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

(a) An issuer may not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy or certificate form has been filed with and approved by the director. (b) An issuer may not use or change premium rates for a medicare supplement policy or ce…

(a) A rate credit or dividend paid may be used only in the loss ratio determinations if it directly inures to the benefit of the person who actually pays the premium for the coverage provided. (b) A rate credit reserve on dividend liability may be used only in the loss ratio dete…

(a) Medicare supplement policies and certificates must include a renewal or continuation provision The language or specifications of the provisions must be consistent with the type of contract issued The provisions must be appropriately captioned, must appear on the first page of…

(a) Application forms must include the following statements and questions designed to obtain information as to whether, as of the date of the application, the applicant currently has a medicare supplement policy, medicare advantage plan, medicaid coverage, or another health insur…

(a) An issuer or other entity may provide a commission or other compensation to an agent or other representative for the sale of a medicare supplement policy or certificate only if the first-year commission or other first-year compensation is no more than 200 percent of the commi…

(a) A health insurance policy or certificate, other than a medicare supplement policy; a policy issued under a contract under 42 U.S.C. 1395- 1395 ccc (sec. 1876 of the Social Security Act); or a disability income policy or certificate delivered or issued for delivery in this sta…

An issuer shall provide a copy of any medicare supplement advertisement intended for use in this state, whether through written, radio, or television medium, for review and approval by the director. Notes 3 AAC 28.503 Eff. 8/8/90, Register 115; am 7/1/92, Register 122 In 2010 the…

(a) An issuer directly or through its producers, shall (1) establish marketing procedures to ensure that any comparison of policies by its agents or other producers will be fair and accurate; (2) establish marketing procedures to ensure excessive insurance is not sold or issued; …

(a) In recommending the purchase or replacement of a medicare supplement policy or certificate, a licensee shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. (b) A sale of a medicare supplement policy or certificate that will …

(a) Annually, on or before March 1, every issuer or other entity providing medicare supplement insurance coverage in this state shall report the following information, on the reporting form contained in Appendix A of this section, for every individual resident of this state for w…

(a) If a medicare supplement policy or certificate replaces another medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new medicar…

(a) An issuer may not, based on an individual's genetic information, (1) deny or condition the issuance or effectiveness of a medicare supplement policy or certificate; or (2) exclude benefits under a medicare supplement policy or certificate for a preexisting condition. (b) An i…

For purposes of 3 AAC 28.410 - 3 AAC 28.510, (1) "applicant" means, (A) for an individual medicare supplement policy, the person who seeks to contract for insurance benefits; and (B) for a group medicare supplement policy, the person who seeks to be the certificate holder; (2) "b…

(a) A political subdivision constitutes a duly formed group for issuance of a group health insurance policy that provides health insurance coverage to the persons that comprise it, if (1) the eligibility for coverage for a person is based on criteria that reflect the common purpo…

For purposes of AS 21.54.151(d), "cost" means the total health insurance premiums paid for the health care insurance plan by a large employer including any portion of the premiums paid by individuals covered under the large employer's health care insurance plan. Notes 3 AAC 28.52…

(a) Except as otherwise specifically provided, and except for provisions of 3 AAC 28.550 - 3 AAC 28.599 that apply only to qualified long-term are insurance contract the provisions of 3 AAC 28.550 - 3 AAC 28.599 apply to all long-term care insurance policies, including qualified …

Long-term care insurance policies delivered or issued for delivery in this state may not use the terms set out in this section, unless the terms are defined in the policy and the definitions satisfy the following requirements: (1) "activities of daily living" means at least bathi…

(a) The terms "guaranteed renewable" and noncancellable may not be used in an individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of 3 AAC 28.555 and subject to the following restrictions: (1) a policy iss…

(a) Each insurer offering long-term care insurance shall comply with the following: (1) an individual long-term care policy or certificate may not be issued until the insurer has received from the applicant either a written designation of at least one person, in addition to the a…

(a) Individual long-term care insurance policies must contain a renewability provision that (1) is appropriately captioned, appears on the first page of the policy, and clearly states that the coverage is guaranteed renewable or noncancellable; this provision may not apply to pol…

(a) This section applies as follows: (1) except as provided in (2) of this subsection, this section applies to a long-term care policy or certificate issued in this state on or after January 1, 2023; (2) for certificates issued on or after March 27, 2022 effective date of regulat…

(a) This section applies to a long-term care policy issued in this state on or after January 1, 2023. (b) An insurer shall provide to the director 45 days before making a long-term care insurance form available for sale the following information:(1) a copy of the disclosure docum…

(a) All applications for long-term care insurance policies or certificates, except those that are guaranteed issue, must contain clear and unambiguous questions designed to ascertain the health condition of the applicant. (b) If an application for long-term care insurance contain…

(a) If it provides benefits for home health care or community care services, a long-term care insurance policy or certificate may not limit or exclude benefits: (1) by requiring that the insured or claimant would need care in a skilled nursing facility if home health care service…

(a) An Insurer may not offer a long-term care insurance policy unless the insurer also offers the policyholder, in addition to other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations th…

(a) An application form must include the questions prescribed by the director designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or c…

(a) Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales. Repor…

(a) This section applies to a long-term care policy issued in this state on or after January 1, 2023. The following annual submission requirements apply after the initial rate filings for individual long-term care insurance policies. (b) An actuarial certification prepared, dated…

A producer is not authorized to sell, solicit, or negotiate with respect to long-term care insurance except as authorized by AS 21.27. Notes 3 AAC 28.565 Eff. 3/27/2022, Register 241, April 2022 Authority:AS 21.06.090 AS 21.27.010 AS 21.53.020 AS 21.53.030 AS 21.53.050 AS 21.53.0…

The director may, upon written request and after an administrative hearing, issue an order to modify or suspend one or more specific provision of 3 AAC 28.550 - 3 AAC 28.599 with respect to a specific long-term care insurance policy or certificate upon a written finding that; (1)…

(a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to the policies, policy reserves for the benefits shall be determined in accordance with AS 21.45.300. Claim reserves shall also be established in …

(a) This section applies to all long-term care insurance policies or certificates except those covered under 3 AAC 28.557 and 3 AAC 28.570. (b) Benefits under long-term care insurance policies shall be considered reasonable in relation to premiums; the expected loss ratio is a, l…

(a) This section applies as follows:(1) except as provided in (2) of this subsection, this section applies to a long-term care policy or certificate issued in this state on or after January 1, 2023; and (2) for certificates issued on or after effective date of 3 AAC 28.550 - 3 AA…

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…