3 AAC 28 — Life, Health, Variable, and Related Insurance (Article 1 to 13)

Before an insurer or similar organization offers group long-term care insurance to a resident of this state under AS 22.53.070. it shall file with the director evidence that the group policy or certificates under that section has been approved by a state having statutory or regul…

(a) Every insurer, health care service plan, or other entity providing long-term care insurance or benefits in this state shall provide a copy of a long-term care insurance advertisement intended for use in this state whether through written, radio, television, or other electroni…

(a) Every insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall (1) establish marketing procedures and agent training requirements to assure that (A) marketing activities, including a…

(a) With respect to the obligations set out in (a) of this section, the primary responsibility of an association, as defined in AS 21.53.200(3)(B), when endorsing or selling long-term care insurance is to educate its members concerning long-term care issues in general so that its…

(a) This section does not apply to life insurance policies that accelerate benefits for long-term care. (b) 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 purchas…

If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive the time periods applicable to preexisting conditions and probationary periods in the new long-term care policy for similar benefits to the…

(a) An insurer shall notify policyholders of the availability of a new long-term policy series that provides coverage for new long-term care services or providers material in nature and not previously available through the insurer to the general public. The notice shall be provid…

(a) Every long-term care insurance policy and certificate must include a provision that allows the policyholder or certificate holder to reduce coverage and lower the policy or certificate premium in at least one of the following ways; (1) reducing the maximum benefit; (2) reduci…

(a) This section does not apply to life insurance policies or riders containing accelerated long-term care benefits. (b) To comply with the requirement to offer a nonforfeiture benefit under the provisions of AS 21.53.064; (1) a policy or certificate offered with nonforfeiture be…

(a) A long-term care insurance policy must condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment. Eligibility for the payment of benefits may not be more restrictive than requiring either a …

(a) A qualified long-term care insurance contract may pay only for qualified long-term care services received by a chronically ill individual provided under a plan of care prescribed by a licensed health care practitioner. (b) A qualified long-term care insurance contract must co…

(a) For purposes of this section, "authorized representative" is authorized to act as the covered person's personal representative within the meaning of 45 C.F.R. 164.502(g) and means the following:(1) a person to whom a covered person has given express written consent to represe…

(a) Not later than 30 days after receipt of a claim for benefits under a long-term care insurance policy or certificate, an insurer shall pay the claim if it is a clean claim, or send a written notice acknowledging the date of receipt of the claim and one of the following;(1) the…

An outline of coverage to a prospective applicant for long-term care insurance must follow a standard format and content for an outline of coverage, subject to the following standards: (1) the outline of coverage must be a free-standing document, using no smaller than 10 point ty…

(a) A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the director, shall be provided to all prospective applicants of a long-term care insurance policy or certificate. Th…

(a) An insurer, hospital or medical service corporation, or fraternal benefit society may provide commission or other compensation to an agent for the sale of a long-term care insurance policy or certificate only if the first year commission or other first year compensation is no…

In addition to other penalties provided by the laws of this state, an insurer and an agent found to have violated a requirement of this state relating to the regulation of long-term care insurance or the marketing of long-term care insurance are subject to a fine of up to three t…

In this chapter, (1) "applicant" has the meaning given in AS 21.53.200(1); (2) "benefit trigger", for the purposes of independent review, means a contractual provision in the insured's policy of long-term care insurance conditioning the payment of benefits on a determination of t…

The 1983 Table "a", the 1983 GAM Table, the Annuity 2000 Mortality Table, the 2012 lAR Table, and the 1994 GAR Table for mortality rates are adopted by reference and are recognized for use in determining the minimum standard of valuation for annuity and pure endowment contracts. …

(a) Except as provided in (b) and (c) of this section, the 1983 Table "a" is recognized and approved as an individual annuity mortality table for valuation and, at the option of the insurance company, may be used to determine the minimum standard of valuation for any individual a…

(a) Except as provided in (b) and (c) of this section, the 1983 GAM Table, the 1983 Table "a", and the 1994 GAR Table are recognized and approved as group annuity mortality tables for valuation and, at the option of the insurance company, any one of these tables may be used to de…

In using the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is calculated as follows: q x 1994+n = q x 1994 (1-AAx) n where q x 1994 and AAx are as specified in the 1994 GAR Table. Notes 3 AAC 28.610 Eff. 12/31/85, Register 96; am 3/11/98, Register 145 T…

In using the 2012 lAR Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows: qx2012+n = qx2012 (1 - G2x)n The resulting qx2012+n must be rounded to three decimal places per 1,000, for example, 0.741 deaths per 1,000. Also, the rounding must occu…

If any provision of 3 AAC 28.600 - 3 AAC 28.611, or 3 AAC 28.690, or the application of it to any person or circumstances is for any reason held to be invalid, the remainder of the section and the application of its provisions to other persons or circumstances is not affected by …

(a) Except as provided in (g) of this section, the 2001 CSO Mortality Tables are adopted by reference and are recognized for use under (b) and (c) of this section in determining the minimum standard of valuation for policies for which AS 21.18.110(b)(1)(A)(iii) and AS 21.45.300(t…

(a) At the election of an insurer, for each calendar year of issue, for any one or more specified plans of insurance and subject to the conditions set out in (b) and (c) of this section, the insurer may substitute, as the minimum valuation standard for policies issued on or after…

The 2001 CSO Mortality Tables may be used in complying with 3 AAC 21.900 - 3 AAC 21.949 subject to the following: (1) the net level reserve premium under 3 AAC 21.900(2) (B) must be based on the ultimate mortality rates in the 2001 CSO Mortality Tables; (2) calculations under 3 A…

