{"data":{"id":"us-tx/tex.-insurance-code-1651.053","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1651.053","heading":"LOSS RATIO STANDARDS.","body":"(a) A long-term care benefit plan must provide a benefit plan holder with benefits that are reasonable in relation to the rates charged.\n(b) The commissioner shall adopt reasonable rules to establish minimum standards for loss ratios of long-term care benefit plans on the basis of:\n(1) incurred claims experience;\n(2) earned premiums;\n(3) the period for which rates are computed to provide coverage;\n(4) experienced and projected trends;\n(5) concentration of experience within early benefit plan duration;\n(6) expected claim fluctuations;\n(7) experience refunds;\n(8) adjustments;\n(9) dividends;\n(10) renewability features;\n(11) all relevant expense factors;\n(12) interest;\n(13) reserves;\n(14) mix of business by risk classification; and\n(15) product features otherwise affecting claims experience.\n(c) Annually, each entity providing a long-term care benefit plan in this state shall:\n(1) file its rates, rating schedule, and supporting documentation to demonstrate compliance with the applicable loss ratio standards of this state; and\n(2) comply with any other filing requirement adopted by the commissioner relating to loss ratios.\n(d) Rules adopted under this section shall be no less favorable to the holders of long-term care benefit plans than any model laws, rules, and regulations adopted in connection with minimum standards for benefits for long-term care benefit plans.\nAdded by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE I. SPECIALIZED COVERAGES","CHAPTER 1651. LONG-TERM CARE BENEFIT PLANS","SUBCHAPTER B. BENEFIT PLAN STANDARDS"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1651.htm#1651.053","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"08e0ee217e4a7f67430d0a24e4d9c61f04591adf3529a0eeafe6af577e64e50c","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1651.052","next":"us-tx/tex.-insurance-code-1651.054"},"notice":"GroundRules: Original legal text. Not legal advice."}