11 NCAC 12 — Life and Health Division

11 NCAC 12 .0425 LIFE INSURANCE ADVERTISING: APPLICABILITY (a) These rules shall apply to any life insurance or annuity advertisement intended for dissemination in this state. (b) Every insurer shall establish and at all times maintain a system of control over the content, form a…

11 NCAC 12 .0426 LIFE INSURANCE ADVERTISING: FORM AND CONTENT (a) Advertisements shall be truthful and not misleading in fact or by implication. The form and content of an advertisement of a policy shall be sufficiently complete and clear so as to avoid deception. It shall not ha…

11 NCAC 12 .0427 LIFE INSURANCE ADVERTISING: DISCLOSURE REQUIREMENTS (a) The information required to be disclosed by 11 NCAC 12 .0424 to .0433 shall not be minimized, rendered obscure or presented in an ambiguous fashion or intermingled with the text of the advertisement so as to…

11 NCAC 12 .0428 LIFE INSURANCE ADVERTISING: IDENTITY OF INSURER (a) The name of the insurer shall be clearly identified in all advertisements, and if any specific individual policy is advertised it shall be identified either by form number or other appropriate description. If an…

11 NCAC 12 .0429 LIFE INSURANCE ADVERTISING: LICENSING: STATUS OF INSURER (a) An advertisement which is intended to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed shall not imply licensing beyond such limits. (b) An advertisement may state…

11 NCAC 12 .0430 LIFE INSURANCE ADVERTISING: STATEMENTS ABOUT THE INSURER An advertisement shall not contain statements, pictures or illustrations which are false or misleading, in fact or by implication, with respect to the assets, liabilities, insurance in force, corporate stru…

11 NCAC 12 .0431 LIFE INSURANCE ADVERTISING: ENFORCEMENT PROCEDURES (a) Each insurer shall maintain at its home or principal office a complete file containing a specimen copy of every printed, published or prepared advertisement of its policies, hereafter disseminated in this sta…

11 NCAC 12 .0432 LIFE INSURANCE ADVERTISING: ADVERTISING EXPENSE Total advertising expense incurred by the insurer or by an affiliated corporation on behalf of the insurer for the purposes of solicitation and conservation of life insurance business shall be included as line items…

11 NCAC 12 .0433 LIFE INSURANCE ADVERTISING: PRIOR REVIEW OR PRIOR APPROVAL The commissioner may, when in his discretion he deems it in the public interest, require the filing of all or any part of the advertising material of an insurer with this department for review prior to it…

11 NCAC 12 .0434 VARIABLE LIFE INSURANCE: DEFINITIONS As used in this Rule and in 11 NCAC 12 .0435 through 11 NCAC 12 .0443: (1) "Affiliate" of an insurer means any person, directly or indirectly, controlling, controlled by, or under common control with such insurer; any person w…

11 NCAC 12 .0435 QUALIFICATION OF INSURER TO ISSUE VARIABLE LIFE INSURANCE The following requirements are applicable to all insurers either seeking authority to issue variable life insurance in this state or which have authority to issue variable life insurance in this state: (1)…

11 NCAC 12 .0436 INSURANCE POLICY REQUIREMENTS The Commissioner shall not approve any variable life insurance form filed pursuant to this Rule unless it conforms to the requirements of this Section: (1) Filing of Variable Life Insurance Policies. All variable life insurance polic…

11 NCAC 12 .0437 RESERVE LIABILITIES FOR VARIABLE LIFE INSURANCE (a) Reserve liabilities for variable life insurance policies shall be established pursuant to G.S. 58-58-50 accordance with actuarial procedures that recognize the variable nature of the benefits provided and any mo…

11 NCAC 12 .0438 SEPARATE ACCOUNTS The following requirements apply to the establishment and administration of variable life insurance separate accounts: (1) Establishment and Administration of Separate Accounts. An insurer issuing variable life insurance in this state shall esta…

11 NCAC 12 .0439 INFORMATION FURNISHED TO APPLICANTS An insurer delivering or issuing for delivery in this state any variable life insurance policies shall deliver to the applicant for the policy, and obtain a written acknowledgment of receipt from such applicant coincident with …

