Title 24, Insurance

§431:10H-104 Definitions. As used in this article, unless the context requires otherwise, the definitions in this section apply throughout this article. "Applicant" means: "Certificate" means, for the purposes of this article, any certificate issued under a group long-term care i…

[§431:10H-105] Extraterritorial jurisdiction; group policies. No group long-term insurance coverage may be offered to a resident of this State under a group policy issued in another state to a group described in paragraph (4) under the definition of "group long-term care insuranc…

[§431:10H-106] Rules. The commissioner may adopt rules that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of el…

[§431:10H-106.5] Producer training requirements. (a) Effective on the date that is one year following the enactment by the State of legislation establishing the long-term care partnership program as provided in title VI, section 6021 of the Federal Deficit Reduction Act of 2005, …

[§431:10H-107] Basic standards. No long-term care insurance policy may:

[§431:10H-108] Preexisting conditions--group and individual policies. (a) No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in paragraph (1) of the definition of "group long-term care insurance" in section…

[§431:10H-109] Prior hospitalization; prior institutionalization. (a) No long-term care insurance policy may be delivered or issued for delivery in this State if the policy: (b) A long-term care insurance policy containing post-confinement, post-acute care, or recuperative benefi…

[§431:10H-110] Loss ratio standards; factors; commissioner approval. The commissioner may adopt rules establishing loss ratio standards for long-term care insurance policies; provided that a specific reference to long-term care insurance policies is contained in the rule. [L 1999…

§431:10H-111 Right to return; free look provision. Long-term care insurance applicants shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is…

§431:10H-112 Outline of coverage required. (a) An outline of coverage shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that prominently direct the attention of the recipient to the document and its purpos…

[§431:10H-113] Group policy certificate requirements. A certificate issued pursuant to a group long-term care insurance policy which is delivered or issued for delivery in this State shall include:

§431:10H-114 Life insurance policies offering long-term care benefits. (a) At the time of policy delivery, a policy summary shall be delivered for an individual life insurance policy that provides long-term care benefits within the policy or by rider. In the case of direct respon…

§431:10H-115 Incontestability period--group and individual policies. (a) For a policy or certificate that has been in force for less than six months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim u…

[§431:10H-116] Nonforfeiture benefits. (a) Except as provided in subsection (b), a long-term care insurance policy shall not be delivered or issued for delivery in this State unless the policyholder or certificate holder has been offered an option to purchase a policy or certific…

[§431:10H-116.5] Delivery of the contract or certificate of insurance. If an application for a long-term care insurance contract or certificate is approved, the issuer shall deliver the contract or certificate of insurance to the applicant no later than thirty days after the date…

[§431:10H-116.6] Denial of claims; compliance requirements. (a) If a claim under a long-term care insurance contract is denied, the issuer, within sixty days of the date of a written request by the policyholder or certificate holder, or a representative thereof shall: (b) Any pol…

§431:10H-117 Authority to adopt rules. The commissioner may adopt reasonable rules to promote premium adequacy and to protect the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, producer compensation, producer t…

PART II. LONG-TERM CARE INSURANCE MODEL REGULATION §431:10H-201 Policy definitions. (a) No long-term care insurance policy delivered or issued for delivery in this State shall use the terms set forth in this section, unless the terms are defined in the policy and the definitions …

§431:10H-202 Renewability. (a) The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of section 431:10H-211. A policy issued to …

[§431:10H-202.5] Licensing. A producer is not authorized to sell, solicit, or negotiate with respect to long-term care insurance except as authorized by article 9A. [L 2007, c 233, pt of §4]

§431:10H-203 Limitations and exclusions. (a) A policy may not be delivered or issued for delivery in this State as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as follows: (b) This section…

[§431:10H-204] Extension of benefits. Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without interruption after ter…

[§431:10H-204.5] Electronic enrollment for group policies. (a) In the case of a group defined in paragraph (1) of the definition of "group long-term care insurance" in section 431:10H-104, any requirement that a signature of an insured be obtained by an agent or insurer shall be …

