reglab/housing_qa huggingface dataset:
NC Gen Stat § 58-54-50 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 54 - Medicare Supplement Insurance Minimum Standards.|§ 58-54-50 - Rules for compliance with federal law and regulations.

 58-54-50. Rules for compliance with federal law and regulations.The Commissioner may adopt temporary rules necessary to conform Medicare supplement policies and certificates to the requirements of federal law and regulations, including:(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements.(2) Establishing a uniform methodology for calculating and reporting loss ratios.(3) Assuring public access to policies, premiums, and loss ratio information of issuers of Medicare supplement insurance.(4) Establishing standards for Medicare Select policies and certificates.(5) Any other changes required by Congress or the U.S. Department of Health and Human Services, or any successor agency. (1998-211, s. 13; 2001-334, s. 11.1.)
NC Gen Stat § 58-55-1 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-1 - Short title.

 58-55-1. Short title.This Article may be cited as the "Long-Term Care Insurance Act". (1987, c. 331.)
NC Gen Stat § 58-55-5 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-5 - Dual options.

 58-55-5. Dual options.(a) No policy that conditions the eligibility of benefits on prior hospitalization may be delivered or issued for delivery in this State unless the insurer or other entity offering that policy also offers a policy that does not condition eligibility of benefits on such a requirement.(b) Policies that were delivered, issued for delivery, or renewed on and after October 1, 1989, that did not condition the eligibility of benefits on prior hospitalizations shall be amended, upon the insured's written request, to condition eligibility of benefits on prior hospitalization, provided that the insured receives the appropriate reduction in premium. (1991, c. 644, s. 24.)
NC Gen Stat § 58-55-10 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-10 - Purposes.

 58-55-10. Purposes.The purposes of this Article are to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage. (1987, c. 331.)
NC Gen Stat § 58-55-15 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-15 - Scope.

 58-55-15. Scope.This Article applies to long-term care insurance policies in this State. This Article does not supersede the obligations of any person subject to its provisions to comply with other applicable laws and rules if those laws and rules do not conflict with this Article. The laws and rules established to govern Medicare supplement insurance policies shall not apply to long-term care insurance. A policy that is not advertised, marketed, or offered as long-term care insurance or nursing home insurance is not subject to this Article. (1987, c. 331; 1991, c. 720, s. 84.)
NC Gen Stat § 58-55-25 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-25 - Limits of group long-term care insurance.

 58-55-25. Limits of group long-term care insurance.No group long-term care insurance coverage may be offered to a resident of this State under a group policy issued in another state to a group described in G.S. 58-55-20(3)d, unless the Commissioner or the insurance regulator of the other state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this State has made a determination that such requirements have been met. (1987, c. 331; 1991, c. 720, s. 44.)
NC Gen Stat § 58-55-31 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-31 - Additional requirements.

 58-55-31. Additional requirements.(a) No policy shall be used in this State unless it provides for an offer of nonforfeiture, which shall not be less than an offer of reduced paid-up insurance benefits, extended term insurance benefits, or a shortened benefit period. No policy shall pay a cash surrender value unless the dividends or refunds are applied as a reduction of future premiums or an increase in future benefits.(b) The Commissioner shall adopt rules to provide for annual reports by insurers of the number of claims denied, number of rescissions, and the percentage of sales involving the replacement of policies.(c) No policy shall be used in this State unless the insurer has developed a financial or personal asset suitability test to determine whether or not issuing long-term care insurance to an applicant is appropriate. For purposes of this section:(1) All insurers except those issuing life insurance that accelerates the death benefit for long-term care shall use the financial or suitability form and format standards as developed and adopted by the NAIC. A personal long-term care worksheet and disclosure notice of issues an applicant should know before buying long-term care insurance shall be completed and provided before an application is taken.(2) Each applicant that does not meet the recommended financial or personal asset suitability test criteria shall receive a letter of notification and shall be given an option to waive the results of the financial suitability test and proceed with the purchase of the policy.(d) The Commissioner shall adopt standards to handle consumer complaints about noncompliance with State requirements. (1997-259, s. 15.)
NC Gen Stat § 58-55-50 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-50 - Rules for compliance with federal law and regulations.

