§ 23-97-301. Short title

This subchapter shall be known and may be cited as the “Long-Term Care Insurance Act of 2005”.

§ 23-97-302. Purpose

The purpose of this subchapter is to: (1) Promote the public interest; (2) Promote the availability of long-term care insurance policies; (3) Protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices; (4) Establish standards for long-term care insurance; (5) Facilitate public understanding and comparison of long-term care insurance policies; and […]

§ 23-97-303. Scope

(a) The requirements of this subchapter apply to policies delivered or issued for delivery in this state on or after August 12, 2005. (b) Except as provided in subsection (c) of this section, this subchapter is not intended to supersede the obligations to comply with other applicable insurance laws that do not conflict with this […]

§ 23-97-304. Definitions

As used in this subchapter: (1) “Applicant” means: (A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (B) In the case of a group long-term care insurance policy, the proposed certificate holder; (2) “Association” means a professional, trade, or occupational association or associations, if […]

§ 23-97-305. Requirements for associations

(a) Prior to advertising, marketing, or offering a policy within this state, an association or the insurer of the association shall file evidence with the Insurance Commissioner that the association has: (1) A minimum of one hundred (100) persons; (2) Been organized and maintained in good faith for purposes other than that of obtaining insurance; […]

§ 23-97-306. Extraterritorial jurisdiction — Group long-term care insurance

No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state determines that the definition of “group long-term care insurance” under […]

§ 23-97-307. Disclosure and performance standards for long-term care insurance

(a) The Insurance Commissioner may adopt rules for long-term care insurance that include, but are not limited to, standards for full and fair disclosure addressing: (1) The manner, content, and required disclosures for the sale of long-term care insurance policies; (2) Terms of renewability; (3) Initial and subsequent conditions of eligibility; (4) Nonduplication of coverage […]

§ 23-97-308. Preexisting condition

(a) No long-term care insurance policy or certificate other than a policy or certificate issued to a group approved by the Insurance Commissioner under § 23-97-304(6)(B) shall: (1) Use a definition of “preexisting condition” that is more restrictive than the following: “Preexisting condition” means a condition for which medical advice or treatment was recommended by […]

§ 23-97-309. Prior hospitalization or institutionalization

(a) No long-term care insurance policy shall be delivered or issued for delivery in this state if the policy: (1) Conditions eligibility for any benefits on a prior hospitalization requirement; (2) Conditions eligibility for any benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or (3) Conditions […]

§ 23-97-310. Loss ratio standards

(a) The Insurance Commissioner may adopt rules establishing loss ratio standards for long-term care insurance policies. (b) A specific reference to long-term care insurance policies shall be contained in the rules.

§ 23-97-311. Right to return — Free look

(a) Long-term care insurance applicants shall have the right to return the policy or certificate within thirty (30) days of its delivery and to have the premium refunded if after examination of the policy or certificate the applicant is not satisfied for any reason. (b) Long-term care insurance policies and certificates shall contain a notice […]

§ 23-97-312. Outline of coverage

(a) (1) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the outline of coverage and its purpose. (2) The Insurance Commissioner shall prescribe a standard format for the outline, including style, […]

§ 23-97-313. Certificates

A certificate issued for delivery in this state under a group long-term care insurance policy shall include: (1) A description of the principal benefits and coverage provided in the policy; (2) A statement of the principal exclusions, reductions, and limitations contained in the policy; and (3) A statement that the group master policy determines governing […]

§ 23-97-314. Delivery of policy and summary — Disclosures

(a) If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty (30) days after the date of approval. (b) (1) At the time of the delivery of the policy, a policy summary shall be delivered […]

§ 23-97-315. Acceleration of death benefit

(a) Any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, a monthly report shall be provided to the policyholder. (b) The report shall include: (1) Any long-term care benefits paid out during the month; (2) An explanation of any changes […]

§ 23-97-316. Denial of claims

If a claim under a long-term care insurance contract is denied, within sixty (60) days of the date of a written request by the policyholder or certificate holder or a representative of the policyholder or certificate holder, the issuer shall: (1) Provide a written explanation of the reasons for the denial; and (2) Make available […]

§ 23-97-317. Offer of long-term care or nursing home insurance

Any policy or rider advertised, marketed, or offered as long-term care or nursing home insurance shall comply with the provisions of this subchapter.

§ 23-97-318. Incontestability period

(a) An insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim if: (1) The long-term care insurance policy or certificate has been in force for less than six (6) months and the insurer relied upon a material misrepresentation in providing coverage; or (2) The long-term […]

§ 23-97-319. Nonforfeiture benefits

(a) (1) Except as provided in subsection (b) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate containing a nonforfeiture benefit. (2) The offer of a nonforfeiture benefit […]

§ 23-97-320. Authority to promulgate rules

The Insurance Commissioner shall issue rules for long-term care insurance to: (1) Promote premium adequacy; (2) Protect the policyholder in the event of substantial rate increases; and (3) Establish minimum standards for: (A) Marketing practices; (B) Agent compensation; (C) Agent testing; (D) Penalties; and (E) Reporting practices.