11 NCAC 12 .0440 APPLICATIONS The application for a variable life insurance policy shall contain: (1) a prominent statement that the death benefit may be variable or fixed under specified conditions; (2) a prominent statement that cash values may increase or decrease in accordanc…

11 NCAC 12 .0441 REPORTS TO POLICYHOLDERS Any insurer delivering or issuing for delivery in this state any variable life insurance policies shall mail to each variable life insurance policyholder at his or her last known address the following reports: (1) within 30 days after eac…

11 NCAC 12 .0442 FOREIGN COMPANIES If the law or regulation in the place of domicile of a foreign company provides a degree of protection to the policyholders and the public which is substantially equal to that provided by these regulations, the commissioner, to the extent deemed…

11 NCAC 12 .0443 QUALIFICATION: FOR THE SALE OF VARIABLE LIFE INSURANCE (a) Qualifications to Sell Variable Life Insurance (1) No person may sell or offer for sale in this state any variable life insurance policy unless such person is an agent and has filed with the commissioner,…

11 NCAC 12 .0444 SEPARABILITY ARTICLE History Note: Authority G.S. 58-9(1); 58-79.2; Eff. January 1, 1978; Readopted Eff. September 26, 1978; Repealed Eff. July 1, 1988.

11 NCAC 12 .0445 INTEREST CHARGES ON MISSTATEMENT OF AGE OR SEX Interests on overpayments made by an insurer because of misstatement of age or sex shall not be charged unless an equal rate of interest is paid by the insurer for under payments. History Note: Authority G.S. 58-2-40…

11 NCAC 12 .0446 SOUND HEALTH No policy of life insurance shall contain a provision that the policy will be voided if the insured is not in sound or good health on the effective date of the policy, or date of reinstatement unless such provision contains the following: (1) The bur…

11 NCAC 12 .0447 FREE LOOK PROVISION (a) An insurer, prior to the time that any individual life insurance or annuity policy is issued for delivery or delivered, shall ensure that a "Ten Day Free Look" provision is displayed by sticker or printed on the face of each life insurance…

11 NCAC 12 .0448 WAITING PERIODS ON LIFE INSURANCE RIDERS On all life insurance riders providing additional benefits, attached subsequent to the date of the policy, a sticker shall be attached in a prominent place on the rider stating, when appropriate, substantially the followin…

11 NCAC 12 .0449 LIMITED INITIAL DEATH BENEFIT No policy or certificate of life insurance which provides a limited death benefit for a stated initial period shall be issued except on a guaranteed issue basis. Such policy shall have printed on the face in bold type Graded Death Be…

11 NCAC 12 .0450 REQUIREMENT FOR MODIFIED PREMIUM LIFE INSURANCE The application for a modified premium life insurance policy which has a higher first year premium shall contain an acknowledgment, signed by the applicant, stating that he understands: (1) He is paying a higher fir…

11 NCAC 12 .0451 POLICY LOAN INTEREST RATES History Note: Authority G.S. 58-9; 58-195; Eff. September 26, 1978; Repealed Eff. July 1, 1988.

11 NCAC 12 .0457 CREDIT INSURANCE: AUTOMOBILE LEASES History Note: Authority G.S. 58-9; Eff. July 1, 1986; Repealed Eff. April 1, 1989.

11 NCAC 12 .0458 RESERVED FOR FUTURE CODIFICATION

11 NCAC 12 .0459 RESERVED FOR FUTURE CODIFICATION

11 NCAC 12 .0460 PREARRANGEMENT INSURANCE DISCLOSURE History Note: Authority G.S. 58-2-40; 58-58-1; 58-60-35; Eff. February 1, 1992; Repealed Eff. February 1, 1996.

11 NCAC 12 .0461 USE OF SENIOR-SPECIFIC CERTIFICATIONS AND PROFESSIONAL DESIGNATIONS (a) This Rule applies to the solicitation, sale, or purchase of, or advice made in connection with the solicitation, sale or purchase of a life insurance or annuity product. (b) The NAIC Model Re…

11 NCAC 12 .0462 SUITABILITY IN ANNUITY TRANSACTIONS (a) The NAIC Suitability in Annuity Transactions Model Regulation (#275) ("NAIC Model Regulation #275"), as adopted by the National Association of Insurance Commissioners at the Spring National Meeting of 2020, including subseq…

SECTION .0500 - ACCIDENT AND HEALTH: GENERAL NATURE 11 NCAC 12 .0501 ACCIDENT AND HEALTH: GENERAL NATURE History Note: Authority G.S. 57-4; 57-7; 58-9; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. July 1, 1988.