 58-55-50. Rules for compliance with federal law and regulations.The Commissioner may adopt temporary rules necessary to conform long-term care policies and certificates to the requirements of federal law and regulations, including any changes required by Congress or the U.S. Department of Health and Human Services, or any successor agencies. (2001-334, s. 11.2.)
NC Gen Stat § 58-55-55 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-55 - Definitions.

 58-55-55. Definitions.The following definitions apply in this section:(1) Asset. - Resources and income.(2) Department. - The Department of Health and Human Services.(3) Division. - The Division of Health Benefits.(4) Estate recovery. - The placing of a statutory claim on the estate of a deceased Medicaid recipient, as provided by G.S. 108A-70.5.(5) Medicaid. - The federal medical assistance program established under Title XIX of the Social Security Act.(6) Qualified long-term care partnership policy or qualified policy. - A long-term care insurance policy approved for use in North Carolina and that meets all the requirements of the federal Deficit Reduction Act of 2005, P.L. 109-171.(7) Resource. - Cash or its equivalent and real or personal property that is available to an applicant or recipient.(8) Resource disregard. - The amount of resources of an applicant for long-term care Medicaid that is equal to the amount of benefits paid to the applicant under a qualified long-term care partnership policy.(9) Resource protection. - An amount equal to the resource disregard given to a Medicaid recipient during the long-term care Medicaid eligibility determination process.  (2010-68, s. 4; 2019-81, s. 15(a).)
NC Gen Stat § 58-55-65 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-65 - Compliance with federal regulations.

 58-55-65. Compliance with federal regulations.(a) The Commissioner may adopt rules to conform long-term care policies and certificates to the requirements of federal law and regulations, including any changes required by Congress or the U.S. Department of Health and Human Services, or any successor agencies.(b) The tax-qualified long-term care provisions required of the Health Insurance Portability and Accountability Act of 1996, including subsequent amendments and editions, are hereby incorporated into Article 55 of Chapter 58 of the General Statutes.(c) The long-term care partnership provisions required of the Deficit Reduction Act of 2005, including subsequent amendments and editions, are hereby incorporated into Article 55 of Chapter 58 of the General Statutes.  (2010-68, s. 4.)
NC Gen Stat § 58-55-70 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-70 - Disclosure notices.

 58-55-70. Disclosure notices.(a) Prior to making a change requested by the policyholder to a qualified long-term care partnership policy that would result in the loss to the policy of qualified policy status, the insurer shall provide to the policyholder a written explanation within 30 calendar days of how this action would affect the insured and shall obtain the insured's signature indicating consent to the change.(b) If a qualified long-term care partnership policy subsequently loses qualified policy status, the insurer shall explain in writing within 30 calendar days to the policyholders the reason for the loss of status.(c) The disclosures required in this section shall be provided to any insured who exchanges a policy for a qualified long-term care partnership policy.  (2010-68, s. 4.)
NC Gen Stat § 58-55-75 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-75 - Exchange of long-term care policies for long-term care partnership policies.

 58-55-75. Exchange of long-term care policies for long-term care partnership policies.An insurer shall offer, on a onetime basis, in writing, to all existing policyholders that were issued a long-term care policy on or after February 8, 2006, the option to exchange their existing long-term care coverage for coverage that is intended to qualify under North Carolina's Long-Term Care Partnership Program. The insurer shall provide notification of this onetime offer within 180 days from the date on which the company begins to offer partnership coverage in the State. The mandatory offer of an exchange shall only apply to products issued by the insurer that are comparable to the type of policy form, such as group policies and individual policies, and on the policy series that the company has certified as partnership qualified. This exchange may be subject to underwriting and premium adjustment. A policy received in an exchange after the effective date of North Carolina's Long-Term Care Partnership Program is treated as newly issued and is eligible for qualified policy status. For purposes of applying the Medicaid rules relating to qualified long-term care partnership policies, the addition of a rider, endorsement, or change in schedule page for a policy may be treated as giving rise to an exchange. The effective date of the long-term care partnership policy shall be the date the policy was exchanged.  (2010-68, s. 4.)
NC Gen Stat § 58-55-80 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 55 - Long-Term Care Insurance.|§ 58-55-80 - Information sharing.

