Texas General Lines — Life, Accident, Health and HMOTexas Statutes and Rules Specific to Accident, Health and HMOEasy
A Texas resident applies for a new health insurance policy. The insurer requires a medical examination as part of the underwriting process. Under Texas law, who is responsible for the cost of this required medical examination?
- AThe insurer, regardless of whether the policy is issued.
- BThe applicant, if the policy is declined.
- CThe cost is split evenly between the applicant and the insurer.
- DThe applicant, if the policy is issued.
Show answer & explanationAnswer & explanation
Correct answer: A. The insurer, regardless of whether the policy is issued.
In Texas, if an insurer requires a medical examination as part of the underwriting process for a health insurance policy, the insurer is responsible for the cost of that examination, regardless of whether the policy is ultimately issued or declined.
Why the other options are wrong
- B. This is incorrect; the insurer pays even if the policy is declined.
- C. This is incorrect; the insurer bears the full cost.
- D. This is incorrect; the insurer is always responsible for the cost of a required exam.
Cost of Required Medical Exam (TX)
Under Texas law, if an insurer requires a medical examination for health insurance underwriting, the insurer must pay for the cost of that examination, regardless of the policy's outcome.
- Applies to health insurance underwriting.
- Exam must be 'required' by the insurer.
- Insurer pays 100% of the cost.
- Applies whether policy is issued or declined.
Memory trick: If the 'Doc Exam' is 'Required', the 'Insurer Pays' the bill.