reglab/housing_qa huggingface dataset:
CA Ins Code § 10232.81 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10232.81.

10232.81.  Every long-term care policy, certificate, or rider that purports to provide benefits of home care, community-based services, and residential care facility services under the California Partnership for Long-Term Care Program established by Section 22000 of the Welfare and Institutions Code shall provide at least the following:(a) Care in a residential care facility.(b) Home health care.(c) Adult day care.(d) Personal care.(e) Homemaker services.(f) Hospice services.(g) Respite care.(Amended by Stats. 2018, Ch. 565, Sec. 2. (SB 1248) Effective January 1, 2019.)
CA Ins Code § 10232.93 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10232.93.

10232.93.  Every long-term care policy or certificate shall define the maximum lifetime benefit as a single dollar amount that may be used interchangeably for any home- and community-based services defined in Section 10232.9, assisted living benefit defined in Section 10232.92, or institutional care covered by the policy or certificate. There shall be no limit on any specific covered benefit except for a daily, weekly, or monthly limit set for home- and community-based care and for assisted living care, and for the limits for institutional care. Nothing in this section shall be construed as prohibiting limitations for reimbursement of actual expenses and incurred expenses up to daily, weekly, and monthly limits.(Added by Stats. 1997, Ch. 699, Sec. 6. Effective October 6, 1997.)
CA Ins Code § 10232.95 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10232.95.

10232.95.  Every long-term care policy or certificate that provides reimbursement for care in a nursing facility shall cover and reimburse for per diem expenses, as well as the costs of ancillary supplies and services, up to but not to exceed the maximum lifetime daily facility benefit of the policy or certificate.(Added by Stats. 1997, Ch. 699, Sec. 6.3. Effective October 6, 1997.)
CA Ins Code § 10232.96 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10232.96.

10232.96.  When a policy or certificate holder of an insurance contract issued prior to December 31, 1996, requests a material modification to the contract as defined by federal law or regulations, the insurer, prior to approving such a request, shall provide written notice to the policy or certificate holder that the contract change requested may constitute a material modification that jeopardizes the federal tax status of the contract and appropriate tax advice should therefore be sought.(Added by Stats. 1997, Ch. 699, Sec. 6.5. Effective October 6, 1997.)
CA Ins Code § 10232.97 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10232.97.

10232.97.  In every long-term care policy or certificate that covers care in a nursing facility, the threshold establishing eligibility for nursing facility care shall be no more restrictive than a provision that the insured will qualify if either one of two criteria are met:(a) Impairment in two activities of daily living.(b) Impairment in cognitive ability.(Added by Stats. 1999, Ch. 947, Sec. 7. Effective January 1, 2000.)
CA Ins Code § 10233 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.

10233.  Precedent to the payment of benefits for any care covered by the terms of the policy, any insurer offering long-term care insurance as described in Section 10231.2 may obtain a written declaration by a physician, independent needs assessment agency, or any other source of independent judgment suitable to the insurer that services are necessary.(Added by Stats. 1989, Ch. 1273, Sec. 7.)
CA Ins Code § 10233.2 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.2.

10233.2.  Long-term care insurance may not:(a) Be canceled, nonrenewed, or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder.(b) Contain a provision establishing a new waiting period in the event existing coverage is converted to, or replaced by, a new or other form within the same insurer, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder.(c) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care.(d) Provide for payment of benefits based on a standard described as “usual and customary,” “reasonable and customary,” or words of similar import.(e) Terminate a policy, certificate, or rider, or contain a provision that allows the premium for an in-force policy, certificate, or rider, to be increased due to the divorce of a policyholder or certificate holder.(f) Include an additional benefit for a service with a known market value other than the statutorily required home- and community-based service benefits in Section 10232.9, the assisted living benefit in Section 10232.92, or a nursing facility benefit, unless the additional benefit provides for the payment of at least five times the daily benefit and the dollar value of the additional benefit is disclosed in the schedule page of the policy.(Amended by Stats. 1999, Ch. 947, Sec. 8. Effective January 1, 2000.)
CA Ins Code § 10233.25 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.25.