 58-55-80. Information sharing.(a) In order to assist in the performance of the Commissioner's duties under the long-term care partnership program specified in the federal Deficit Reduction Act of 2005, the Commissioner may:(1) Share information, including identifying information, related to the long-term care partnership program with other state and federal agencies, the National Association of Insurance Commissioners, and any entity contracting with the federal government under the program.(2) Receive information, including identifying information, related to the long-term care partnership program from other state and federal agencies, the National Association of Insurance Commissioners, and any entity contracting with the federal government under the program, and shall maintain as confidential or privileged any identifying information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information. Information received under this subdivision of this subsection is not a "public record" as defined in G.S. 132-1.(3) Enter into agreements governing sharing and use of information consistent with this section.(b) No waiver of an existing privilege or claim of confidentiality in the identifying information shall occur as a result of disclosure to the Commissioner under this section or as a result of sharing as authorized in subsection (a) of this section.(c) A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this section shall be available and enforced in any proceeding in, and in any court of, this State.(d) As used in this section, "identifying information" has the same meaning as in G.S. 14-113.20(b).  (2010-68, s. 4.)
NC Gen Stat § 58-56-6 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-6 - Written agreement necessary.

 58-56-6. Written agreement necessary.(a) No TPA may act as a TPA without a written agreement between the TPA and the insurer. The written agreement shall be retained as part of the official records of both the insurer and the TPA for the duration of the agreement and for five years thereafter. The agreement shall contain all provisions required by this Article, to the extent those requirements apply to the functions performed by the TPA.(b) The agreement shall include a statement of duties that the TPA is expected to perform on behalf of the insurer and the kinds of insurance the TPA is to be authorized to administer. The agreement shall provide for underwriting or other standards pertaining to the business underwritten by the insurer.(c) The insurer or TPA may, with written notice, terminate the agreement for cause as provided in the agreement. The insurer may suspend the underwriting authority of the TPA during the pendency of any dispute regarding the cause for termination of the agreement. The insurer must fulfill any lawful obligations with respect to policies affected by the agreement, regardless of any dispute between the insurer and the TPA. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-11 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-11 - Payment to TPA.

 58-56-11. Payment to TPA.If an insurer uses the services of a TPA, the payment to the TPA of any premiums or charges for insurance by or on behalf of the insured party is considered payment to the insurer. The payment of return premiums or claim payments forwarded by the insurer to the TPA is not considered payment to the insured party or claimant until the payments are received by the insured party or claimant. This section does not limit any right of the insurer against the TPA resulting from the failure of the TPA to make payments to the insurer, insured parties, or claimants. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-16 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-16 - Records to be kept.

 58-56-16. Records to be kept.(a) Every TPA shall maintain and make available to the insurer complete books and records of all transactions performed on behalf of the insurer. The books and records shall be maintained in accordance with prudent standards of insurance record keeping and must be maintained for a period of at least five years after the date of their creation.(b) The Commissioner shall have access to books and records maintained by a TPA for the purposes of examination, audit, and inspection. The Commissioner shall keep confidential any trade secrets contained in those books and records, including the identity and addresses of policyholders and certificate holders, except that the Commissioner may use the information in any judicial or administrative proceeding instituted against the TPA.(c) The insurer shall own the records generated by the TPA pertaining to the insurer, but the TPA shall retain the right to continuing access to books and records to permit the TPA to fulfill all of its contractual obligations to insured parties, claimants, and the insurer.(d) In the event the insurer and the TPA cancel their agreement, notwithstanding the provisions of subsection (a) of this section, the TPA may, by written agreement with the insurer, transfer all records to a new TPA rather than retain them for five years. In this case, the new TPA shall acknowledge, in writing, that it is responsible for retaining the records of the prior TPA as required in subsection (a) of this section. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-21 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-21 - Approval of advertising.

 58-56-21. Approval of advertising.A TPA may use only the advertising pertaining to the business underwritten by an insurer that has been approved in writing by the insurer in advance of its use. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-26 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-26 - Responsibilities of the insurer.

