insurer’s use of an applicant’s personal information is governed by the FCRA, the Gramm-Leach-Bliley Act and state insurance privacy law.
In states that adopted the NAIC’s Insurance Information and Privacy Protection Model Act, an authorization to collect personal information signed with an application is valid for no more than 30 months for life, health or disability insurance and one year for property or casualty insurance.
Telemarketing
The National Do Not Call Registry is a list of telephone numbers whose owners do not want to receive telemarketing calls. Telemarketers may not call registered numbers without the person’s permission or an established business relationship, and unsolicited sales calls:
- May be made only between 8 a.m. and 9 p.m. in the recipient’s local time
- Must disclose the caller’s identity, the company the caller represents and that the purpose is a sale
CAN-SPAM
A commercial email must:
- Be identified clearly as an advertisement
- Carry accurate header information and a subject line that is not deceptive
- Include the sender’s valid physical postal address
- Offer a way to opt out, and the sender must honor an opt-out within 10 business days