11 NCAC 12 .0502 RATE INCREASES FOR INDIVIDUAL AND BLANKET POLICIES History Note: Authority G.S. 58-251.2; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. April 1, 1989.

11 NCAC 12 .0503 WAITING PERIOD (a) If a sickness or disease first manifests itself during the waiting period, it must be covered at the end of said waiting period. (b) If the company can prove that the condition existed prior to the effective date of coverage, the company will n…

11 NCAC 12 .0504 APPROVAL OF FILING: 90 DAY DEEMER NOT IN EFFECT History Note: Authority G.S. 58-254.7; 58-370(a); Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. April 1, 1989; Repealed Eff. February 1, 1992.

11 NCAC 12 .0505 MAIL ORDER APPLICATION: ACCIDENT AND HEALTH History Note: Authority G.S. 58-257; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. July 1, 1986.

11 NCAC 12 .0506 MASS MARKETING APPLICATION Applications used in the solicitation for accident and health insurance on a mass marketing basis may not require information on pre-existing conditions dating back further than five years prior to the date of the application. History N…

11 NCAC 12 .0507 FRATERNAL ORDERS: SOCIETIES AND ASSOCIATIONS History Note: Authority G.S. 58-9(1); Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. March 1, 1992.

11 NCAC 12 .0508 ACCIDENT AND HEALTH TRAVEL: NEWSPAPER SUBSCRIPTIONS Travel insurance procured in connection with newspaper subscriptions must comply with the following procedures: (1) All advertising matters shall be published over the name of the regularly licensed agent. (2) T…

11 NCAC 12 .0509 ACCIDENT AND HEALTH INSURANCE: NATURAL DEATH BENEFIT No policy of accident and health insurance may be issued in North Carolina which contains a provision wherein the company promises to pay a funeral benefit, a fatal sickness benefit, a natural death benefit or …

11 NCAC 12 .0510 ACCIDENT AND HEALTH INSURANCE: TOTAL TEMPORARY DISABILITY Accident and health policies providing total temporary disability benefits must provide for the payment of at least three months benefits if the insured is prevented from performing the duties of his occup…

11 NCAC 12 .0511 GROUP ACCIDENT AND HEALTH INSURANCE: EXCLUSIONS Individual accident and health certificates issued under a group accident and health policy must contain all exclusions that are set out in the master policy. History Note: Authority G.S. 58-2-40(1); 58-51-1; Eff. F…

11 NCAC 12 .0512 ACCIDENT AND HEALTH INSURANCE: EFFECTIVE DATE The effective date of an accident and health policy shall be the date of issue when the premium or policy fee is paid in advance. This does not prevent the policy from containing some provision that coverage on the po…

11 NCAC 12 .0513 ACCIDENT AND HEALTH: RIDER OR ELIMINATION ENDORSEMENT All companies writing non-group accident, health or hospitalization insurance policies shall print in bold type on the face of the policy a notification that a rider or elimination endorsement has been attache…

11 NCAC 12 .0514 COORDINATION: GROUP A/H CONTRACT BENEFITS: GROUP COVERAGES Purpose. In order to promote consistency in liability for claims and claims determination for group accident and health coverage, when a person has more than one type of group insurance and there is a bas…

11 NCAC 12 .0515 COUNTERSIGNATURE BY AGENT History Note: Authority G.S. 58-9(1); 58-44; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. April 1, 1989.

11 NCAC 12 .0516 ACCIDENT AND HEALTH ADVERTISING: RESPONSIBILITY OF INSURER Every insurer shall establish and at all times maintain a system of control over the content, form and method of dissemination of all advertisements of its policies. All such advertisements, regardless of…

11 NCAC 12 .0517 ACCIDENT AND HEALTH ADVERTISING: DEFINITIONS The following definitions are applicable to accident and health advertising Rules 11 NCAC 12 .0516 to .0536 only: (1) "Advertisement" is defined as: (a) printed and published material, audio visual material, and descri…