 58-56-26. Responsibilities of the insurer.(a) If an insurer uses the services of a TPA, the insurer is responsible for determining the benefits, premium rates, underwriting criteria, and claims payment procedures applicable to the coverage and for securing reinsurance, if any. The rules pertaining to these matters must be provided, in writing, by the insurer to the TPA. The responsibilities of the TPA as to any of these matters shall be set forth in the agreement between the TPA and the insurer.(b) It is the sole responsibility of the insurer to provide for competent administration of its programs.(c) In cases where a TPA administers benefits for more than 100 certificate holders on behalf of an insurer, the insurer shall, at least semiannually, conduct a review of the operations of the TPA. At least one semiannual review shall be an on-site audit of the operations of the TPA. On July 1, 2010, and annually thereafter, every insurer shall file with the Commissioner a certification of completion of the audits as required by this subsection and performed during the previous calendar year, in the format, content, and manner as specified by the Commissioner. The insurer shall maintain in its corporate records documentation of the audits conducted to support its certification of audits for a period of five years or, if a domestic insurer, until the completion of the next quinquennial examination.(d) The Commissioner may adopt rules necessary to implement, administer, and enforce the provisions of this section.  (1991, c. 627, s. 1; 2009-382, ss. 12, 13.)
NC Gen Stat § 58-56-31 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-31 - Premium collection and payment of claims.

 58-56-31. Premium collection and payment of claims.(a) All insurance charges or premiums collected by a TPA on behalf of or for an insurer, and the return of premiums received from that insurer, shall be held by the TPA in a fiduciary capacity. These funds shall be immediately remitted to the person entitled to them or shall be deposited promptly in a fiduciary account established and maintained by the TPA in a federally or State insured financial institution. The agreement between the TPA and the insurer shall require the TPA to periodically render an accounting to the insurer detailing all transactions performed by the TPA pertaining to the business underwritten by the insurer.(b) If charges or premiums deposited in a fiduciary account have been collected on behalf of or for one or more insurers, the TPA shall keep records clearly recording the deposits in and withdrawals from the account on behalf of each insurer. The TPA shall keep copies of all the records and, upon request of an insurer, shall furnish the insurer with copies of the records pertaining to the deposits and withdrawals.(c) The TPA shall not pay any claim by withdrawals from a fiduciary account in which premiums or charges are deposited. Withdrawals from this account shall be made only as provided in the agreement between the TPA and the insurer. The agreement shall address, but not be limited to, the following:(1) Remittance to an insurer entitled to remittance.(2) Deposit in an account maintained in the name of the insurer.(3) Transfer to and deposit in a claims-paying account, with claims to be paid as provided in subsection (d) of this section.(4) Payment to a group policyholder for remittance to the insurer entitled to the remittance.(5) Payment to the TPA of its commissions, fees, or charges.(6) Remittance of a return premium to the person entitled to the return premium.(d) All claims paid by the TPA from funds collected on behalf of or for an insurer shall be paid only on drafts or checks of and as authorized by the insurer. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-36 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-36 - Compensation to the TPA.

 58-56-36. Compensation to the TPA.A TPA shall not enter into any agreement or understanding with an insurer that makes the amount of the TPA's commissions, fees, or charges contingent upon savings effected in the adjustment, settlement, and payment of losses covered by the insurer's obligations. This section does not prohibit a TPA from receiving performance-based compensation for providing hospital or other auditing services and does not prevent the compensation of a TPA from being based on premiums or charges collected or the number of claims paid or processed. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-41 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-41 - Notice to covered individuals; disclosure of charges and fees.

 58-56-41. Notice to covered individuals; disclosure of charges and fees.(a) When the services of a TPA are used, the TPA shall provide a written notice approved by the insurer to covered individuals advising them of the identity of, and relationship among, the TPA, the policyholder, and the insurer.(b) When a TPA collects funds, the reason for collection of each item must be identified to the insured party and each item must be shown separately from any premium. Additional charges may not be made for services to the extent the services have been paid for by the insurer.(c) The TPA shall disclose to the insurer all charges, fees and commissions received from all services in connection with the provision of administrative services for the insurer, including any fees or commissions paid by insurers providing reinsurance. (1991, c. 627, s. 1.)
NC Gen Stat § 58-56-46 (2021)
2021 North Carolina General Statutes|Chapter 58 - Insurance|Article 56 - Third Party Administrators.|§ 58-56-46 - Delivery of materials to covered individuals.

 58-56-46. Delivery of materials to covered individuals.Any policies, certificates, booklets, termination notices, and other written communications delivered by the insurer to the TPA for delivery to insured parties or covered individuals shall be delivered by the TPA promptly after receipt of instructions from the insurer to deliver them. (1991, c. 627, s. 1.)