Texas General Lines — Life, Accident, Health and HMOTexas Statutes and Rules Specific to Accident, Health and HMOEasy
A Texas resident is applying for a new individual health insurance policy. The insurer requires a medical examination, which is performed by a physician of the insurer's choice. According to Texas law, who is responsible for the cost of this medical examination?
- AThe applicant, if the policy is declined.
- BThe applicant, if the policy is issued.
- CThe insurer, regardless of whether the policy is issued.
- DThe physician, as part of their professional service.
Show answer & explanationAnswer & explanation
Correct answer: C. The insurer, regardless of whether the policy is issued.
Texas law stipulates that the insurer is responsible for the cost of any medical examination it requires for underwriting purposes, regardless of the policy's outcome.
Why the other options are wrong
- A. The applicant is not responsible for the cost, even if the policy is declined.
- B. The applicant is not responsible for the cost of a required medical examination.
- D. The physician performs the service but is paid by the insurer, not directly bears the cost.
Cost of Required Medical Exam (Texas)
In Texas, when an insurer requires a medical examination for underwriting an individual health insurance policy, the insurer must pay for the examination.
- Applies to individual health insurance.
- Insurer-required medical exams.
- Insurer pays, regardless of policy outcome.
Memory trick: The insurance company pays the 'doc's' 'bill' for the 'check-up'.