10233.25.  No long-term care policy or certificate that is issued, amended, renewed, or delivered on and after January 1, 2002, shall contain a provision that prohibits or restricts any health facilities’ compliance with the requirements of Section 1262.5 of the Health and Safety Code.(Added by Stats. 2001, Ch. 691, Sec. 7. Effective January 1, 2002.)
CA Ins Code § 10233.3 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.3.

10233.3.  If a policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods to the extent that similar exclusions have been satisfied under the original policy or certificate.(Added by Stats. 1992, Ch. 1132, Sec. 14. Effective January 1, 1993.)
CA Ins Code § 10233.4 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.4.

10233.4.  No long-term care insurance benefits may be reduced because of out-of-pocket expenditures by the insured or on behalf of the insured by a family member of the insured or by any other individual.(Added by Stats. 1989, Ch. 1273, Sec. 9.)
CA Ins Code § 10233.6 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.6.

10233.6.  A certificate issued pursuant to a group long-term care insurance policy, which policy is delivered or issued for delivery in this state, shall include all of the following:(a) A description of the principal benefits and coverage provided in the policy.(b) A statement of the principal exclusions, reductions, and limitations contained in the policy.(c) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums.(d) A statement that the group master policy determines governing contractual provisions.(e) An explanation of the insured’s rights regarding continuation, conversion, and replacement.(Amended by Stats. 1992, Ch. 1132, Sec. 16. Effective January 1, 1993.)
CA Ins Code § 10233.7 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.7.

10233.7.  No policy may be advertised, marketed, or offered as long-term care or nursing home insurance unless it complies with this chapter.(Added by Stats. 1989, Ch. 1273, Sec. 12.)
CA Ins Code § 10233.8 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - General Provisions|Section 10233.8.

10233.8.  (a) A long-term care insurance policy or certificate issued, amended, renewed, or delivered on or after January 1, 2020, shall not do any of the following based solely and without any additional actuarial risks upon the status of a person as a living organ donor:(1) Refuse to insure, or refuse to continue to insure, the person under a long-term care insurance policy or certificate.(2) Limit the amount, extent, or kind of coverage available to the person under a long-term care insurance policy or certificate.(3) Charge the person a different rate for the same coverage under a long-term care insurance policy or certificate.(4) Otherwise discriminate in the offering, issuance, cancellation, amount of coverage, price, or any other condition of a long-term care insurance policy or certificate for the person.(b) With respect to any health condition other than being a living organ donor, a person who is a living organ donor shall be subject to the same standards of sound actuarial principles or actual or reasonably anticipated experience as persons who are not living organ donors.(c) For purposes of this section, “living organ donor” means an individual who has donated all or part of an organ and is not deceased.(Added by Stats. 2019, Ch. 316, Sec. 5. (AB 1223) Effective January 1, 2020.)
CA Ins Code § 10234 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - Administration and Enforcement|Section 10234.

10234.  The commissioner shall, as required by this chapter, or from time to time as conditions warrant, pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, adopt reasonable regulations, and amendments and additions thereto, as are necessary to administer this chapter.(Added by Stats. 1989, Ch. 1273, Sec. 15.)
CA Ins Code § 10234.2 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - Administration and Enforcement|Section 10234.2.

10234.2.  (a) In addition to all other powers and remedies vested in the commissioner by law, the commissioner shall have administrative authority to assess the penalties prescribed in this article for violation of any provision in this chapter against insurers, brokers, agents, and other entities which have been determined by the commissioner to be engaged in the business of insurance.(b) Upon a showing of a violation of this chapter in any civil action, a court may also assess the penalties prescribed in this article. The court shall award reasonable attorney’s fees and costs to a prevailing plaintiff who establishes a violation of this chapter.(c) Actions for injunctive relief, penalties prescribed in this article, damages, restitution, and all other remedies in law or equity, may be brought in superior court by the Attorney General, a district attorney, or city attorney on behalf of the people of the State of California for violation of any provision in this chapter. The court shall award reasonable attorney’s fees and costs to a prevailing plaintiff who establishes a violation of this chapter.(Added by Stats. 1992, Ch. 1132, Sec. 18. Effective January 1, 1993.)
CA Ins Code § 10234.3 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - Administration and Enforcement|Section 10234.3.

