North Dakota Administrative Code

Multiple employer welfare arrangements are subject to the provisions of the unfair trade practices act found at North Dakota Century Code section 26.1-04-03. History: Effective April 1, 2017. General Authority: NDCC 28-32-02 Law Implemented: NDCC 26.1-01-07.4, 26.1-04-03, 26.1-07…

Each policy issued by a self-funded multiple employer welfare arrangement must contain, in at least ten-point type on the front page and the declaration page, the following notice: NOTICE This policy is issued by a self-funded multiple employer welfare arrangement. A self-funded …

The commissioner may sanction a multiple employer welfare arrangement or suspend or revoke any certificate of authority issued to a multiple employer welfare arrangement upon any of the following grounds: 1. Failure to comply with any provision of these rules or any applicable pr…

"Short-term care insurance" means any insurance policy, group certificate, or rider primarily advertised, marketed, offered, or designed to provide coverage for less than twelve consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis,…

No short-term care insurance policy or group certificate 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…

1. Guaranteed renewable for life - Limitation on preexisting conditions. Any short-term care insurance policy or group certificate must be guaranteed renewable for life. For purposes of this section. "guaranteed renewable for life" means the insured has the right to continue the …

Each insurer offering short-term care insurance shall, as a protection against unintentional lapse, comply with the following: 1. a. Notice before lapse or termination. No individual short-term care policy or certificate shall be issued until the insurer has received from the app…

A short-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 these terms and an explanation of the terms in its accompanying…

1. A statement that the policy may be subject to rate increases in the future. 2. If a short-term care policy uses gender rating to determine the policy's premium rate, the short-term care policy must contain the following language in conspicuous font on the application, on the o…

1. a. If an application for short-term care insurance contains a question which asks whether the applicant has had medication prescribed by a physician, it shall also ask the applicant to list all medication that has been prescribed. b. If the medications listed in the applicatio…

1. The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a short-term care insurance policy or certificate: "Caution: If your answers on this application are incorrect or untrue, [company] has the…

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

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

1. Display prominently on the first page of the outline of coverage and policy the following: "Notice to buyer: This policy may not cover all of the costs associated with short-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully…

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

1. A short-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…

1. "Application" includes an application for individual coverage or a group enrollment form. 2. "Short-term limited-duration health insurance plan" means health insurance coverage provided pursuant to an insurance policy or group certificate of insurance that has an expiration da…

All applications for short-term limited-duration insurance policies must contain clear and unambiguous questions designed to ascertain the reason for the health condition of the applicant as follows: 1. Do you have comprehensive major medical coverage in force as of the date of t…

1. Disclosure statement. All short-term limited-duration policies as defined under North Dakota Century Code section 26.1-36-49 must contain the following disclosure on the front cover page of the policy, the certificate of coverage, and the application in large print: 1 THIS IS …

An issuer through its producers, shall: 1. Provide an outline of coverage to applicants at the time application is presented to the prospective applicant and shall obtain an acknowledgment of receipt of the outline from the applicant. 2. Establish marketing procedures to assure a…

1. "Board" means the public employees retirement system board created by North Dakota Century Code section 54-52-03. 2. "Commissioner" means the insurance commissioner. 3. "Fiscal year" means a self-insurance health plan's twelve-month fiscal year. 4. "Runoff self-insurance healt…

The provisions in this chapter are intended to ensure the financial integrity and the competent and equitable administration of the self-insurance health plan. History: Effective April 1, 2021. General Authority: NDCC 26.1-36.6 Law Implemented: NDCC 26.1-36.6

This chapter applies to all self-insurance health plans established by the board as set forth in North Dakota Century Code chapter 54-52.1. History: Effective April 1, 2021. General Authority: NDCC 26.1-36.6 Law Implemented: NDCC 26.1-36.6 1…

1. Termination. The board may terminate its self-insurance health plan as set forth in North Dakota Century Code chapter 54-52.1. The board shall notify the commissioner of its decision to terminate within ninety days of its decision to terminate. 2. Runoff self-insurance health …

1. Service company. The board may contract with one or more service companies for services necessary to conduct the day-to-day operations of the self-insurance health plan. The service company or companies must have expertise in and be licensed for the services provided to the se…

A reserve must be established for all charges, claims, costs, and expenses of the self-insurance health plan. This reserve must be set at a level to cover between two and four months of expected charges, claims, costs, and expenses. The reserve must be adjusted as new information…

