W. Va. Code R. § 114-32-1

Current through Register Vol. XLI, No. 49, December 6, 2024

Section 114-32-1 - General

1.1. Scope. -- The purpose of this rule is to implement W. Va. Code § 33-15A-1et seq., to promote the public interest, to promote the availability of long-term care insurance coverage, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to facilitate public understanding and comparison of long-term care insurance coverages, and to facilitate flexibility and innovation in the development of long-term care insurance. This rule is based on the National Association of Insurance Commissioners' ("NAIC") "Long-Term Care Insurance Model Regulation" (Model 641), as amended in 2009.

Except as otherwise specifically provided, this rule applies to all long-term care insurance policies including qualified long-term care contracts and life insurance policies that accelerate benefits for long-term care delivered or issued for delivery in this state on or after the effective date hereof, by insurers; fraternal benefit societies; nonprofit health, hospital and medical service corporations; prepaid health plans; health maintenance organizations and all similar organizations. Certain provisions of this rule apply only to qualified long-term care insurance contracts as noted.

Additionally, this rule is intended to apply to policies having indemnity benefits that are triggered by activities of daily living and sold as disability income insurance, if:

1.1.a. The benefits of the disability income policy are dependent upon or vary in amount based on the receipt of long-term care services;

1.1.b. The disability income policy is advertised, marketed or offered as insurance for long-term care services; or

1.1.c. Benefits under the policy may commence after the policyholder has reached Social Security's normal retirement age unless benefits are designed to replace lost income or pay for specific expenses other than long-term care services.

1.2. Authority. -- W. Va. Code §§ 33-2-10 and 33-15A-6.

1.3. Filing Date. -- May 10, 2011.

1.4. Effective Date. -- July 1, 2011.

W. Va. Code R. § 114-32-1