reglab/housing_qa huggingface dataset:
HI Rev Stat § 431:10H-203 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-203 Limitations and exclusions.

 §431:10H-203 Limitations and exclusions. (a) A policy may not 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 follows:  (1) Preexisting conditions or diseases;  (2) Mental or nervous disorders; however, this shall not permit exclusion or limitation of benefits on the basis of Alzheimer's disease;  (3) Alcoholism and drug addiction;  (4) Illness, treatment, or medical condition arising out of:  (A) War or act of war, whether declared or undeclared;  (B) Participation in a felony, riot, or insurrection;  (C) Service in the armed forces or units auxiliary thereto;  (D) Suicide (sane or insane), attempted suicide, or intentionally self-inflicted injury; or  (E) Aviation (this exclusion applies only to non-fare-paying passengers);  (5) Treatment provided in a government facility (unless required by law), services for which benefits are available under medicare or other governmental program (except medicaid), any state or federal workers' compensation, employer's liability, or occupational disease law, or any motor vehicle insurance 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;  (6) Expenses for services or items available or paid under another long-term care insurance or health insurance policy; or  (7) In the case of a qualified long-term care insurance contract, expenses for services or items to the extent that the expenses are reimbursable under title XVIII of the Social Security Act or would be so reimbursable but for the application of a deductible or coinsurance amount.  (b) This section is not intended to prohibit exclusions and limitations by type of provider. However, no long-term care issuer may deny a claim because services are provided in a state other than the state of policy issue under the following conditions:  (1) When the state other than the state of policy issue does not have the provider licensing, certification, or registration required in the policy, but where the provider satisfies the policy requirements outlined for providers in lieu of licensure, certification, registration; or  (2) When the state other than the state of policy issue licenses, certifies, or registers the provider under another name.  For purposes of this subsection, "state of policy issue" means the state in which the individual policy or certificate was originally issued.  (c) This section is not intended to prohibit territorial limitations. [L 1999, c 93, pt of §2; am L 2007, c 233, §12]
HI Rev Stat § 431:10H-204 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-204 Extension of benefits.

 §431:10H-204 Extension of benefits. Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without interruption after termination. The 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. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-204.5 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-204.5 Electronic enrollment for group policies.

 §431:10H-204.5 Electronic enrollment for group policies. (a) In the case of a group defined in paragraph (1) of the definition of "group long-term care insurance" in section 431:10H-104, any requirement that a signature of an insured be obtained by an agent or insurer shall be deemed satisfied if:  (1) The consent is obtained by telephonic or electronic enrollment by the group policyholder or insurer. A verification of enrollment information shall be provided to the enrollee;  (2) The telephonic or electronic enrollment provides necessary and reasonable safeguards to assure the accuracy, retention, and prompt retrieval of records; and  (3) The telephonic or electronic enrollment provides necessary and reasonable safeguards to assure that the confidentiality of individually identifiable information and privileged information is maintained.  (b) The insurer shall make available, upon request of the commissioner, records that will demonstrate the insurer's ability to confirm enrollment and coverage amounts. [L 2007, c 233, pt of §4]
HI Rev Stat § 431:10H-206 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-206 Discontinuance and replacement.

 §431:10H-206 Discontinuance and replacement. If a group long-term care insurance policy is replaced by another group long-term care insurance policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group policy on its date of termination. Coverage provided or offered to individuals by the insurer and premiums charged to person under the new group policy shall not:  (1) Result in an exclusion for preexisting conditions that would have been covered under the group policy being replaced; and   (2) Vary or otherwise depend on the individual's health or disability status, claim experience, or use of long-term care services. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-207 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-207 Premiums charged--group and individual policies.

  §431:10H-207 Premiums charged--group and individual policies. (a) The premium charged to an insured shall not increase due to either:  (1) Increasing age of the insured at ages beyond sixty-five; or  (2) The duration the insured has been covered under the policy.  (b) The purchase of additional coverage shall not be considered a premium rate increase, but for purposes of the calculation required under section 431:10H-233, the portion of the premium attributable to the additional coverage shall be added to and considered part of the initial annual premium.  (c) A reduction of benefits shall not be considered a premium change, but for purpose of calculation required under section 431:10H-233, the initial annual premium shall be based on reduced benefits. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-208 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-208 Unintentional lapse.

