§ 8081. Purpose The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance […]
§ 8082. Definitions As used in this chapter: (1) “Applicant” means: (A) In the case of an individual long-term care insurance policy, the individual who seeks to contract for benefits. (B) In the case of a group long-term care insurance policy, the proposed certificate holder. (2) “Certificate” means, as used in this chapter, any certificate […]
§ 8083. Extraterritorial jurisdiction No group long-term care insurance coverage may be offered to a resident of this State under a group policy issued in another state to a group described in subdivision 8082(4)(D) of this title, unless this State or another state having statutory and regulatory long-term care insurance requirements substantially similar to those […]
§ 8084. Disclosure standards (a) The Commissioner shall adopt rules establishing standards for full and fair disclosure of the terms of a long-term care insurance policy. (b) The disclosure standards established under subsection (a) of this section shall include provisions setting forth the manner, content, and required disclosures for the sale of long-term care insurance […]
§ 8084a. Required disclosure of rating practices to consumers (a) Other than policies for which no applicable premium rate or rate schedule increases can be made, insurers shall provide all of the information listed in this subsection to the applicant at the time of application or enrollment, unless the method of application does not allow […]
§ 8084b. Suitability (a) This section shall not apply to life insurance policies that accelerate benefits for long-term care. (b) The “issuer,” meaning every insurer, health care service plan, or other entity marketing long-term care insurance, shall: (1) develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is […]
§ 8085. Minimum benefits and coverage; general (a) The Commissioner shall adopt rules establishing standards for minimum benefits and coverage that must be provided by a long-term care insurance policy to carry out the purposes of subsection (b) of this section. Nothing in this section prohibits an insurer from underwriting in accordance with that insurer’s […]
§ 8086. Preexisting conditions (a) No long-term care insurance policy or certificate shall 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 or received from a provider of health care services within six months preceding the effective […]
§ 8087. Prior institutionalization No long-term care insurance policy shall condition benefits upon a period of prior hospitalization or upon admission to a facility for the same or related condition that led to hospitalization or admission to the facility. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
§ 8088. Loss ratio standards The Commissioner may adopt rules establishing loss ratio standards for long-term care insurance policies, provided that a specific reference to long-term care insurance policies is contained in the rule. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
§ 8089. Right to return; free look (a) Individual long-term care insurance policyholders shall have the right to return the policy within 30 days of its delivery and to have the premium refunded if, after examination of the policy, the policyholder is not satisfied for any reason. Individual long-term care insurance policies shall have a […]
§ 8090. Outline of coverage for applicant; certificate (a) 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 document and its purpose. The Commissioner shall prescribe a standard format, including style, […]
§ 8091. Policy summary for life insurance policy providing long-term care benefits (a) If an individual life insurance policy provides long-term care benefits within the policy or by rider, a policy summary shall be delivered at the time of policy delivery. In the case of direct response solicitations, the insurer shall deliver the policy summary […]
§ 8092. Acceleration of life insurance death benefit; monthly report Anytime 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. The report shall include: (1) any long-term care benefits paid out during the […]
§ 8093. Denial of claims; written explanation (a) If a claim under a long-term care insurance contract is denied, the issuer shall, within 60 days of the date of a written request by the policyholder or certificate holder, or a representative thereof: (1) provide a written explanation of the reasons for the denial; and (2) […]
§ 8094. Incontestability period (a) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage. (b) For […]
§ 8095. Nonforfeiture benefits (a) 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 that includes a nonforfeiture benefit. The offer of […]
§ 8096. Secondary notice of cancellation The Commissioner shall adopt the National Association of Insurance Commissioners’ model rule regarding secondary notice of cancellation of long-term care policies. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
§ 8097. Authority to adopt rules The Commissioner shall adopt reasonable rules to promote premium adequacy and to protect the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, agent compensation, field issuance, agent testing, penalties, and reporting practices for long-term care insurance. (Added 2003, No. 124 (Adj. […]
§ 8098. Buyer’s guide The Commissioner shall require that a person offering long-term care insurance distribute to applicants a buyer’s guide in a form prescribed by the Commissioner. (Added 2003, No. 124 (Adj. Sess.), § 2, eff. Jan. 1, 2005.)
