State RegulationsTX specificDifficulty 3/5
A Texas resident who was a resident on the date of liquidation holds both a major medical policy and a Medicare Supplement policy with an insurer that has been ordered liquidated. Under TIC Chapter 463, what are the per-life limits of Guaranty Association coverage for these health benefits?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under TIC Chapter 463, health benefit coverage is limited to $500,000 per life for basic hospital, medical-surgical, and major medical coverage; $300,000 per life for disability income and long-term care coverage; and $200,000 per life for other types of health coverage, which includes Medicare Supplement. Practical consequence: because the limits are stated by category, a policyowner holding coverage in more than one category can draw on more than one limit.
Why the other options are wrong
- A) $300,000 is the limit for disability income and long-term care coverage, not for Medicare Supplement coverage.
- B) $250,000 is the individual annuity present value limit, and the health limits apply by category rather than as one combined cap.
- C) The limits are reversed; $500,000 is the major medical figure, and the Medicare Supplement figure is lower rather than higher.
Memory hook
For health, think 500 major medical, 300 disability and long-term care, 200 everything else.