 §431:10H-208 Unintentional lapse. (a) Each insurer offering long-term care insurance, as a protection against unintentional lapse, shall comply with this section.  (b) No individual long-term care policy or certificate shall be issued until the insurer has received from the applicant a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy or certificate for nonpayment of premium, or a written waiver dated and signed by the applicant electing not to designate additional persons to receive notice. The applicant has the right to designate at least one person who is to receive the notice of termination, in addition to the insured. Designation shall not constitute acceptance of any liability on the third party for services provided to the insured. The form used for the written designation shall provide space clearly designated for listing at least one person. The designation shall include each person's full name and home address.  (c) In the case of an applicant who elects not to designate an additional person, the waiver shall state: "Protection Against Unintended Lapse. I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this long-term care insurance policy for nonpayment of premium. I understand that notice will not be given until thirty (30) days after a premium is due and unpaid. I elect NOT to designate a person to receive this notice."  (d) The insurer shall notify the insured of the right to change this written designation, no less often than every two years.  (e) When the policyholder or certificate holder pays premium for a long-term care insurance policy or certificate through a payroll or pension deduction plan, the notice requirement contained in subsection (c) need not be met until sixty days after the policyholder or certificate holder is no longer on a payment plan. The application or enrollment form for these policies or certificates shall clearly indicate the payment plan selected by the applicant. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-209 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-209 Lapse or termination for nonpayment of premium.

  §431:10H-209 Lapse or termination for nonpayment of premium. No individual long-term care policy or certificate shall lapse or be terminated for nonpayment of premium unless the insurer, at least thirty days before the effective date of the lapse or termination, has given notice to the insured and to those persons designated in section 431:10H-208 at the address provided by the insured for purposes of receiving notice of lapse or termination. Notice shall be given by first class United States mail, postage prepaid and notice may not be given until thirty days after a premium is unpaid. Notice shall be deemed to have been given as of five days after the date of mailing. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-210 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-210 Reinstatement.

 §431:10H-210 Reinstatement. In addition to the requirements of sections 431:10H-208 and 431:10H-209, a long-term care insurance policy or certificate shall include a provision that provides for reinstatement of coverage, in the event of lapse if the insurer is provided proof that the policyholder or certificate holder was cognitively impaired or had a loss of functional capacity before the grace period contained in the policy expired. This option shall be available to the insured if requested within five months after termination and shall allow for the collection of past due premium, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy and certificate. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-211 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-211 Disclosure; renewability.

 §431:10H-211 Disclosure; renewability. (a) Individual long-term care insurance policies shall contain a renewability provision. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed. This provision shall not apply to policies that do not contain a nonrenewability provision, and under which the right to nonrenew is reserved solely to the policyholder.  (b) A long-term care insurance policy or certificate, other than one where the insurer does not have the right to change the premium, shall include a statement that premium rates may change. [L 1999, c 93, pt of §2; am L 2007, c 233, §13]
HI Rev Stat § 431:10H-212 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-212 Disclosure; riders and endorsements.

 §431:10H-212 Disclosure; riders and endorsements. (a) 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 the date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured.  (b) After the date of policy issuance, any rider or endorsement that increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing by the insured, except if the increased benefits or coverages are required by law.   (c) Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge shall be set forth in the policy, rider, or endorsement. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-213 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-213 Disclosure; payment of benefits.

 §431:10H-213 Disclosure; payment of benefits. A long-term care insurance policy that provides for the payment of benefits based on standards described as "usual and customary", "reasonable and customary", or similar words or phrases shall include a definition of these terms and an explanation of the terms in its accompanying outline of coverage. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-214 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-214 Disclosure; limitations.

 §431:10H-214 Disclosure; limitations. If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as "Preexisting Condition Limitations". [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-215 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-215 Disclosure; other limitations and conditions on eligibility for benefits.

 §431:10H-215 Disclosure; other limitations and conditions on eligibility for benefits. A long-term care insurance policy or certificate containing any limitations or conditions for eligibility other than those prohibited in section 431:10H-109 shall set forth a description of the limitations or conditions, including any required number of days of confinement, in a separate paragraph of the policy or certificate and shall be labeled as "Limitations or Conditions on Eligibility of Benefits". [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-216 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-216 Disclosure of tax consequences.

 §431:10H-216 Disclosure of tax consequences.  With regard to life insurance policies that provide for an accelerated benefit for long-term care, a disclosure is required at the time of application for the policy and at the time the accelerated benefit payment request is submitted that receipt of these accelerated benefits may be taxable, and that assistance should be sought from a personal tax advisor. The disclosure statement shall be prominently displayed on the first page of the policy and any other related documents. This section shall not apply to qualified long-term care insurance contracts. [L 1999, c 93, pt of §2; am L 2007, c 233, §14]
HI Rev Stat § 431:10H-217 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-217 Disclosure; benefit triggers.

