North Dakota Administrative Code

Except as otherwise specifically provided, this chapter applies to all long-term care insurance policies, including qualified long-term care contracts and life insurance policies that accelerate benefits for long-term care delivered or issued for delivery in this state on or afte…

For the purpose of this chapter, the terms "long-term care insurance", "qualified long-term care insurance", "group long-term care insurance", "commissioner", "applicant", "policy", and "certificate" shall have the meanings set forth in North Dakota Century Code section 26.1-45-0…

No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements: 1. "Activities of daily living" means at least bathing, contin…

1. Renewability. The terms "guaranteed renewable" and "noncancelable" shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of section 45-06-05.1-06. a. A policy issued to an individ…

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. No individual long-term care policy or certificate shall be issued until the insurer has received from the appli…

1. Renewability. Individual long-term care insurance policies shall contain a renewability provision. a. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state that the coverage is guaranteed renewable or noncancelabl…

1. This section shall apply as follows: a. Except as provided in subdivision b, this section applies to any long-term care policy or certificate issued in this state on or after September 1, 2004. b. For certificates issued on or after the effective date of this amended regulatio…

1. This section applies to any long-term care policy issued in this state on or after September 1, 2004. 2. An insurer shall provide the information listed in this subsection to the commissioner sixty days prior to making a long-term care insurance form available for sale. a. A c…

1. This section applies to any long-term care policy issued in this state on or after March 1, 2020. 2. An insurer shall provide the information listed in this subsection to the commissioner sixty days prior to making a long-term care insurance form available for sale. a. A copy …

1. 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. 2. a. If an application for long-term care insurance contain…

long-term care insurance policies. 1. 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: a. By requiring that the insured or claimant would need care in a skilled nursing …

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 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 in force or whether a long-term care policy or certificate is inten…

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

A producer is not authorized to sell, solicit, or negotiate with respect to long-term care insurance except as authorized by chapter 45-02-02 and North Dakota Century Code chapter 26.1-26. History: Effective March 1, 2004. General Authority: NDCC 28-32-02 Law Implemented: NDCC 26…

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 chapter with respect to a specific long-term care insurance policy or certificate upon a written finding that: 1. The mod…

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 the benefits shall be determined in accordance with North Dakota Century Code section 26.1-35-02. Claim reserv…

1. A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums paid, if the policy complies with all of the following provisions: a. The interest credited internally to …

1. This section shall apply as follows: a. Except as provided in subdivision b, this section applies to any long-term care policy or certificate issued in this state on or after September 1, 2004. b. For certificates issued on or after the effective date of this amended regulatio…

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. Every 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 i…

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 and agent training requirements to assure that: (1) Any marketing activities, includi…

1. This section shall not apply to life insurance policies that accelerate benefits for long-term care. 2. Every insurer, health care service plan, or other entity marketing long-term care insurance (the "issuer") shall: a. Develop and use suitability standards to determine wheth…

replacement policies or certificates. If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and 32 probationary periods in the new long-ter…

1. This section does not apply to life insurance policies or riders containing accelerated long-term care benefits. 2. To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of North Dakota Century Code section 26.1-45-14: a. A policy or certif…

1. 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 restrictive than requiring either …

insurance contracts. 1. For purposes of this section, the following definitions apply: a. (1) "Chronically ill individual" has the meaning prescribed for this term by section 7702B(c)(2) of the Internal Revenue Code of 1986, as amended. Under this provision, a chronically ill ind…

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 shall be a freestanding document, using no…

1. A long-term care insurance shopper's guide in the format developed by the national association of insurance commissioners, or a guide developed or approved by the commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate.…

In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to thre…

As used in this chapter: 1. "Associate member of an employee organization" means any individual who participates in an employee benefit plan (as defined in 29 U.S.C. 1002(1)) that is a multiemployer plan (as defined in 29 U.S.C. 1002(37A)), other than the following: a. An individ…

1. Except as provided in section 45-06-06.1-13, this chapter applies to any health benefit plan, whether provided on a group or individual basis, which: a. Meets one or more of the conditions set forth in subdivisions a, b, and c of subsection 1 of North Dakota Century Code secti…

1. A small employer carrier that establishes more than one class of business pursuant to the provisions of North Dakota Century Code section 26.1-36.3-03 shall maintain on file for inspection by the commissioner the following information with respect to each class of business so …

1. a. A small employer carrier shall not transfer or assume the entire insurance obligation or risk of a health benefit plan covering a small employer in this state unless: (1) The transaction has been approved, to the extent required by law, by the insurance supervisory official…

1. This section applies only to a health benefit plan offered by a small employer who employed an average of at least two but not more than twenty-five eligible employees on business days during the preceding calendar year and who employs at least two employees on the first day o…

1. a. A small employer carrier that offers coverage to a small employer shall offer to provide coverage to each eligible employee and to each dependent of an eligible employee. Except as provided in subdivision b, the small employer carrier shall provide the same health benefit p…

1. Except as provided in subsections 2 and 3, a small employer carrier may not consider the trade or occupation of the employees of a small employer or the industry or type of business in which the small employer is engaged in determining whether to issue or continue to provide c…

1. A carrier that has been prohibited from writing coverage for small employers in this state pursuant to subsection 2 of North Dakota Century Code section 26.1-36.3-05 may not resume offering health benefit plans to small employers in this state until the carrier has made a peti…

Repealed effective December 1, 1997.

1. A restrictive rider, endorsement, or other provision that would violate the provisions of paragraph 2 of subdivision e of subsection 3 of North Dakota Century Code section 26.1-36.3-06 and that was in force on the effective date of this chapter may not remain in force beyond t…

1. a. A small employer carrier shall actively market each of its health benefit plans to small employers in this state. A small employer carrier may not suspend the marketing or issuance of a health benefit plan unless the carrier has good cause and has received the prior approva…

1. A carrier shall not offer health benefit plans to small employers after January 1, 1994, or continue to provide coverage after September 1, 1994, under health benefit plans previously issued to small employers in this state, unless the filing provided pursuant to section 45-06…

1. a. Except as provided in subdivision b, a small employer carrier shall, as a condition of continuing to transact business in this state with small employers, offer to provide a health benefit plan as described in subsection 3 to any small employer whose coverage was terminated…

1. Employees losing other coverage. A group health plan shall permit an employee who is eligible, but not enrolled, for coverage (or a dependent of the employee if the dependent is eligible, but not enrolled) to enroll for coverage under the terms of the plan if each of the follo…

This chapter applies to all health maintenance organizations that are required to obtain a certificate of authority in this state. In the event of conflict between the provisions of this chapter and the provisions of any other chapter issued by the commissioner, the provisions of…

1. All group and individual contracts written or issued on or after December 31, 1993, must conform with the provisions of these rules. 2. Group or individual contract or evidence of coverage may not be reissued, renewed, amended, or extended in this state on or after December 31…

Group or individual contract or evidence of coverage delivered or issued for delivery to any person in this state by a health maintenance organization required to obtain a certificate of authority in this state may not contain definitions respecting the matters set forth below un…

Each subscriber is entitled to receive an individual contract or evidence of coverage in a form that has been approved by the commissioner. Each group contractholder is entitled to receive a group contract as approved by the commissioner. Group contracts, individual contracts, an…

1. Preexisting conditions. a. A health maintenance organization may impose a preexisting condition exclusion only if: (1) The exclusion relates to a condition, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or rec…

1. Access to care. a. A health maintenance organization shall establish and maintain adequate arrangements to provide health services for its enrollees, including: (1) Reasonable proximity to the business or personal residences of the enrollees so as not to result in unreasonable…