Chapter 20:06:21 - Long-term care insurance
- Section 20:06:21:01 - Definitions
- Section 20:06:21:01.01 - Nature of care - How defined
- Section 20:06:21:01.02 - Service providers - How defined
- Section 20:06:21:01.03 - Long-term care insurance
- Section 20:06:21:01.04 - Similar policy forms
- Section 20:06:21:01.05 - Treatment of accelerated benefits in life insurance
- Section 20:06:21:01.06 - Claim and clean claim - Defined
- Section 20:06:21:02 - Minimum standards for long-term care insurance policies
- Section 20:06:21:02.01 - Annuity policies with long-term care benefits subject to waiting period
- Section 20:06:21:03 - Renewability of group policies - Required disclosures
- Section 20:06:21:04 - Permissible exclusions from coverage
- Section 20:06:21:05 - Loss ratios
- Section 20:06:21:05.01 - Relation of benefits to premium for accelerated death benefit on life insurance
- Section 20:06:21:06 - Cost-of-living adjustments - Basis
- Section 20:06:21:06.01 - Cost-of-living adjustments - Minimum standards
- Section 20:06:21:06.02 - Group cost-of-living adjustments - Exceptions
- Section 20:06:21:06.03 - Cost-of-living adjustments - Continuation of benefit increases
- Section 20:06:21:06.04 - Cost-of-living adjustments - Automatic increases - Conspicuous offer of constant premium
- Section 20:06:21:06.05 - Cost-of-living adjustments - Rejection by policyholder
- Section 20:06:21:07 - Applicability of rules to long-term care insurance riders
- Section 20:06:21:08 - "Medically necessary" defined
- Section 20:06:21:09 - Basis for conversion of coverage from group defined
- Section 20:06:21:10 - Converted policy from group defined
- Section 20:06:21:11 - Converted policy from group - Time allowed for written application
- Section 20:06:21:12 - Converted policy from group - Calculation of policy premium
- Section 20:06:21:13 - Continuation or conversion is mandatory - Exceptions
- Section 20:06:21:14 - Converted policy from group to individual - Reduction of benefits - Exception
- Section 20:06:21:15 - Converted policy from group - Benefits payable
- Section 20:06:21:16 - Converted policy from group - Eligibility for coverage of relatives
- Section 20:06:21:17 - Converted policy from group - Managed care plan defined
- Section 20:06:21:18 - Discontinuance and replacement of a group policy
- Section 20:06:21:19 - Premium increase prohibitions
- Section 20:06:21:20 - Lapse or termination notice required
- Section 20:06:21:21 - Lapse or termination for payment through payroll or pension deduction plan
- Section 20:06:21:22 - Lapse or termination for nonpayment of premium
- Section 20:06:21:23 - Disclosure of renewability
- Section 20:06:21:24 - Disclosure of payment of benefits based on certain standards
- Section 20:06:21:25 - Disclosure of limitations on preexisting conditions
- Section 20:06:21:26 - Disclosure of other limitations or conditions on eligibility for benefits
- Section 20:06:21:26.01 - Notice to claimants - Temporary leave
- Section 20:06:21:27 - Outline of coverage
- Section 20:06:21:28 - Outline of coverage - Standard format
- Section 20:06:21:28.01 - Applications - Questions about replacement
- Section 20:06:21:29 - Replacement notices
- Section 20:06:21:30 - Filing requirements for advertising - Exemption
- Section 20:06:21:31 - Standards for marketing - Requirements
- Section 20:06:21:32 - Standards for marketing - Prohibited practices
- Section 20:06:21:33 - Standards for marketing - Associations
- Section 20:06:21:34 - Extension of benefits
- Section 20:06:21:35 - Basis for continuation or conversion from group coverage required
- Section 20:06:21:36 - Basis for continuation of coverage from group defined
- Section 20:06:21:37 - Reinstatement
- Section 20:06:21:38 - Disclosure of riders and endorsements
- Section 20:06:21:39 - Disclosure of tax consequences
- Section 20:06:21:40 - Applications - Health and medication questions
- Section 20:06:21:41 - Applications - Notice about incorrect answers
- Section 20:06:21:42 - Policies - Notice about incorrect answers on applications
- Section 20:06:21:43 - Elderly applicants - Required information
- Section 20:06:21:44 - Applications - Delivery
- Section 20:06:21:44.01 - Applications - Delivery upon approval.Repealed
- Section 20:06:21:45 - Records of rescissions - Maintaining and filing records
- Section 20:06:21:46 - Minimum standards for home health and community care benefits
- Section 20:06:21:47 - Policy summary for individual life insurance policy containing long-term care benefits
- Section 20:06:21:48 - Monthly report to policyholder
- Section 20:06:21:49 - Incontestability period
- Section 20:06:21:50 - Assisted living center or facility defined
- Section 20:06:21:51 - Assisted living centers - Minimum benefit standards