§431:10H-205 Continuation or conversion. (a) Group long-term care insurance issued in this State beginning July 1, 2000, shall provide covered individuals with a basis for continuation or conversion of coverage. (b) Group policies that restrict provision of benefits and services …

[§431:10H-206] Discontinuance and replacement. If a group long-term care insurance policy is replaced by another group long-term care insurance policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group poli…

[§431:10H-207] Premiums charged--group and individual policies. (a) The premium charged to an insured shall not increase due to either: (b) The purchase of additional coverage shall not be considered a premium rate increase, but for purposes of the calculation required under sect…

§431:10H-207.5 Premium rate schedule increases. (a) This section shall apply as follows: (b) An insurer shall request approval from the commissioner of a premium rate schedule increase, including an exceptional increase, at least sixty days prior to the notice to the policyholder…

[§431:10H-208] Unintentional lapse. (a) Each insurer offering long-term care insurance, as a protection against unintentional lapse, shall comply with this section. (b) No individual long-term care policy or certificate shall be issued until the insurer has received from the appl…

[§431:10H-209] Lapse or termination for nonpayment of premium. No individual long-term care policy or certificate shall lapse or be terminated for nonpayment of premium unless the insurer, at least thirty days before the effective date of the lapse or termination, has given notic…

[§431:10H-210] Reinstatement. In addition to the requirements of sections 431:10H-208 and 431:10H-209, 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 th…

§431:10H-211 Disclosure; renewability. (a) Individual long-term care insurance policies shall contain a renewability provision. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of re…

[§431:10H-212] Disclosure; riders and endorsements. (a) 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-term car…

[§431:10H-213] Disclosure; 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 similar words or phrases shall include a definition of these terms and…

[§431:10H-214] Disclosure; 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 and shall be labeled as "Preexisting Cond…

[§431:10H-215] Disclosure; other limitations and conditions on eligibility for benefits. A long-term care insurance policy or certificate containing any limitations or conditions for eligibility other than those prohibited in section 431:10H-109 shall set forth a description of t…

§431:10H-216 Disclosure of tax consequences. With regard to life insurance policies that provide for an accelerated benefit for long-term care, a disclosure is required at the time of application for the policy and at the time the accelerated benefit payment request is submitted …

§431:10H-217 Disclosure; 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 paragraph and shall be labeled "Eligibility for the Payme…

§431:10H-217.5 Required disclosure of rating practices to consumers. (a) This section shall apply as follows: (b) Other than for policies for which no applicable premium rate or rate schedule increases can be made, insurers shall provide all of the information listed in this subs…

§431:10H-218 Prohibition against post-claims underwriting. (a) 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 applicant. …

[§431:10H-219] Minimum standards for home health and community care benefits. (a) A long-term care insurance policy or certificate shall not, if it provides benefits for home health care or community care services, limit or exclude benefits by: (b) A long-term care insurance poli…

§431:10H-220 Requirement to offer inflation protection; group and individual policies. (a) 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 …

§431:10H-221 Requirements for application forms and replacement coverage. (a) Application forms shall include questions designed to elicit information as to whether, as of the date of application, the applicant has another long-term care insurance policy or certificate in force o…

§431:10H-222 Reporting requirements. (a) Every insurer shall maintain records for each producer of the producer's amount of replacement sales as a per cent of the producer's total annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a…

[§431:10H-223] Discretionary powers of the commissioner. The commissioner may upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provisions of this part with respect to a specific long-term care insurance policy o…

[§431:10H-224] Reserve standards; life insurance policies or riders. (a) When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to these policies, the policy reserves for the benefits shall be determined in…

[§431:10H-225] Reserve standards; insurance other than life. When long-term care benefits are provided through insurance other than as in section 431:10H-224, reserves shall be determined by a table certified as appropriate as a statutory valuation table by a member of the Americ…