Section 760 IAC 2-20-36 - Required policy, certificate, and rider provisionsAuthority: IC 27-8-12-7.1
Affected: IC 12-15-2; IC 12-15-39.6
Sec. 36.
All qualified policies, certificates, and riders shall meet the following requirements:
(1) Have premiums:(A) based on the issue age of the applicant; or(B) level for the life of the policy or certificate. Nothing in this subdivision shall preclude an issuer from reducing premiums of a policy or certificate or using a policy form or certificate form in which the premiums are no longer required to be paid after a specified period of time.
(2) Include a provision that the policy, certificate, or rider will utilize the insured event criteria, defined in section 21 of this rule, for determining eligibility for benefits and for determining the amount of asset disregard.(3) Include a provision which, in the event the qualified policy or certificate is about to lapse, offers the policyholder or certificateholder the option to reduce his or her coverage to a lower benefit amount. However, this benefit amount offer, plus the amount of benefits used to date, cannot be less than the minimum benefit amount requirement specified in section 36.1(l) or 36.2(l) of this rule. The issuer need only allow this offer to be exercised one (1) time. Premiums shall be based on the age of the policyholder or certificateholder at the time of the issuance of the original qualified policy or certificate.(4) Include a provision that, upon sale of a qualified long term care insurance policy or certificate, the issuer shall do the following:(A) Offer to collect and store the name and address of an individual designated as an authorized designee by the purchaser to be notified when a policy or certificate lapse is imminent. The issuer must obtain a signed statement from purchasers who do not choose to designate an authorized designee that they have been offered this opportunity and declined. It shall be the issuer's responsibility to notify such designee prior to canceling a policy or certificate due to lack of premium payment. The designee notification shall occur no later than fifteen (15) days after the beginning of the thirty (30) day grace period for premium payments. The issuer shall permit the policyholder or certificateholder to periodically update the authorized designee.(B) Provide at least a ninety (90) day guaranteed reinstatement period for a policyholder or certificateholder whose policy or certificate has lapsed due to nonpayment of premium, who meets the insured event criteria, and who has paid all due and unpaid premiums. The reinstated policy or certificate shall have the same benefits, terms, and premiums as the policy or certificate which lapsed.(5) Include a provision that benefits shall only be paid after the payment of all other benefits to which the policyholder or certificateholder is otherwise entitled, excluding Medicaid. The issuer shall make reasonable efforts to determine whether benefits are available from other policies or certificates or from Medicare.(6) Include a provision that the policy form shall not be changed or otherwise modified without the signed acceptance of the policyholder, or include a provision that the certificate form issued under a group long term care policy shall not be changed or otherwise modified without the signed acceptance of the certificateholder.(7) For purposes of approving any future premium adjustments, all individual qualified policies issued by the same issuer shall be considered a single risk pool and all group qualified policies issued by the same issuer shall be considered a single risk pool, except a group issuer may form a separate risk pool whenever at least two thousand (2,000) certificates are in force for: (A) a single employer, labor organization, or trust established by a single employer or labor organization;(B) a single nonprofit association composed of individuals who are or were actively engaged in the same profession, trade, or occupation and organized in good faith for purposes other than obtaining insurance; and(C) a single nonprofit association created and maintained in good faith for the benefit of its members and not for the purposes of obtaining insurance, in active existence for at least five (5) years, and with a constitution and bylaws and a board with member representation. Nothing in this subdivision shall preclude an issuer from pooling their qualified and nonqualified policies, certificates, and riders to avoid or reduce the amount of any future premium increase that otherwise might have occurred to the risk pool of qualified policies, certificates, and riders.
Department of Insurance; 760 IAC 2-20-36; filed Nov 20, 1992, 9:00 a.m.: 16 IR 1152; filed Jun 15, 1994, 10:00 a.m.: 17 IR 2650; filed Feb 9, 1999, 5:02 p.m.: 22 IR 1993; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; readopted filed Nov 27, 2007, 4:01 p.m.: 20071226-IR-760070717RFA; readopted filed November 26, 2013, 3:43 p.m.: 20131225-IR-760130479RFAReadopted filed 11/19/2019, 9:18 a.m.: 20191218-IR-760190497RFAReadopted filed 11/30/2022, 11:39 a.m.: 20221228-IR-760220302RFA