- Section 20:06:21:52 - Reporting requirements for insurers
- Section 20:06:21:53 - Appropriateness of recommended purchase or replacement
- Section 20:06:21:53.01 - Suitability standards
- Section 20:06:21:53.02 - Suitability - Long-term care insurance personal worksheet
- Section 20:06:21:53.03 - Suitability - Response letter
- Section 20:06:21:53.04 - Suitability - Policies not included
- Section 20:06:21:53.05 - Suitability - Overinsurance
- Section 20:06:21:54 - Requirement to deliver shopper's guide
- Section 20:06:21:55 - Standards for benefit triggers
- Section 20:06:21:56 - Additional standards for benefit triggers for qualified long-term care insurance contracts
- Section 20:06:21:57 - Nonforfeiture benefits
- Section 20:06:21:58 - Nonforfeiture benefit requirement
- Section 20:06:21:59 - Electronic enrollment for group policies
- Section 20:06:21:60 - Required disclosure of rating practices to consumers - Rate stabilization
- Section 20:06:21:61 - Initial filing requirements
- Section 20:06:21:62 - Reserve standards
- Section 20:06:21:63 - Premium rate schedule increases - Notice of pending increase
- Section 20:06:21:64 - Premium rate schedule increase requirements
- Section 20:06:21:65 - Premium rate schedule increases - Review by the director
- Section 20:06:21:66 - Premium rate schedule increases - Adverse lapsation
- Section 20:06:21:67 - Premium rate schedule increases - Policies to which does not apply
- Section 20:06:21:68 - Premium rate schedule increases - Group insurance policies
- Section 20:06:21:69 - Premium rate schedule increases - Adoption of rules
- Section 20:06:21:70 - Premium rate schedule increases - Exceptional increases
- Section 20:06:21:71 - Permitted compensation arrangements
- Section 20:06:21:72 - Disclosure to applicant for a claim denial
- Section 20:06:21:73 - Providers in a different state
- Section 20:06:21:74 - Agent training required to market long-term care plans
- Section 20:06:21:75 - Insurers required to verify agent training and maintain records
- Section 20:06:21:76 - Long-term care partnership policies - Inflation protection requirements
- Section 20:06:21:77 - Long-term care partnership policies - Required policy disclosures
- Section 20:06:21:78 - Long-term care partnership policies - Filing requirements
- Section 20:06:21:79 - Long-term care - Minimum benefit requirements
- Section 20:06:21:80 - Long-term care partnership policies - Policy amendments
- Section 20:06:21:81 - Long-term care policies - Policy amendments
- Section 20:06:21:82 - Availability of new services or providers
- Section 20:06:21:83 - Policies issued considered exchanges
- Section 20:06:21:84 - Policies offered through employers, labor unions, and associations
- Section 20:06:21:85 - Applicability of new provider or service requirements
- Section 20:06:21:86 - Right to reduce coverage and lower premiums
- Section 20:06:21:87 - Authorized representative
- Section 20:06:21:88 - Notice to insured
- Section 20:06:21:89 - Internal appeal
- Section 20:06:21:90 - Internal appeal notice requirements
- Section 20:06:21:91 - Independent review of benefit trigger determination
- Section 20:06:21:92 - Independent review process
- Section 20:06:21:93 - Additional appeal information
- Section 20:06:21:94 - Independent review notification
- Section 20:06:21:95 - Independent review organization selection
- Section 20:06:21:96 - Review of information
- Section 20:06:21:97 - Additional information to independent review
- Section 20:06:21:98 - Process if determination overturned
- Section 20:06:21:99 - Review decision requirements
- Section 20:06:21:100 - Acceptance of state certification
- Section 20:06:21:101 - Certification of long-term care insurance independent review organizations
- Section 20:06:21:102 - Maintenance of records and reporting obligations by independent review organizations
- Section 20:06:21:103 - Additional rights
- Section 20:06:21:104 - Applicability
- Section 20:06:21:105 - Payment of clean claim
- Section 20:06:21:106 - Claim timeframes
- Section 20:06:21:107 - Unpaid claims
- Section 20:06:21:108 - Violations
- Appendix A - Outline of Coverage
- Appendix B - Replacement of Individual Accident and Sickness or Long-Term Care Coverage
- Appendix C - Replacement of Accident and Sickness or Long-Term Care Coverage
- Appendix D - Rescission Reporting Form
- Appendix E - Personal Worksheet
- Appendix F - Disclosure Form
- Appendix G - Response Letter
- Appendix H - Sample Claims Denial Format
- Appendix I - Potential Rate Increase Disclosure Form
- Appendix J - Replacement and Lapse Reporting Form
- Appendix K - Partnership Disclosure Form
- Appendix L - Partnership Certification Form
- Appendix M - Guidelines for Long-Term Care Independent Review Entities