10234.3.  (a) Any broker, agent, or other entity determined by the commissioner to engage in the business of insurance, other than an insurer, who violates this chapter is liable for an administrative penalty of not less than two hundred fifty dollars ($250) for each first violation. The penalty for committing a subsequent or a knowing violation of this chapter shall be not less than one thousand dollars ($1,000) and not more than twenty-five thousand dollars ($25,000) for each violation. The penalty for inappropriate replacement of long-term care coverage shall be not more than five thousand dollars ($5,000) for each violation.(b) Any insurer that violates this chapter is liable for an administrative penalty of not less than five thousand dollars ($5,000) for each first violation. The penalty for committing a subsequent or knowing violation shall be not less than ten thousand dollars ($10,000) for each violation. The penalty for violating this chapter in a manner indicating a general business practice shall reflect the magnitude of the violation against the public interest and shall be not less than ten thousand dollars ($10,000) and not more than five hundred thousand dollars ($500,000).(c) Penalties shall be paid to the Insurance Fund.(Added by Stats. 1992, Ch. 1132, Sec. 19. Effective January 1, 1993.)
CA Ins Code § 10234.4 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - Administration and Enforcement|Section 10234.4.

10234.4.  In addition to the assessment of penalties and other applicable remedies, the commissioner may take the following actions upon determination that a violation of this chapter, or a regulation adopted pursuant to this chapter, has occurred:(a) Suspend or revoke the license of any broker, agent, or other producer licensed by the department.(b) Suspend an insurer’s certificate of authority to transact disability insurance.(c) Order any broker, agent, insurer, or other entity determined by the commissioner to be engaged in the business of insurance, to cease marketing in California a particular policy form of long-term care insurance, to cease marketing any long-term care insurance, or to take such actions as are necessary to comply with this chapter.(Repealed and added by Stats. 1992, Ch. 1132, Sec. 21. Effective January 1, 1993.)
CA Ins Code § 10234.5 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - Administration and Enforcement|Section 10234.5.

10234.5.  (a) Any broker, agent, insurer, or other entity within the jurisdiction of the department who is charged with a violation of this chapter shall be afforded due process through proper notice and public hearing, if requested, before a penalty may be assessed under Section 10234.3, an order issued under Section 10234.4, or other remedy imposed by the commissioner.(b) Written notice, served by registered mail, shall include:(1) A summary of the facts establishing reasonable cause that a violation has occurred.(2) Citation of the code section or other standard allegedly violated.(3) A statement of the commissioner’s intent to assess a penalty including the amount of the penalty, or to seek another remedy.(4) A statement of the respondent’s right to elect any of the following:(A) To accept assessment of the penalty or other remedy as stated in the notice.(B) To respond to the charge in writing, after which the commissioner may issue a final order or set a hearing.(C) To request, within 10 days of receipt of the notice, a public hearing.(c) If timely requested by the respondent or ordered by the commissioner, a public hearing before the Administrative Law Bureau of the department shall be held within 30 days after the notice is served. Within 20 days after the hearing, the administrative law judge shall issue findings of fact and a proposed order. The commissioner shall issue his or her final order or the proposed order shall become the final order of the commissioner within 30 working days after the hearing unless reconsideration is granted for good cause by the administrative law judge. If the notice issued to the respondent assessed a penalty of one hundred thousand dollars ($100,000) or more and the respondent has timely requested, the hearing shall be conducted in accordance with Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of Title 2 of the Government Code, and the commissioner shall have all the powers granted therein.(d) The final order of the commissioner may contain one or more of the remedies set forth in this article. The amount of any penalty assessed need not be limited to the amount stated in the notice to the respondent.(e) In addition to the penalties set forth in this section and any other penalties provided by law, the commissioner may suspend an insurer’s certificate of authority under Section 704 or assess a penalty under Section 704.7 if the commissioner finds, after notice and hearing, that the insurer has violated this chapter or regulations adopted pursuant to this chapter or that the insurer has knowingly permitted any person or entity to do so.(Repealed and added by Stats. 1992, Ch. 1132, Sec. 23. Effective January 1, 1993.)
CA Ins Code § 10234.7 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3 - Administration and Enforcement|Section 10234.7.

