North Dakota Administrative Code

1. In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. 2. Any sale of a Medicare supplement policy or certificate that will p…

1. On or before March first of each year, an issuer must report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate: a. Policy and certificate number. b. Date of issuance. …

periods, and probationary periods in replacement policies or certificates. 1. If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer must waive any time periods applicable to preexisting conditions, waiting …

testing. This section applies to all policies with policy years beginning on or after May 21, 2009. 1. An issuer of a Medicare supplement policy or certificate shall not: a. Deny or condition the issuance or effectiveness of the policy or certificate, including the imposition of …

If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances may not be affected thereby. 90 History: Effective …

Repealed effective October 1, 2019. 91 APPENDIX A MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR _________________________ TYPE1 SMSBP2 For the State of Company Name NAIC Group Code NAIC Company Code Address Person Completing Exhibit Title Telephone Number (a) (b) …

Unless otherwise defined, or made inappropriate by context, all words used in this chapter shall have the meanings given them under North Dakota Century Code chapter 26.1-08. History: Effective February 1, 1983. General Authority: NDCC 26.1-08-03 Law Implemented: NDCC 26.1-08-01,…

association and comprehensive health insurance plan. 1. Insurers which are members of the association will be assessed annually for their proportionate share of administrative expenses of the association and the amount by which operating, administrative, and claims expenses of th…

If an insurer fails to pay an assessment, in the time prescribed, subject to the hearing requirements of North Dakota Century Code chapter 28-32, its membership in the association will cease, and it shall not be permitted to write accident and sickness insurance policies as defin…

The contracts issued by the comprehensive health association of North Dakota for accident and sickness insurance coverage must in all cases be considered secondary to any other accident and sickness insurance policy the insured may have. Benefits to be paid by the comprehensive h…

1. "Applicant" means an individual seeking enrollment under the association. 2. "Board" means the board of directors of the association as set forth under North Dakota Century Code section 26.1-08-03. 3. "Enrollee" means an eligible person who is covered under an association plan…

1. The board of directors of the association shall establish and maintain a grievance procedure which has been approved by the commissioner to provide procedures for the resolution of grievances initiated by enrollees or applicants. The board shall maintain records regarding grie…

A child will be deemed an "eligible person" pursuant to subdivision b of subsection 4 of North Dakota Century Code section 26.1-08-01, despite the lack of eighteen months of qualifying previous coverage, if: 1. The child was covered under any qualifying previous coverage within t…

As used in this chapter: 1. "CDT-1 codes" means the current dental terminology prescribed by the American dental association. 2. "CPT-4 codes" means the current procedural terminology published by the American medical association. 3. "HCFA" means the health care financing adminis…

1. Except as otherwise specifically provided, the requirements of this chapter apply to issuers, health care practitioners, and institutional care practitioners. 2. Nothing in this chapter prevents an issuer from requesting additional information that is not contained on the form…

1. Health care practitioners and institutional care practitioners shall file claims in a manner consistent with the requirements of this chapter. Claims filed in paper form must be printed on eight and one-half by eleven-inch [21.59 by 27.94-centimeter] paper. 2. Issuers shall ac…

The purpose of this chapter is to assure truthful and adequate disclosure of all material and relevant information in the advertising of disability and accident and sickness insurance (including nursing home, long-term care, and Medicare supplement insurance). This purpose is int…

1. This chapter applies to every "advertisement", as that term is defined in this chapter unless otherwise specified in this chapter, intended for presentation, distribution, or dissemination in this state when such presentation, distribution, or dissemination is made either dire…

1. An "advertisement" for the purpose of this chapter includes: 1 a. Printed and published material, audio visual material, and descriptive literature of an insurer, agent, or broker used in direct mail, newspapers, magazines, radio scripts, television scripts, billboards, and si…

1. The format and content of an advertisement to which this chapter applies must be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Whether an advertisement has a capacity or tendency to mislead or deceive must be determined b…

1. No advertisement may omit information or use words, phrases, statements, references, or illustrations if the omission of such information or use of such words, phrases, statements, references, or illustrations has the capacity, tendency, or effect of misleading or deceiving pu…

1. When an advertisement which is an invitation to contract refers to either a dollar amount, or a period of time for which any benefit is payable, or the cost of the policy, or specific policy benefit, or the loss for which such benefit is payable, it must also disclose those ex…

