reglab/housing_qa huggingface dataset:
CA Ins Code § 10234.9 (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 10234.9.

10234.9.  (a) Every insurer providing long-term care coverage in California shall provide a copy of any advertisement intended for use in California to the commissioner for review at least 30 days before dissemination. The advertisement shall comply with all laws in California. In addition, the advertisement shall be retained by the insurer in accordance with Section 10508 for at least three years.(b) An advertisement designed to produce leads must prominently disclose that “an insurance agent will contact you” if that is the case.(c) An agent, broker, or other person who contacts a consumer as a result of receiving information generated by a cold lead device, shall immediately disclose that fact to the consumer.(Repealed and added by Stats. 1992, Ch. 1132, Sec. 25. Effective January 1, 1993.)
CA Ins Code § 10234.97 (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 3.7 - Consumer Protection|Section 10234.97.

10234.97.  (a) Any time long-term care coverage is replaced, the sales commission that is paid by the insurer and that represents the percentage of the sale normally paid for first year sales of long-term care policies or certificates shall be calculated based on the difference between the annual premium of the replacement coverage and that of the original coverage. If the premium on the replacement product is less than or equal to the premium for the product being replaced, the sales commission shall be limited to the percentage of sale normally paid for renewal of long-term care policies or certificates. Replacement shall be contingent upon the insurer’s declaration that the replacement policy materially improves the position of the insured, pursuant to Section 10235.16. This provision does not apply to replacement coverage which is group insurance as described in subdivision (a) of Section 10231.6.(b)  For purposes of this section, “commission or other compensation” includes pecuniary or nonpecuniary remuneration of any kind relating to the sale or renewal of the policy or certificate including, but not limited to, bonuses, gifts, prizes, awards, and finder’s fees.(c)  Every long-term care insurer shall file with the commissioner within six months of the effective date of this section, its commission structure or an explanation of the insurer’s compensation plan. Any amendments to the commission structure shall be filed with the commissioner before implementation.(Amended by Stats. 1993, Ch. 316, Sec. 1. Effective August 30, 1993.)
CA Ins Code § 10235 (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 4 - Implementation|Section 10235.

10235.  Except as provided in Section 10235.95, this article applies to all long-term care insurance policies delivered or issued for delivery in this state on or after January 1, 1990.(Amended by Stats. 2008, Ch. 171, Sec. 1. Effective January 1, 2009.)
CA Ins Code § 10235.2 (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 4 - Implementation|Section 10235.2.

10235.2.  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:(a) “Medicare” shall be defined as the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965 as then constituted or later amended, or Title I, Part I of Public Law 89-97, as enacted by the 89th Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof, or words of similar import.(b) “Skilled nursing care,” “intermediate care,” “home health care,” and other services shall be defined in relation to the level of skill required, the nature of the care and the setting in which care is required to be delivered. (c) All providers of services, including, but not limited to, skilled nursing facilities, intermediate care facilities, and home health agencies shall be defined in relation to the services and facilities required to be available and the licensure or degree status of those providing or supervising the services. The definition may require that the provider be appropriately licensed or certified.(Amended by Stats. 1999, Ch. 947, Sec. 9.5. Effective January 1, 2000.)
CA Ins Code § 10235.8 (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 4 - Implementation|Section 10235.8.

10235.8.  No policy may be delivered or issued for delivery in this state as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition, or accident, except as to the following:(a) Preexisting conditions or diseases.(b) Alcoholism and drug addiction.(c) Illness, treatment, or a medical condition arising out of any of the following:(1) War or act of war, whether declared or undeclared.(2) Participation in a felony, riot, or insurrection.(3) Service in the Armed Forces or units auxiliary thereto.(4) Suicide, whether or not the person had mental capacity to control what he or she was doing, attempted suicide, or intentionally self-inflicted injury.(5) Aviation in the capacity of a non-fare-paying passenger.(d) Treatment provided in a government facility, unless otherwise required by law, services for which benefits are available under Medicare or other governmental programs (except Medi-Cal or medicaid), state or federal workers’ compensation, employer’s liability or occupational disease law, or a motor vehicle no fault law, services provided by a member of the covered person’s immediate family, and services for which no charge is normally made in the absence of insurance.(e) This section does not prohibit exclusions and limitations by type of provider or territorial limitations.(Amended by Stats. 2014, Ch. 144, Sec. 45. (AB 1847) Effective January 1, 2015.)
CA Ins Code § 10235.9 (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 4 - Implementation|Section 10235.9.

10235.9.  (a) Every insurer shall report annually by June 30 the total number of claims denied by each class of business in the state and the number of these claims denied for failure to meet the waiting period or because of a preexisting condition as of the end of the preceding calendar year.(b) The insurer shall provide every policyholder or certificate holder whose claim is denied a written notice within 40 days of the date of denial of the reasons for the denial and all information directly related to the denial. Insurers shall annually report to the department the number of denied claims.(c) The department shall make available to the public, upon request, the denial rate of claims by insurer.(Added by Stats. 1997, Ch. 699, Sec. 12. Effective October 6, 1997.)
CA Ins Code § 10235.9a (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 4 - Implementation|Section 10235.9a.