10234.7.  The commissioner’s annual report to the Legislature, as required by Section 10234.6, shall be compiled in consultation with a task force designated by the commissioner for this purpose, which shall include insurance industry representatives, other individuals deemed appropriate by the commissioner, and one or more representatives from each of the following:(a) The Health Insurance Counseling and Advocacy Program.(b) The California Health Policy and Data Advisory Commission.The commissioner shall have the responsibility, in consultation with the task force, to develop analytic methods and to select indicators for evaluation of the impact of long-term care insurance on the public share of costs for long-term care.(Added by Stats. 1989, Ch. 1273, Sec. 15.)
CA Ins Code § 10234.8 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3.7 - Consumer Protection|Section 10234.8.

10234.8.  (a) With regard to long-term care insurance, all insurers, brokers, agents, and others engaged in the business of insurance owe a policyholder or a prospective policyholder a duty of honesty, and a duty of good faith and fair dealing.(b) Conduct of an insurer, broker, or agent during the offer and sale of a policy previous to the purchase is relevant to any action alleging a breach of the duty of honesty, and a duty of good faith and fair dealing.(Amended by Stats. 2000, Ch. 442, Sec. 4. Effective January 1, 2001.)
CA Ins Code § 10234.85 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3.7 - Consumer Protection|Section 10234.85.

10234.85.  No insurer, broker, agent, or other person shall cause a policyholder to replace a long term care insurance policy unnecessarily. Nothing in this section shall be construed to allow an insurer, broker, agent, or other person to cause a policyholder to replace a long term care insurance policy that will result in a decrease in benefits and an increase in premium.It shall be presumed that any third or greater policy sold to a policyholder in any 12-month period is unnecessary within the meaning of this section. This section shall not apply to those instances in which a policy is replaced solely for the purpose of consolidating policies with a single insurer.(Added by Stats. 1989, Ch. 631, Sec. 1.)
CA Ins Code § 10234.86 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3.7 - Consumer Protection|Section 10234.86.

10234.86.  (a) 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.(b) Every insurer shall report annually by June 30, the 10 percent of its agents in the state with the greatest percentage of lapses and replacements as measured by subdivision (a).(c) Every insurer shall report annually by June 30, the number of lapsed policies as a percent of its total annual sales in the state, as a percent of its total number of policies in force in the state, and as a total number of each policy form in the state, as of the end of the preceding calendar year.(d) Every insurer shall report annually by June 30, the number of replacement policies sold as a percent of its total annual sales in the state and as a percent of its total number of policies in force in the state as of the end of the preceding calendar year.(e) Reported replacement and lapse rates do not alone constitute a violation of insurance laws or imply wrongdoing. The reports are for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance.(Amended by Stats. 2011, Ch. 426, Sec. 7. (SB 712) Effective January 1, 2012.)
CA Ins Code § 10234.87 (2021)
2021 California Code|Insurance Code - INS|DIVISION 2 - CLASSES OF INSURANCE|PART 2 - LIFE AND DISABILITY INSURANCE|CHAPTER 2.6 - Long-Term Care Insurance|ARTICLE 3.7 - Consumer Protection|Section 10234.87.

10234.87.  (a) If an insurer replaces a policy or certificate that it has previously issued, the insurer shall recognize past insured status by granting premium credits toward the premiums for the replacement policy or certificate. The premium credits shall equal five percent of the annual premium of the prior policy or certificate for each full year the prior policy or certificate was in force. The premium credit shall be applied toward all future premium payments for the replacement policy or certificate, but the cumulative credit allowed need not exceed 50 percent. No credit need be provided if a claim has been filed under the original policy or certificate.(b) The cumulative credits allowed need not reduce the premium for the replacement policy or certificate to less than the premium of the original policy or certificate.(c) This section shall not apply to life insurance policies that accelerate benefits for long-term care.(Amended by Stats. 1998, Ch. 1067, Sec. 5. Effective January 1, 1999.)