(a) An insurer may elect to use a gender-blended mortality table for determining minimum cash surrender values and amounts of paid-up nonforfeiture benefits for each plan of insurance if the (1) same premium rates and charges are used for male and female lives; or (2) insurer is …

In this chapter, (1) "the 1983 Table 'a'" means the mortality table developed by the Society of Actuaries Committee to Recommend a New Mortality Basis for Individual Annuity Valuation, and adopted as a recognized mortality table for annuities in June 1982 by the National Associat…

(a)3 AAC 28.700 - 3 AAC 28.725 apply to all insurers transacting health insurance in this state for claims that are paid on an expense-incurred basis. (b)3 AAC 28.700 - 3 AAC 28.725 do not apply to claims for vision care or drugs, or to benefits paid on other than an expense-incu…

(a) An insurer shall accept a properly completed claim submitted on the applicable uniform form set out in Uniform Claim Forms for Health Insurance, dated June 23, 1995 and hereby adopted by reference. A properly completed claim includes (1) completion of a uniform claim form wit…

For purposes of 3 AAC 28.700 - 3 AAC 28.725, "health insurance" means an individual or group contract or other plan providing coverage for health care services that is issued by an insurer licensed to transact the business of health insurance; a health maintenance organization un…

(a) A health care insurer that offers, issues for delivery, delivers, or renews a health care insurance plan that provides coverage for prescription drugs or devices and that issues, uses, requires, or reissues a card for prescription claims processing shall issue to a covered in…

A health care insurer must comply with 3 AAC 28.740 for new policies issued on or after 12 months from the effective date of 3 AAC 28.740 and for renewal policies on the first renewal date after 12 months from the effective date of 3 AAC 28.740. Notes 3 AAC 28.745 Eff. 9/15/2004,…

The purpose of 3 AAC 28.800 - 3 AAC 28.849 is to protect the public from false, misleading, or deceptive illustrations of life insurance policies by (1) providing formats for life insurance policy illustrations; (2) specifying the disclosures that are required for life insurance …

(a)3 AAC 28.800 - 3 AAC 28.849 apply to all group and individual life insurance policies and certificates except (1) variable life insurance; (2) individual and group annuity contracts; (3) credit life insurance under AS 21.57; and (4) individual and group life insurance policies…

(a) When a policy form subject to 3 AAC 28.800 - 3 AAC 28.849 is filed under AS 21.42.120, the insurer marketing that policy form shall notify the director in writing whether the policy form will be marketed with or without an illustration. For a policy form subject to 3 AAC 28.8…

(a) Failure to comply with 3 AAC 28.800 - 3 AAC 28.849 is a violation of AS 21.36.020 and 21.36.030. (b) An illustration used in the sale of a life insurance policy must satisfy the requirements of 3 AAC 28.800 - 3 AAC 28.849, be clearly labeled "life insurance illustration," and…

(a) Format. A basic illustration must conform with the following requirements: (1) the terms used in an illustration must be consistent with the terms used in the policy that is being illustrated; (2) an illustration must be labeled with the date on which it was prepared; (3) eac…

(a) A supplemental illustration may be provided if: (1) it is appended to, accompanied by, or preceded by a basic illustration that complies with 3 AAC 28.800 - 3 AAC 28.849; (2) the non-guaranteed elements shown in the supplemental illustration are not more favorable to the poli…

(a) If a basic illustration is used in the solicitation of a life insurance policy that is applied for as illustrated, the person soliciting the policy must provide a copy of that illustration, signed as required under 3 AAC 28.820, to the applicant at the time of application and…

(a) If a policy is designated as one for which an illustration will be used, the insurer shall provide each policy owner with an annual report on the status of the policy that contains at least the following information: (1) for a universal life policy, the report must include (A…

(a) The board of directors of an insurer shall appoint one or more illustration actuaries. The illustration actuary or actuaries shall annually certify that the disciplined current scale used in each illustration in current use, as well as those used since the prior certification…

(a) In determining the disciplined current scale, an insurer may rely on the standards established by the Actuarial Standards Board if the standards (1) conform with the requirements of 3 AAC 28.800 - 3 AAC 28.849; (2) limit a disciplined current scale to reflect only actions tha…

For the purposes of 3 AAC 28.800 - 3 AAC 28.849, (1) "Actuarial Standards Board" means the board established by the American Academy of Actuaries to develop and adopt standards of actuarial practice; (2) "basic illustration" means a presentation or depiction used in the sale of a…

3 AAC 28.900 - 3 AAC 28.918 apply to (1) a health care insurer that (A) transacts health care insurance in this state; and (B) provides or performs utilization review services; (2) a designee of the health care insurer under (1) of this section, including a utilization review org…

A health care insurer shall (1) monitor all utilization review activities carried out by, or on behalf of, the health care insurer; (2) ensure that the requirements of 3 AAC 28.900 - 3 AAC 28.918 are met; and (3) ensure that appropriate personnel have operational responsibility f…

If a health care insurer contracts to have a utilization review organization or other entity perform the utilization review functions required under 3 AAC 28.900 - 3 AAC 28.918, the director will (1) hold the health care insurer responsible for monitoring the activities of the ut…

(a) A health care insurer that requires utilization review of a benefit request under a health care insurance policy shall develop and implement a written utilization review program that describes, at a minimum, the following utilization review activities: (1) filing of a benefit…

(a) A utilization review program must use documented clinical review criteria that are (1) based on sound clinical evidence; and (2) evaluated periodically by a health care insurer's organizational mechanism specified under 3 AAC 28.906(b)(6) to ensure the program's effectiveness…