 §431:10H-217 Disclosure; benefit triggers. Activities of daily living and cognitive impairment shall be used to measure an insured's need for long-term care and shall be described in the policy or certificate in a separate paragraph and shall be labeled "Eligibility for the Payment of Benefits". Any additional benefit triggers shall also be explained in this section. If these benefit triggers differ for different benefits, explanation of the trigger shall accompany each benefit description. If an attending physician, advanced practice registered nurse, or other specified person is required to certify a certain level of functional dependency in order to be eligible for benefits, this requirement shall be specified. [L 1999, c 93, pt of §2; am L 2014, c 45, §10]
HI Rev Stat § 431:10H-219 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-219 Minimum standards for home health and community care benefits.

  §431:10H-219 Minimum standards for home health and community care benefits. (a) 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 by:  (1) Requiring that the insured or claimant would need care in a skilled nursing facility if home health care services were not provided;  (2) Requiring that the insured or claimant first or simultaneously receive nursing or therapeutic services, or both, in a home, community, or institutional setting before home health care services are covered;  (3) Limiting eligible services to services provided by registered nurses or licensed practical nurses;  (4) Requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide, or other licensed or certified home care worker acting within the scope of the person's licensure or certification;  (5) Excluding coverage for personal care services provided by a home health aide;  (6) Requiring that the provision of home health care services be at a level of certification or licensure greater than that required by the eligible service;  (7) Requiring that the insured or claimant have an acute condition before home health care services are covered;  (8) Limiting benefits to services provided by medicare-certified agencies or providers; or  (9) Excluding coverage for adult day care service.  (b) A long-term care insurance policy or certificate, if it provides for home health or community care services, shall provide total home health or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, at the time covered home health or community care services are being received. This requirement shall not apply to policies or certificates issued to residents of continuing care retirement communities.  (c) Home health care coverage may be applied to nonhome health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate. [L 1999, c 93, pt of §2]
HI Rev Stat § 431:10H-222 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-222 Reporting requirements.

 §431:10H-222 Reporting requirements. (a) Every insurer shall maintain records for each producer of the producer's amount of replacement sales as a per cent of the producer's total annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a per cent of the producer's total annual sales.  (b) Every insurer shall report annually by June 30 the ten per cent of its producers with the greatest percentages of lapses and replacements as measured in subsection (a). The form shall be in the format contained in Appendix G to the April, 2002, NAIC Long-Term Care Insurance Model Regulation.  (c) Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely producer activities regarding the sale of long-term care insurance.  (d) Every insurer shall report annually by June 30 the number of lapsed policies as a per cent of its total annual sales and as a per cent of its total number of policies in force as of the end of the preceding calendar year. The form shall be in the format contained in Appendix G to the April, 2002, NAIC Long-Term Care Insurance Model Regulation.  (e) Every insurer shall report annually by June 30 the number of replacement policies sold as a per cent of its total annual sales and as a per cent of its total number of policies in force as of the end of the preceding calendar year. The form shall be in the format contained in Appendix G to the April, 2002, NAIC Long-Term Care Insurance Model Regulation.  (f) For qualified long-term care insurance contracts, every insurer shall report annually by June 30, the number of claims denied for each class of business, expressed as a percentage of claims denied. The form shall be in the format contained in Appendix E to the April, 2002, NAIC Long-Term Care Insurance Model Regulation.  (g) Reports required under this section shall be filed with the commissioner.  (h) For purposes of this section:  "Claim" means a request for payment of benefits under an in force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met. Claims shall be subject to the definition of "denied".  "Denied" means the insurer refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.  "Policy" means only long-term care insurance.  "Report" means on a statewide basis. [L 1999, c 93, pt of §2; am L 2001, c 216, §22; am L 2007, c 233, §17]
HI Rev Stat § 431:10H-223 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10H-223 Discretionary powers of the commissioner.

 §431:10H-223 Discretionary powers of the commissioner. 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 part with respect to a specific long-term care insurance policy or certificate upon a written finding that:  (1) The modification or suspension would be in the best interest of the insureds;  (2) The purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and  (3) One of the following conditions have been met:  (A) The modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long-term care;  (B) 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 modification or suspension is reasonably related to the special needs or nature of the community; or  (C) The modification or suspension is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product. [L 1999, c 93, pt of §2]