10235.9a.  For policies or certificates issued on or after January 1, 2017, that contain an alternate plan of care provision pursuant to Section 10231.3, if an insurer and insured cannot agree on the terms of an alternate plan of care, the insurer shall provide a written explanation to the policyholder or certificate holder as to the specific reason or reasons why the agreement cannot be reached. The insurer shall provide the written explanation within 60 days of the insurer’s determination that an agreement cannot be reached.(Added by Stats. 2016, Ch. 589, Sec. 4. (SB 1091) Effective January 1, 2017.)
CA Ins Code § 10235.10 (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 4 - Implementation|Section 10235.10.

10235.10.  Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if that institutionalization began while the long-term care insurance was in force and continues without interruption after termination. This extension of benefits beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefits and may be subject to any policy waiting period, and all other applicable provisions of the policy.(Added by Stats. 1989, Ch. 767, Sec. 2.)
CA Ins Code § 10235.14 (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 4 - Implementation|Section 10235.14.

10235.14.  (a) Individual long-term care insurance policies shall contain a renewability provision. This provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly disclose the term of coverage for which the policy is initially issued, the terms and conditions under which the policy may be renewed, and whether or not the issuer has the right to change the premium. If this right exists, the policy provisions shall clearly and concisely describe each circumstance under which the premium may change.(b) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured. After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the insured, unless the increased benefits or coverage are required by law. If a separate additional premium is charged for benefits provided in connection with riders or endorsements, that premium charge shall be set forth in the policy, rider, or endorsement.(c) If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, those limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as “preexisting condition limitations.”(d) A long-term care insurance policy or certificate containing any limitations or conditions for eligibility shall set forth in a separate paragraph of the policy or certificate a description of those limitations or conditions, including any required number of days of confinement, and shall label that paragraph “Limitations or Conditions on Eligibility for Benefits.”(Amended by Stats. 1992, Ch. 1132, Sec. 31. Effective January 1, 1993.)
CA Ins Code § 10235.17 (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 4 - Implementation|Section 10235.17.

10235.17.  For purposes of this chapter, the commissioner shall define inappropriate replacement of long-term care insurance in consultation with other interested parties.(Added by Stats. 1992, Ch. 1132, Sec. 33. Effective January 1, 1993.)
CA Ins Code § 10235.18 (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 4 - Implementation|Section 10235.18.

10235.18.  (a) Insurers using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy or certificate. The required notice shall be provided in the following form: “NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing accident and sickness or long-term care insurance and replace it with the long-term care insurance coverage delivered herewith issued by (company name) Insurance Company. Your new coverage provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy or certificate. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new coverage.(1) Health conditions which you may presently have (preexisting conditions), may not be immediately or fully covered under the new coverage. This could result in denial or delay in payment of benefits under the new coverage, whereas a similar claim might have been payable under your present coverage.(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy coverage. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.(3) (To be included only if the application is attached to the policy or certificate). If, after due consideration, you still wish to terminate your present coverage and replace it with new coverage, read the copy of the application attached to your new coverage and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (company name and address) within thirty (30) days if any information is not correct and complete, or if any past medical history has been left out of the application.(Company Name)”(b) For group coverage not subject to the 30-day return provision of Section 10232.7, the notice shall be modified to reflect the appropriate time period in which the policy may be returned and premium refunded.(Added by Stats. 1989, Ch. 767, Sec. 2.)
CA Ins Code § 10235.20 (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 4 - Implementation|Section 10235.20.

10235.20.  The commissioner may waive a specific provision or provisions of this article with respect to a specific long-term care insurance policy or certificate upon making written findings specified in subdivisions (a), (b), and (c), as follows:(a) The waiver would be in the best interest of the insureds.(b) The underlying purposes of this article could not be effectively or efficiently achieved without the waiver.(c) Any of the following:(1) The waiver is necessary to the development of an innovative and reasonable approach for insuring long-term care.(2) The policy or certificate is to be issued to residents of a life care or continuing care retirement community or some other residential community for the elderly and the waiver is reasonably related to the special needs or nature of such a community.(3) The waiver is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product.The commissioner may condition any waiver upon compliance with alternative requirements to achieve the purposes of this article.(Added by Stats. 1989, Ch. 767, Sec. 2.)
CA Ins Code § 10235.30 (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 4 - Implementation|Section 10235.30.

10235.30.  (a) No insurer may deliver or issue for delivery a long-term care policy in this state unless the insurer offers at the time of application an option to purchase a shortened benefit period nonforfeiture benefit with the following features:(1) Eligibility begins no later than after 10 years of premium payments.(2) The lifetime maximum benefit is no less than the dollar equivalent of three months of care at the nursing facility per diem benefit contained in the policy or the amount of the premiums paid, whichever is greater.(3) The same benefits covered in the policy and any riders at the time eligibility begins are payable for a qualifying claim.(4) The lifetime maximum benefit may be reduced by the amount of any claims already paid.(5) Cash back, extended term, and reduced paid-up forms of nonforfeiture benefits shall not be allowed.(6) The lifetime maximum benefit amount increases proportionally with the number of years of premium payment.(b) This section shall not apply to life insurance policies that accelerate benefits for long-term care.(Amended by Stats. 1999, Ch. 947, Sec. 11. Effective January 1, 2000.)
CA Ins Code § 10235.35 (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 4 - Implementation|Section 10235.35.

