District of Columbia Administrative Code

2600 APPLICABILITY AND SCOPE Except as otherwise specifically provided, this chapter shall apply to all long-term care insurance policies and life insurance policies that accelerate benefits for long-term care that are delivered or issued for delivery in the District of Columbia …

2601 POLICY TERMS AND DEFINITIONS A long-term care insurance policy delivered or issued for delivery in the District of Columbia shall not use any of the following terms unless the term is defined in the policy and is defined as set forth in section REF _Ref149634431 \n \h 2699: …

2602 POLICY PRACTICES AND PROVISIONS: RENEWABILITY AND LEVEL PREMIUMS An individual long-term care insurance policy shall contain a renewal provision. A policy issued to an individual shall not contain a renewal provision other than a “guaranteed renewable” or “noncancellable” pr…

2603 POLICY PRACTICES AND PROVISIONS: LIMITATIONS AND EXCLUSIONS A policy shall not be delivered or issued for delivery in the District of Columbia as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident,…

2604 POLICY PRACTICES AND PROVISIONS: EXTENSION OF BENEFITS Termination of long-term care insurance shall be without prejudice to benefits payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without inte…

2605 POLICY PRACTICES AND PROVISIONS: CONTINUATION OR CONVERSION Group long-term care insurance issued in the District of Columbia on or after December 16, 2005, shall provide covered individuals with a basis for continuation or conversion of coverage. Written application for a c…

2606 POLICY PRACTICES AND PROVISIONS: DISCONTINUANCE AND REPLACEMENT If a group long-term care policy is replaced by another group long-term care policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group po…

2607 POLICY PRACTICES AND PROVISIONS: ELECTRONIC ENROLLMENT FOR GROUP POLICIES In the case of the type of group long-term care insurance defined in section 2(4)(A) of the Long-Term Care Insurance Act of 2000, effective May 23, 2000 (D.C. Law 13-121; D.C. Official Code § 31-3601(4…

2608 UNINTENTIONAL LAPSE An insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: No individual long-term care insurance policy or certificate shall be issued until the insurer has received from the applicant eith…

2609 REINSTATEMENT In addition to the requirements of section REF _Ref149634937 \r \h 2608, a long-term care insurance policy or certificate shall include a provision that provides for reinstatement of coverage, in the event of lapse, if the insurer is provided proof that the pol…

2610 REQUIRED DISCLOSURE PROVISIONS: RENEWABILITY AND PREMIUM RATE CHANGES The renewal provision required by section REF _Ref152663525 \r \h 2602 shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the coverage is guarantee…

2611 REQUIRED DISCLOSURE PROVISIONS: RIDERS AND ENDORSEMENTS Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-ter…

2612 REQUIRED DISCLOSURE PROVISIONS: PAYMENT OF BENEFITS A long-term care insurance policy that provides for the payment of benefits based on standards described as “usual and customary,” “reasonable and customary,” or words of similar import shall include a definition of those t…

2613 REQUIRED DISCLOSURE PROVISIONS: PREEXISTING CONDITIONS LIMITATIONS If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate that shal…

2614 REQUIRED DISCLOSURE PROVISIONS: LIMITATIONS AND CONDITIONS OTHER THAN PREEXISTING CONDITIONS A long-term care insurance policy or certificate that contains any limitations or conditions for eligibility, other than a limitation covered by section REF _Ref150588856 \n \h \* ME…

2615 REQUIRED DISCLOSURE PROVISIONS: TAX CONSEQUENCES With regard to life insurance policies that provide an accelerated benefit for long-term care, a disclosure statement shall be provided at the time of application for the policy or rider and at the time the accelerated benefit…

2616 REQUIRED DISCLOSURE PROVISIONS: BENEFIT TRIGGERS Activities of daily living and cognitive impairment shall be used to measure an insured’s need for long-term care and shall be described in the policy or certificate in a separate section that shall be labeled “Eligibility for…

2617 REQUIRED DISCLOSURE PROVISIONS: QUALIFIED AND NON-QUALIFIED CONTRACTS A qualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage, which disclosure statement shall be in the form set forth in subsection REF …

2618 REQUIRED DISCLOSURE OF RATING PRACTICES TO CONSUMERS Except as provided in subsection REF _Ref149984779 \n \h 2618.2, this section shall apply to a long-term care insurance policy or certificate issued in the District of Columbia on or after June 16, 2006. For certificates i…

2619 INITIAL FILING REQUIREMENTS The requirements of this section shall apply to a long-term care insurance policy issued in the District of Columbia on or after June 16, 2006. An insurer shall provide the following information to the Commissioner at least thirty (30) days prior …

2620 APPLICATION QUESTIONS; PROHIBITION AGAINST POST-CLAIMS UNDERWRITING All applications for long-term care insurance policies or certificates, except those that are guaranteed issue, shall contain clear and unambiguous questions designed to ascertain the health condition of the…

2621 COMPLETED APPLICATIONS A copy of the completed application or enrollment form (whichever is applicable) shall be delivered to the insured no later than at the time of the delivery of the policy or certificate unless a copy of the completed application was retained by the app…

2622 RECORDS AND REPORTS OF RESCISSIONS Every insurer selling or issuing long-term care insurance shall maintain a record of all policy or certificate rescissions, both in the District and nationally, except those that the insured or other entity voluntarily effectuated, and shal…

2623 MINIMUM STANDARDS FOR HOME HEALTH AND COMMUNITY CARE BENEFITS A long-term care insurance policy or certificate that provides benefits for home health care or community care services shall not limit or exclude those benefits by any of the following means: Requiring that the i…

2624 REQUIREMENT TO OFFER INFLATION PROTECTION No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder in addition to any other inflation protection the option to purchase a policy that provides for benefit levels to increase with…