1. An advertisement which is subject to the requirements of section 45-06-04-06 must, in negative terms, disclose the extent to which any loss is traceable to a condition existing prior to the effective date of the policy. The use of the term "preexisting condition" without an ap…

1. Testimonials used in advertisements must be genuine, represent the current opinion of the author, be applicable to the policy advertised, and be accurately reproduced. The insurer, in using a testimonial, makes as its own all of the statements contained therein, and the advert…

1. An advertisement which reasonably is expected to be seen or heard beyond the limits of the jurisdiction in which the insurer is licensed may not imply licensing beyond those limits. 2. An advertisement may not create the impression directly or indirectly that the insurer, its …

1. The full legal name of the actual insurer and insurance agent or agency must be shown in each advertisement. An advertisement may not use a trade name, any insurance group designation, name of the parent company of the insurer, name of a particular division of the insurer or a…

Each insurer shall maintain at its home or principal office a complete file containing every printed, published, or prepared advertisement of its individual policies and typical printed, published, or prepared advertisements of its blanket, franchise, and group policies hereafter…

A violation of this chapter by an insurance company or agent is an unfair method of competition and an unfair or deceptive act or practice in the conduct of the business of insurance, pursuant to North Dakota Century Code section 26.1-04-03. History: Effective March 1, 1988. Gene…

Except as otherwise specifically provided, this section applies to all long-term care insurance policies delivered or issued for delivery in this state between July 1, 1988, and February 29, 2004, by insurers, fraternal benefit societies, nonprofit health, hospital and medical se…

For the purpose of this regulation, the terms "long-term care insurance", "group long-term care insurance", "commissioner", "applicant", "policy", and "certificate" have the meanings set forth in North Dakota Century Code section 26.1-45-01. History: Effective July 1, 1988. Gener…

No long-term care insurance policy delivered or issued for delivery in this state may use the terms set forth in this section, unless the terms are defined in the policy and the definitions satisfy the following requirements: 1 1. "Acute condition" means that the individual is me…

1. Renewability. The terms "guaranteed renewable" and "noncancelable" may not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of section 45-06-04-05. a. No such policy issued to an indiv…

Each insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: 1. a. Notice before lapse or termination. An individual long-term care policy or certificate may not be issued until the insurer has received from the app…

1. Renewability. Individual long-term care insurance policies must contain a renewability provision. Such provision must be appropriately captioned, must appear on the first page of the policy, and must clearly state the duration, where limited, of renewability and the duration o…

1. All applications for long-term care insurance policies or certificates, except those which are guaranteed issue, must contain clear and unambiguous questions designed to ascertain the health condition of the applicant. 2. a. If an application for long-term care insurance conta…

long-term care insurance policies. 1. A long-term care insurance policy or certificate may not, if it provides benefits for home health care or community care services, limit or exclude benefits: a. By requiring that the insured or claimant would need care in a skilled nursing fa…

1. 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 benefit maximums or reasonable durations wh…

1. Application forms must 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 in force or whether a long-term care policy or certificate is intend…

1. 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. 2. Eac…

The commissioner may, upon written request and after an administrative hearing, issue an order to modify or suspend a specific provision or provision of this chapter with respect to a specific long-term care insurance policy or certificate upon a written finding that: 1. The modi…

Benefits under long-term care insurance policies must be deemed reasonable in relation to premiums provided the expected loss ratio is at least sixty percent, calculated in a manner which provides for adequate reserving of the long-term care insurance risk. In evaluating the expe…

1. When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for such benefits must be determined in accordance with North Dakota Century Code chapter 26.1-35. Claim reserves …

Prior to an insurer or similar organization offering group long-term care insurance to a resident of this state pursuant to North Dakota Century Code section 26.1-45-03, it shall file with the commissioner evidence that the group policy or certificate thereunder has been approved…

1. An insurer, health care service plan, or other entity providing long-term care insurance or benefits in this state shall provide a copy of any long-term care insurance advertisement intended for use in this state whether through written, radio, or television medium to the insu…

1. Every insurer, health care service plan, or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: a. Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fa…

In recommending the purchase or replacement of any long-term care insurance policy or certificate, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. History: Effective July 1, 1994. General Authority: NDCC 28-32-02 L…

This section implements, interprets, and makes specific the provisions of subsection 2 of North Dakota Century Code section 26.1-45-09 in prescribing a standard format and the content of an outline of coverage. 1. The outline of coverage must be a freestanding document, using no …