10235.35.  (a) Notwithstanding any other law, the commissioner may require the administration by an insurer of the contingent benefit upon lapse, as described in Section 28 (A), (D) (3), (E), (F), (G), and (J) of the Long-Term Care Insurance Model Regulation promulgated by the National Association of Insurance Commissioners, as adopted in September 2014, as a condition of approval or acknowledgment of a rate adjustment for a block of business for which the contingent benefit upon lapse is not otherwise available.(b) The insurer shall notify policyholders and certificate holders of the contingent benefit upon lapse when required by the commissioner in conjunction with the implementation of a rate adjustment. The commissioner may require an insurer who files for such a rate adjustment to allow policyholders and certificate holders to reduce coverage pursuant to Section 10235.50 to avoid an increase in the policy’s premium amount.(c) The commissioner may also approve any other alternative mechanism filed by the insurer in lieu of the contingent benefit upon lapse.(Amended by Stats. 2015, Ch. 348, Sec. 24. (AB 1515) Effective January 1, 2016.)
CA Ins Code § 10235.51 (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 4 - Implementation|Section 10235.51.

10235.51.  (a) Every policy or certificate shall include a provision that gives the insured the option to elect, no less frequently than on each anniversary date after the policy or certificate is issued, to pay an extra premium for one or more riders that increase coverage in any of the following ways:(1) Increase the amount of the per diem benefits.(2) Increase the lifetime maximum benefit.(3) Increase the amount of both the nursing facility per diem benefit and the home- and community-based care benefits of a comprehensive long-term care insurance policy or certificate.(b) The premiums for the riders to increase coverage may be based on the attained age of the insured. The premium for the original policy or certificate will not be changed and will continue to be based on the insured’s age when the original policy or certificate was issued.(c) The insurer may require the insured to undergo new underwriting, in addition to the payment of an additional premium, to qualify for the additional coverage. The insurer may restrict the age for issuance of additional coverage and restrict the aggregate amount of additional coverage an insured may acquire to the maximum age and coverage the insurer allows when issuing a new policy or certificate.(Added by Stats. 1997, Ch. 699, Sec. 16. Effective October 6, 1997.)
CA Ins Code § 10235.52 (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 4 - Implementation|Section 10235.52.

10235.52.  (a) Each policy shall contain a provision that, if the insurer develops new benefits or benefit eligibility or new policies with new benefits or benefit eligibility not included in the previously issued policy, the insurer shall grant current holders of its policies who are not in benefit or within the elimination period all of the following rights:(1) The insurer shall notify the policyholder of the availability of the new benefits or benefit eligibility or new policy within 12 months of the date that the new policy series is made available for sale in this state. The insurer shall file the notice with the department at the same time as the new policy or rider.(2) The insurer shall offer the policyholder new benefits or benefit eligibility in one of the following ways:(A) By adding a rider to the existing policy and paying a separate premium for the new benefits or benefit eligibility based on the insured’s attained age. The premium for the existing policy shall remain unchanged based on the insured’s age at issuance.(B) By replacing the existing policy or certificate in accordance with Section 10234.87.(C) By replacing the existing policy or certificate with a new policy or certificate, in which case consideration for past insured status shall be recognized by setting the premium for the replacement policy or certificate at the issue age of the policy or certificate being replaced.(b) The insured may be required to undergo new underwriting, but the underwriting can be no more restrictive than if the policyholder or certificate holder were applying for a new policy or certificate.(c) The insurer of a group policy as defined under subdivisions (a) to (c), inclusive, of Section 10231.6 shall offer the group policyholder the opportunity to have coverage for the new benefits and provisions extended to existing certificate holders, but the insurer is relieved of the obligations imposed by this section if the holder of the group policy declines the issuer’s offer.(d) For purposes of this section, new benefits means coverage for new long-term care services or providers that are material in nature. New benefits that are material in nature do not include changes to policy structure, benefits, or provisions that are minor in nature. Changes that are minor in nature include, but are not limited to, changes in elimination periods, benefit periods, and benefit amounts.(Amended by Stats. 2017, Ch. 561, Sec. 140. (AB 1516) Effective January 1, 2018.)
CA Ins Code § 10235.91 (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 4 - Implementation|Section 10235.91.

10235.91.  In the event a non-medicaid national or state long-term care program is created through public funding that substantially duplicates benefits covered by the policy or certificate, the policyholder or certificate holder will be entitled to select either a reduction in future premiums or an increase in future benefits. An actuarial method for determining the premium reductions and increases in future benefits will be mutually agreed upon by the department and insurers. The amount of the premium reductions and future benefit increases to be made by each insurer will be based on the extent of the duplication of covered benefits, the amount of past premium payments, and claims experience. Each insurer’s premium reduction and benefit increase plans shall be filed and approved by the department.(Added by Stats. 1997, Ch. 699, Sec. 18. Effective October 6, 1997.)