2625 REQUIREMENTS FOR APPLICATION FORMS AND REPLACEMENT COVERAGE (a) Application forms shall include the following questions 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 i…

2626 REPORTING REQUIREMENTS An insurer shall maintain records for each agent of the 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…

2627 LICENSING A producer shall not sell, solicit, or negotiate long-term care insurance except as authorized by the Producer Licensing Act of 2002, effective March 27, 2003 (D.C. Law 14-264; D.C. Official Code § 31-1131.01 et seq. (2001)). SOURCE: Final Rulemaking published at 5…

2629 RESERVE STANDARDS If long-term care benefits are provided through the acceleration of benefits under group or individual life insurance policies or riders to such policies, policy reserves for the benefits shall be determined in accordance with section 1 of chapter V of the …

2630 LOSS RATIO This section shall apply to all long-term care insurance policies or certificates except those covered under sections REF _Ref149720878 \n \h 2619 and REF _Ref149624243 \n \h 2631. Benefits under long-term care insurance policies shall be deemed reasonable in rela…

2631 PREMIUM RATE SCHEDULE INCREASES This section shall apply as follows: Except as provided in paragraph REF _Ref149721217 \n \h (b) of this subsection, this section shall apply to a long term care insurance policy or certificate issued in the District of Columbia on or after Ju…

2632 EXCEPTIONAL INCREASES Except as provided in section REF _Ref149624243 \r \h 2631, exceptional increases shall be subject to the same requirements as other premium rate schedule increases. The Commissioner may request a review by an independent actuary or a professional actua…

2633 FILING AND APPROVAL REQUIREMENT FOR GROUP POLICIES Prior to an insurer or similar organization offering group long-term care insurance to a resident of the District of Columbia pursuant to section 5 of the Long-Term Care Insurance Act of 2000, effective May 23, 2000 (D.C. La…

2634 FILING REQUIREMENTS FOR ADVERTISING An insurer, health care service plan, or other entity providing long-term care insurance or benefits in the District of Columbia shall provide a copy of any long-term care insurance advertisement intended for use in the District of Columbi…

2635 STANDARDS FOR MARKETING — GENERAL An insurer, health care service plan, or other entity marketing long-term care insurance or benefits in the District of Columbia, directly or through its producers, shall: Establish marketing procedures and agent training requirements to ass…

2636 STANDARDS FOR MARKETING — ASSOCIATIONS With respect to the obligations set forth in this section, the primary responsibility of an association, as defined in section 2(4)(B) of the Long-Term Care Insurance Act of 2000, effective May 23, 2000 (D.C. Law 13-121; D.C. Official C…

2637 SUITABILITY This section shall not apply to life insurance policies that accelerate benefits for long-term care. Every insurer, health care service plan, or other entity marketing long-term care insurance (the “issuer”) shall: Develop and use suitability standards to determi…

2638 RESTRICTION ON PREEXISTING CONDITIONS AND PROBATIONARY PERIODS IN REPLACEMENT POLICIES OR CERTIFICATES If a long-term care insurance policy or certificate replaces another long-term care insurance policy or certificate, the replacing insurer shall waive any time periods appl…

2639 NONFORFEITURE BENEFIT REQUIREMENT This section shall not apply to life insurance policies or riders that accelerate benefits for long-term care. To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of section 11 of the Long-Term Care Ins…

2640 STANDARDS FOR BENEFIT TRIGGERS A long-term care insurance policy shall 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 shall not be more r…

2641 ADDITIONAL STANDARDS FOR BENEFIT TRIGGERS FOR QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS A qualified long-term care insurance contract shall pay only for qualified long-term care services received by a chronically ill individual provided pursuant to a plan of care prescrib…

2642 STANDARD FORMAT OUTLINE OF COVERAGE This section implements, interprets, and makes specific the provisions of section 7 of the Long-Term Care Insurance Act of 2000, effective May 23, 2000 (D.C. Law 13-121; D.C. Official Code § 31-3606 (2001)) in prescribing a standard format…

2643 REQUIREMENT TO DELIVER SHOPPER’S GUIDE A long-term care insurance shopper’s guide in the format developed by the National Association of Insurance Commissioners (“NAIC”), or a guide developed or approved by the Commissioner, shall be provided to all prospective applicants fo…

2644 PENALTIES In addition to any other penalties provided by the laws of the District of Columbia, an insurer or agent found to have violated a requirement of District of Columbia law relating to the regulation of long-term care insurance or the marketing of such insurance shall…

2699 DEFINITIONS For the purposes of this chapter, the following words and phrases shall have the meanings ascribed: Activities of daily living - at least bathing, continence, dressing, eating, toileting, and transferring. Acute condition - condition where the individual is medic…

2700 AUTHORITY 2700.1 The following rules applicable to variable life insurance policies are promulgated under the authority of Section 41, ch. III of the Life Insurance Act, as amended, D.C. Code Section 35-639 (1993 & 1994 Supp.). 2700.2 The issuance or delivery of life insuran…

2701 [RESERVED] SOURCE: Final Rulemaking published at 42 DCR 1047(February 24, 1995).

2702 QUALIFICATION OF INSURER TO ISSUE VARIABLE LIFE INSURANCE 2702.1 The following requirements are applicable to all insurers either seeking authority to issue variable life insurance in the District or having authority to issue variable life insurance in the District. 2702.2 A…

2703 FILING FOR APPROVAL TO DO BUSINESS IN THE DISTRICT 2703.1 The Commissioner may, at his discretion, require that an insurer, before it delivers or issues for delivery any variable life insurance policy in the District, file with the Commissioner the following information for …