1. Financial statements. A self-insurance health plan must prepare annual financial statements containing a balance sheet; a statement of revenues, expenses, and surplus; a statement of changes in financial position; and a schedule of investments. The statements must be prepared …

Self-insurance health plans are subject to the provisions of the unfair trade practices act found at North Dakota Century Code section 26.1-04-03. History: Effective April 1, 2021. General Authority: NDCC 26.1-36.6 Law Implemented: NDCC 26.1-36.6

Each policy issued by a self-insurance health plan must contain, in at least ten-point type on the front page and declaration page, the following notice: NOTICE This policy is issued by a self-insurance health plan. A self-insurance health plan may not be subject to all of the in…

As used in this chapter: 1. "Affiliate" has the same meaning as defined in North Dakota Century Code section 26.1-10-01. 2. "Control" has the same meaning as defined in North Dakota Century Code section 26.1-10-01. 3. "Evidence of individual insurability" means a statement furnis…

1. Termination of group consumer credit insurance policy. a. If a debtor is covered by a group consumer credit insurance policy providing for the payment of single premiums to the insurer, or any other premium payment method which prepays coverage beyond one month, then provision…

1. Benefits provided by consumer credit insurance policies must be reasonable in relation to the premium charged. Premium rates charged for credit life or disability satisfy this requirement if the premium rate charged develops or may reasonably be expected to develop a loss rati…

1. Premium rate. Subject to the conditions and requirements in subsection 2 and section 45-07-01.1-10, the prima facie rates shown below are considered to meet the requirements of section 45-07-01.1-03 and may be used without filing additional actuarial support. a. Monthly outsta…

1. Premium rate. Subject to the conditions and requirements in subsection 5 and section 45-07-01.1-10, the prima facie rates shown below are considered to meet the requirements of section 45-07-01.1-03 and may be used without filing additional actuarial support. a. If premiums ar…

1. Each insurer filing rates for credit unemployment insurance shall include in its rate filing with the commissioner the appropriate rate formula upon which its rates are based, including a provision for anticipated losses. Anticipated losses that develop or are expected to deve…

1. Each insurer filing rates for credit property insurance shall include in its rate filing with the commissioner the appropriate rate formula upon which its rates are based, including a provision for anticipated losses. Anticipated losses that develop or are expected to develop …

consumer credit insurance payment, no refund shall be required for the coverage under which the lump sum was paid. If a claim under credit accident and health coverage or credit unemployment coverage is in progress at the time of prepayment, the amount of refund may be determined…

1. The commissioner will, on a triennial basis, beginning January 1, 2006, review the loss ratio standards set forth in section 45-07-01.1-03 and the prima facie rates set forth in sections 45-07-01.1-04 and 45-07-01.1-05 and determine therefrom the rate of expected claims on a s…

1. Use of prima facie rates. An insurer that files rates or has rates on file that are equivalent to the prima facie rates shown in sections 45-07-01.1-04 and 45-07-01.1-05, to the extent adjusted pursuant to section 45-07-01.1-09, may use those rates without further proof of the…

1. Each insurer transacting credit insurance in this state shall be responsible for conducting a thorough periodic triennial review of creditors with respect to their credit insurance business 10 with such creditors to assure compliance with the insurance laws of this state and t…

The following practices, when engaged in by insurers in connection with the sale or placement of credit insurance, or as an inducement thereto, shall constitute unfair methods of competition and shall be subject to the Unfair Trade Practices Act of this state. 1. The offer or gra…

If any provision or clause of this chapter or the application thereof to any person or situation is held invalid, such invalidity shall not affect any other provision or application of the chapter which can be given effect without the invalid provision or application, and to this…

As used in this chapter, these words and terms have the following meanings, unless the context clearly indicates otherwise: 1. a. "Allowable expense", except as set forth below or when a statute requires a different definition, means any health care expense, including coinsurance…

This chapter applies to all plans that are issued on or after the effective date of this chapter. History: Effective January 1, 2006. General Authority: NDCC 26.1-36-38 Law Implemented: NDCC 26.1-36-10, 26.1-36-29, 26.1-41-13

1. Appendix A contains a model coordination of benefits provision for use in contracts. The use of this model coordination of benefits provision is subject to the provisions of subsections 2, 3, and 4 and to the provisions of section 45-08-01.2-04. 2. Appendix B is a plain langua…

When a person is covered by two or more plans, the rules for determining the order of benefit payments are as follows: 1. a. The primary plan shall pay or provide its benefits as if the secondary plan or plans did not exist. b. If the primary plan is a closed panel plan and the s…

claim. In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount…