reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.480 - Loss ratio determinations

Current through May 31, 2024
(a) A rate credit
				  or dividend paid may be used only in the loss ratio determinations if it
				  directly inures to the benefit of the person who actually pays the premium for
				  the coverage provided.
(b) A rate
				  credit reserve on dividend liability may be used only in the loss ratio
				  determinations if the accrued rate credit or dividend will directly inure to
				  the benefit of the person who actually pays the premium for the coverage
				  provided.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, renumbered former AS 21.89.060 as
						AS
						21.96.060. As of Register 196 (January 2011),
						the regulations attorney made a conforming technical revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 28.480, so that the citation to former AS
						21.89.060 now refers to the renumbered statute,
						AS
						21.96.060.
Authority:
AS
						21.06.090
AS 21.42.130
AS
						21.96.060
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.501 - Permitted compensation arrangements

Current through May 31, 2024
(a) An issuer or
				  other entity may provide a commission or other compensation to an agent or
				  other representative for the sale of a medicare supplement policy or
				  certificate only if the first-year commission or other first-year compensation
				  is no more than 200 percent of the commission or other compensation paid for
				  selling or servicing the policy or certificate in the second year or
				  period.
(b) The commission or other
				  compensation provided in subsequent (renewal) years must be the same as that
				  provided in the second year or period and must be provided for no fewer than
				  five renewal years.
(c) No issuer
				  or other entity may provide compensation to its agents or other producers, and
				  no agent or producer may receive compensation greater than the renewal
				  compensation payable by the replacing issuer on renewal policies or
				  certificates if an existing policy or certificate is replaced.
(d) For purposes of this section,
				  "compensation" includes pecuniary or non-pecuniary remuneration of any kind
				  relating to the sale or renewal of the policy or certificate, including
				  bonuses, gifts, prizes, awards, and finders fees.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, renumbered former AS 21.89.060 as
						AS
						21.96.060. As of Register 196 (January 2011),
						the regulations attorney made a conforming technical revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 28.501, so that the citation to former AS
						21.89.060 now refers to the renumbered statute,
						AS
						21.96.060.
Authority:
AS
						21.06.090
AS 21.42.130
AS
						21.96.060
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.503 - Filing requirements for advertising

Current through May 31, 2024
An issuer shall provide a copy of any medicare supplement
					 advertisement intended for use in this state, whether through written, radio,
					 or television medium, for review and approval by the
					 director.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, renumbered former AS 21.89.060 as
						AS
						21.96.060. As of Register 196 (January 2011),
						the regulations attorney made a conforming technical revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 28.503, so that the citation to former AS
						21.89.060 now refers to the renumbered statute,
						AS
						21.96.060.
Authority:
AS
						21.06.090
AS 21.42.130
AS
						21.96.060
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.504 - Standards for marketing

Current through May 31, 2024
(a) An issuer
				  directly or through its producers, shall
(1)
				  establish marketing procedures to ensure that any comparison of policies by its
				  agents or other producers will be fair and accurate;
(2) establish marketing procedures to ensure
				  excessive insurance is not sold or issued;
(3) display prominently by type, stamp, or
				  other appropriate means, on the first page of the policy, the following:
Notice to buyer: This policy might not cover all of your
					 medical expenses;
(4)
				  inquire and otherwise make every reasonable effort to identify whether a
				  prospective applicant or enrollee for medicare supplement insurance already has
				  accident and sickness insurance, and the types and amounts of the
				  insurance;
(5) establish auditable
				  procedures for verifying compliance with this subsection.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.505 - Appropriateness of recommended purchase and excessive insurance

Current through May 31, 2024
(a) In
				  recommending the purchase or replacement of a medicare supplement policy or
				  certificate, a licensee shall make reasonable efforts to determine the
				  appropriateness of a recommended purchase or replacement.
(b) A sale of a medicare supplement policy or
				  certificate that will provide an individual with more than one medicare
				  supplement policy or certificate is prohibited.
(c) An issuer may not issue a medicare
				  supplement policy or certificate to an individual enrolled in medicare Part C
				  unless the effective date of the coverage is after the termination date of the
				  individual's Part C coverage.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, renumbered former AS 21.89.060 as
						AS
						21.96.060. As of Register 196 (January 2011),
						the regulations attorney made a conforming technical revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 28.505, so that the citation to former AS
						21.89.060 now refers to the renumbered statute,
						AS
						21.96.060.
Authority:
AS
						21.06.090
AS 21.42.130
AS
						21.96.060
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.506 - Reporting of multiple policies

Current through May 31, 2024
(a) Annually, on or
				  before March 1, every issuer or other entity providing medicare supplement
				  insurance coverage in this state shall report the following information, on the
				  reporting form contained in Appendix A of this section, for every individual
				  resident of this state for which the issuer or other entity has in force more
				  than one medicare supplement insurance policy or certificate:
(1) policy and subscriber control number;
				  and
(2) date of issuance.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.507 - Prohibition against preexisting conditions, waiting periods, elimination periods, and probationary periods in replacement policies or certificates

Current through May 31, 2024
(a) If a
				  medicare supplement policy or certificate replaces another medicare supplement
				  policy or certificate, the replacing issuer shall waive any time periods
				  applicable to preexisting conditions, waiting periods, elimination periods, and
				  probationary periods in the new medicare supplement policy or certificate for
				  similar benefits to the extent that that time was spent under the original
				  policy.
(b) If a medicare
				  supplement policy or certificate replaces another medicare supplement policy or
				  certificate that has been in effect for at least six months, the replacing
				  policy or certificate must not provide any time period applicable to
				  preexisting conditions, waiting periods, elimination periods, and probationary
				  periods for benefits similar to those contained in the original policy or
				  certificate.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, renumbered former AS 21.89.060 as
						AS
						21.96.060. As of Register 196 (January 2011),
						the regulations attorney made a conforming technical revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 28.507, so that the citation to former AS
						21.89.060 now refers to the renumbered statute,
						AS
						21.96.060.
Authority:
AS
						21.06.090
AS 21.42.130
AS
						21.96.060
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.508 - Prohibition against use of genetic information and requests for genetic testing

Current through May 31, 2024
(a) An issuer may not, based on an
				  individual's genetic information,
(1) deny or
				  condition the issuance or effectiveness of a medicare supplement policy or
				  certificate; or
(2) exclude
				  benefits under a medicare supplement policy or certificate for a preexisting
				  condition.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 5 - Health Insurance Marketed as Medicare Supplements › 3 AAC 28.510 - Definitions

Current through May 31, 2024
For purposes of
					 3 AAC 28.410 - 3 AAC 28.510,
(1) "applicant" means,
(A) for an individual medicare supplement
				  policy, the person who seeks to contract for insurance benefits; and
(B) for a group medicare supplement policy,
				  the person who seeks to be the certificate holder;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 6 - Group Health Insurance › 3 AAC 28.520 - Political subdivision groups

Current through May 31, 2024
(a) A political
				  subdivision constitutes a duly formed group for issuance of a group health
				  insurance policy that provides health insurance coverage to the persons that
				  comprise it, if
(1) the eligibility for
				  coverage for a person is based on criteria that reflect the common purpose for
				  which the political subdivision exists and would preclude from coverage a
				  person who may be associated or attempt to be associated with the political
				  subdivision on a nonpermanent basis for the sole purpose of obtaining group
				  health insurance coverage; and
(2)
				  the benefit payments are made directly to the individuals in the
				  group.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 6 - Group Health Insurance › 3 AAC 28.525 - Definition

Current through May 31, 2024
For purposes of
					 AS
					 21.54.151(d), "cost" means
					 the total health insurance premiums paid for the health care insurance plan by
					 a large employer including any portion of the premiums paid by individuals
					 covered under the large employer's health care insurance
					 plan.
Authority:
AS
						21.06.090
AS
						21.54.151
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.550 - Applicability

Current through May 31, 2024
(a) Except as otherwise specifically
				  provided, and except for provisions of 3 AAC 28.550 - 3 AAC 28.599 that apply
				  only to qualified long-term are insurance contract the provisions of 3 AAC 28.550 - 3 AAC 28.599 apply to all long-term care insurance policies, including
				  qualified long-term care contracts and life insurance policies that accelerate
				  benefits for long-term care delivered or issued for delivery in this state on
				  or after the effective date by
(1)
				  Insurers;
(2) fraternal benefit
				  societies;
(3) hospital and medical
				  service corporations;
(4) health
				  maintenance organizations; and
(5)
				  all similar organizations
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.551 - Policy definitions

Current through May 31, 2024
Long-term care insurance policies delivered or issued for
					 delivery in this state may not use the terms set out in this section, unless
					 the terms are defined in the policy and the definitions satisfy the following
					 requirements:
(1) "activities of daily
				  living" means at least bathing, continence, dressing, eating, toileting and
				  transferring;
(2) "acute condition"
				  means that the individual is medically unstable, the individual requires
				  frequent monitoring by medical professionals, including physicians and
				  registered nurses, to maintain the individual's health status;
(3) "adult day care" means a program for six
				  or more individuals, of social and health-related services provided during the
				  day in a community group setting for the purpose of supporting frail, impaired
				  elderly or other disabled adults who can benefit from care in a group setting
				  outside the home;
(4) "bathing"
				  means washing oneself
(A) by sponge bath;
				  or
(B) in either a tub or shower
				  including the task of getting into or out of the tub or shower;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.552 - Policy practices and provisions

Current through May 31, 2024
(a) The terms
				  "guaranteed renewable" and noncancellable may not be used in an individual
				  long-term care insurance policy without further explanatory language in
				  accordance with the disclosure requirements of 3 AAC 28.555 and subject to the
				  following restrictions:
(1) a policy issued to
				  an individual may not contain renewal provisions other than "guaranteed
				  renewable" or "noncancellable;"
(2)
				  the term guaranteed renewable may only be used when the insured has the right
				  to continue the long-term care insurance in force by the timely payment of
				  premiums and when the insurer has no unilateral right to make a change in a
				  provision of the policy or rider while the insurance is in force, and cannot
				  decline to renew, except that rates may be revised by the insurer on a class
				  basis;
(3) the term noncancellable"
				  may only be used when the insured has the right to continue the long-term care
				  insurance in force by the timely payment of premiums during which period the
				  insurer has no right to unilaterally make a change in a provision of the
				  insurance or in the premium rate;
(4) the term "level premium" may only be used
				  when the insurer does not have the right to change the premium; and
(5) in addition to the other requirements of
				  this subsection, a qualified long-term care insurance contract must be
				  guaranteed renewable, within the meaning of
				  26 U.S.C.
				  7702B(b)(l)(C) (Internal
				  Revenue Code).
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.554 - Unintentional lapse

Current through May 31, 2024
(a) Each insurer offering long-term care
				  insurance shall comply with the following:
(1) an individual long-term care policy or
				  certificate may not be issued until the insurer has received from the applicant
				  either 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 may not
				  constitute acceptance of liability on the third party for services provided to
				  the insured; the form used for the written designation must provide space
				  clearly designated for listing at least one person; the designation snail
				  delude each person's full name and home address; in the case of an applicant
				  who elects not to designate an additional person, the waiver must 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 30 days after a premium is due
				  and unpaid. I elect NOT to designate a person to receive this notice. "the
				  insurer shall notify the insured of the right to change this written
				  designation, no less often than once every two years;
(2) 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 requirements contained in (1)
				  of this subsection need not be met until 60 days after the policyholder or
				  certificate holder is no longer on a payment plan; the application or
				  enrollment form for the policies or certificates must clearly indicate the
				  payment plan fleeted by the applicant;
(3) an individual long-term care policy or
				  certificate may not lapse or be terminated for nonpayment of premium unless the
				  insurer, at least 45 days before the effective date of the lapse or
				  termination, has given notice to the insured and to those persons designated
				  under (1) of this subsection, 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 45 days after a premium is due and unpaid; notice shall be considered to
				  have been given as of five days after the date of mailing.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.555 - Required disclosure provisions

Current through May 31, 2024
(a) Individual
				  long-term care insurance policies must contain a renewability provision that
(1) is appropriately captioned, appears on
				  the first page of the policy, and clearly states that the coverage is
				  guaranteed renewable or noncancellable; this provision may not apply to
				  policies that do not contain a renewability provision, and under which the
				  right to nonrenew is reserved solely to the policyholder; and
(2) includes a statement that premium rates
				  may change for a long-term care insurance policy or certificate, other than one
				  where the insurer does not have the right to change the premium.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.556 - Required disclosure of rating practices to consumers

Current through May 31, 2024
(a) This section
				  applies as follows:
(1) except as provided in
				  (2) of this subsection, this section applies to a long-term care policy or
				  certificate issued in this state on or after January 1, 2023;
(2) for certificates issued on or after March
				  27, 2022 effective date of regulation under a group long-term care insurance
				  policy as defined in
				  AS
				  21.53.200(3)(A), which
				  policy was in force on or after March 23, 2022, the provisions of this section
				  apply on the policy anniversary following January 1, 2023.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.558 - Prohibition against post-claims underwriting

Current through May 31, 2024
(a) All
				  applications for long-term care insurance policies or certificates, except
				  those that are guaranteed issue, must contain clear and unambiguous questions
				  designed to ascertain the health condition of the applicant.
(b) If an application for long-term care
				  insurance contains a question that asks whether the applicant has had
				  medication prescribed by a physician, it must also ask the applicant to list
				  the medication that has been prescribed. If the medications listed in the
				  application were known by the insurer, or should have been known at the time of
				  application, to be directly related to a medical condition for which coverage
				  would otherwise be denied, then the policy or certificate may not be rescinded
				  for that condition.
(c) Except for
				  policies or certificates that are guaranteed issue;
(1) the following language must be set out
				  conspicuously and in close conjunction with the applicant's signature block on
				  an application for a long-term care insurance policy or certificate;
Caution: If your answers on this application are
					 incorrect or untrue, [company] has the right to deny benefits or rescind your
					 policy.;
(2) the
				  following language, or language substantially similar to the following, must be
				  set out conspicuously on the long-term care insurance policy or certificate at
				  the time of delivery:
Caution: The issuance of this long-term care
					 insurance [policy] [certificate] is based upon your responses to the questions
					 on your application. A copy of your [application] [enrollment form] [is
					 enclosed] [was retained by you when you applied]. If your answers are incorrect
					 or untrue, the company has the right to deny benefits or rescind your policy.
					 The best time to clear up any questions is now, before a claim arises! If, for
					 any reason, any of your answers are incorrect, contact the company at this
					 address: ]insert address]
; and
(3) before issuance of a long-term care
				  policy or certificate to an applicant 80 years of age or older, the insurer
				  shall get one of the following.
(A) a report
				  of a physical examination;
(B) an
				  assessment of functional capacity;
(C) an attending physician's statement;
				  or
(D) copies of medical
				  records.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.559 - Minimum standards for home health and community care benefits in long-term care insurance policies

Current through May 31, 2024
(a) If it provides benefits for home health
				  care or community care services, a long-term care insurance policy or
				  certificate may not limit or exclude benefits:
(1) by requiring that the insured or claimant
				  would need care in a skilled nursing facility if home health care services were
				  not provided;
(2) by 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) by limiting eligible services to services
				  provided by registered nurses or licensed practical nurses;
(4) by requiring that a nurse or therapist
				  provide services covered by the policy that can be provided by a home health
				  aide or other home care worker;
(5)
				  by excluding coverage for personal care services provided by a home health
				  aide;
(6) by 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) by requiring that the insured or claimant
				  have an acute condition before home health care services are covered;
(8) by limiting benefits to services provided
				  by Medicare-certified agencies or providers; or
(9) by excluding coverage for adult day care
				  services.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.560 - Requirement to offer inflation protection

Current through May 31, 2024
(a) An Insurer may
				  not offer a long-term care insurance policy unless the insurer also offers the
				  policyholder, in addition to other inflation protection, the option to purchase
				  a policy that provides for benefit levels to increase with benefit maximums or
				  reasonable durations that are meaningful to account for reasonably anticipated
				  increases in the costs of long-term care services covered by the policy.
				  Insurers shall offer to each policyholder, at the time of purchase, the option
				  to purchase a policy with an inflation protection feature no less favorable
				  than one of the following;
(1) increases
				  benefit levels annually in a manner so that the increases are compounded
				  annually at a rate not less than five percent;
(2) guarantees the insured individual the
				  right to periodically increase benefit levels without providing evidence of
				  insurability or health status if the option for the previous period has not
				  been declined; the amount of the additional benefit must no less than the
				  difference between the existing policy benefit and that benefit compounded
				  annually at a rate of at least five percent for the period beginning with the
				  purchase of the existing benefit and extending until the year in which the
				  offer is made; or
(3) covers a
				  specified percentage of actual or reasonable charges and does not include a
				  maximum specified indemnity amount or limit
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.562 - Requirements for application forms and replacement coverage

Current through May 31, 2024
(a) An application
				  form must include the questions prescribed by the director designed to elicit
				  information as to whether, as of the date of the application, the applicant has
				  another long-term care insurance policy or certificate in force or whether a
				  long-term care policy or certificate is intended to replace another
				  accident-and- sickness or long-term care policy or certificate presently in
				  force. A supplementary application or other form to be signed by the applicant
				  and agent, except where the coverage is sold without an agent, containing the
				  questions may be used. With regard to a replacement policy issued to a group
				  defined by
				  AS
				  21.53.200(3)(A), the
				  questions may be modified only to the extent necessary to elicit information
				  about health or long-term care insurance policies other than the group policy
				  being replaced, if the certificate holder has been notified of the
				  replacement.
(b) An agent shall
				  list other health insurance policies that the agent has sold to the applicant,
				  including;
(1) policies sold that are still
				  in force; and
(2) policies sold in
				  the past five years that are no longer in force.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.563 - Reporting requirements

Current through May 31, 2024
(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.
				  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 agent activities regarding the sale of long-term care
				  insurance.
(b) Every insurer shall
				  report annually not later than June 30, the 10 percent of its agents with the
				  greatest percentages of lapses and replacements as measured by (a) of this
				  section.
(c) Every insurer shall
				  report annually not later than June 30, the number of lapsed policies as a
				  percent of its total annual sales and as a percent of its total number of
				  policies in force as of the end of the preceding calendar year
(d) Every insurer shall report annually not
				  later than June 30, the number of replacement policies sold as a percent of its
				  total annual sales and as a percent of its total number of policies in force as
				  of the preceding calendar year.
(e)
				  Every insurer shall report annually not later than June 30, for qualified
				  long-term care insurance contracts, the number of claims denied for each class
				  of business, expressed as a percentage of claims denied.
(f) Reports required under this section shall
				  be filed with the director.
(g) For
				  purposes of this section;
(1) "policy" means
				  only long-term care insurance;
(2)
				  subject to (3) of this subsection, "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 the terms or conditions of the policy have been
				  met;
(3) denied" means the insurer
				  refuses to pay a claim for a reason other than for claims not paid for failure
				  to meet the waiting period or because of an applicable preexisting condition;
				  and
(4) "report" means on a
				  statewide basis.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.564 - Annual rate certification requirements

Current through May 31, 2024
(a) This section
				  applies to a long-term care policy issued in this state on or after January 1,
				  2023. The following annual submission requirements apply after the initial rate
				  filings for individual long-term care insurance policies.
(b) An actuarial certification prepared,
				  dated, and signed by a member of the American Academy of Actuaries who provides
				  the information shall be included and shall provide at least the following
				  information;
(1) a statement of the
				  sufficiency of the current premium rate schedule including:
(A) for the rate schedules currently
				  marketed,
(i) a statement that the premium
				  rate schedule continues to be sufficient to cover anticipated costs under
				  moderately adverse experience and that the premium rate schedule is reasonably
				  expected to be sustainable over the life of the form with no future premium
				  increases anticipated; or
(ii) if
				  the statement in (i) of this subparagraph cannot be made, a statement that
				  margins tor moderately adverse experience may no longer be sufficient; in this
				  situation, the insurer shall provide to the director, not later than 60 days'
				  after the date the actuarial certification is submitted to the director, a plan
				  of action, including a time frame, for the re-establishment of adequate margins
				  for moderately adverse experience so that the ultimate premium rate schedule
				  would be reasonably expected to be sustainable over the future life of the form
				  with no future premium increases anticipated; failure to submit a plan of
				  action to the director not later than 60 days after the actuarial certification
				  is submitted to the director, or to comply with the time frame stated in the
				  plan of action constitutes grounds for the director to withdraw or modify the
				  director's approval of the form for future sales under
				  AS
				  21.42.120 and
				  21.42.130;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.565 - Licensing

Current through May 31, 2024
A producer is not authorized to sell, solicit, or negotiate
					 with respect to long-term care insurance except as authorized by AS 21.27.
Authority:
AS
						21.06.090
AS
						21.27.010
AS
						21.53.020
AS
						21.53.030
AS
						21.53.050
AS
						21.53.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.566 - Discretionary powers of the director

Current through May 31, 2024
The director may, upon written request and after an
					 administrative hearing, issue an order to modify or suspend one or more
					 specific provision of 3 AAC 28.550 - 3 AAC 28.599 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) the modification or
				  suspension
(A) is necessary to the development
				  of an innovative and reasonable approach for insuring long-term care;
(B) is reasonably related to the
				  special needs or nature of the community when 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; or
(C) is necessary to permit long-term care
				  insurance to be sold as part of, or in conjunction with, another insurance
				  product.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.568 - Reserve standards

Current through May 31, 2024
(a) When long-term care benefits are provided
				  through the acceleration of benefits under group or individual life policies or
				  riders to the policies, policy reserves for the benefits shall be determined in
				  accordance with
				  AS
				  21.45.300. Claim reserves shall also be
				  established in the case when the policy or rider is in claim status. Reserves
				  for policies and riders subject to this subsection shall be based on the
				  multiple decrement model utilizing all relevant decrements, except for
				  voluntary termination rates. However, Single decrement approximations are
				  acceptable if the calculation produces essentially similar reserves, if the
				  reserve is clearly more conservative, or if the reserve is immaterial. The
				  calculations may take into account the reduction in life insurance benefits due
				  to the payment of long-term care benefits. However, the reserves for the
				  long-term care benefit and the life insurance benefit may not less than the
				  reserves for the life insurance benefit assuming no long-term care
				  benefit.
(b) In the development and
				  calculation of reserves for policies and riders subject to (a) of this section,
				  consideration shall be given to the applicable policy provisions, marketing
				  methods, administrative procedures, and all other considerations that have an
				  effect on projected claim costs, including the following;
(1) the definition of insured
				  events;
(2) the covered long-term
				  care facilities;
(3) the existence
				  of home convalescence care coverage;
(4) definition of facilities;
(5) existence or absence of barriers to
				  eligibility;
(6) a premium waiver
				  provision;
(7)
				  renewability;
(8) the ability to
				  raise premiums;
(9) marketing
				  method;
(10) underwriting
				  procedures;
(11) claims adjustment
				  procedures;
(12) a waiting
				  period;
(13) the maximum
				  benefit;
(14) availability of
				  eligible facilities;
(15) margins
				  in claim costs;
(16) any optional
				  nature of benefit;
(17) any delay
				  in eligibility for benefit;
(18)
				  inflation protection provisions; and
(19) any guaranteed insurability
				  option.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.569 - Loss ratio

Current through May 31, 2024
(a) This section applies to all long-term
				  care insurance policies or certificates except those covered under 3 AAC 28.557
				  and 3 AAC 28.570.
(b) Benefits
				  under long-term care insurance policies shall be considered reasonable in
				  relation to premiums; the expected loss ratio is a, least 60 percent,
				  calculated in a manner that provides for adequate reserving of the long-term
				  care insurance risk. In evaluating the expected loss ratio, consideration shall
				  be given to all relevant factors, including;
(1) statistical credibility of incurred
				  claims experience and earned premiums;
(2) the period for which rates are computed
				  to provide coverage;
(3)
				  experienced and projected trends;
(4) concentration of experience within early
				  policy duration,
(5) expected
				  claim fluctuation;
(6) experience
				  refunds, adjustments, or dividends,
(7) renewability features;
(8) all appropriate expense
				  factors;
(9) interest;
(10) experimental nature of the
				  coverage;
(11) policy
				  reserves;
(12) mix of business by
				  risk classification; and
(13)
				  product features including long elimination periods, high deductibles, and high
				  maximum limits.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.570 - Premium rate schedule increases for policies subject to loss ratio limits related to original filings

Current through May 31, 2024
(a) This section
				  applies as follows:
(1) except as provided in
				  (2) of this subsection, this section applies to a long-term care policy or
				  certificate issued in this state on or after January 1, 2023; and
(2) for certificates issued on or after
				  effective date of 3 AAC 28.550 - 3 AAC 28.599 under a group long-term care
				  insurance policy as defined in
				  AS
				  21.53.200(3)(A), which
				  policy was in force March 27, 2022, provisions of this section shall apply on
				  the policy anniversary following January 1, 2023.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.573 - Filing requirement

Current through May 31, 2024
Before an insurer or similar organization offers group
					 long-term care insurance to a resident of this state under AS 22.53.070. it
					 shall file with the director evidence that the group policy or certificates
					 under that section has been approved by a state having statutory or regulatory
					 long-term care insurance requirements substantially similar to those adopted in
					 this state.
Authority:
AS
						21.06.090
AS
						21.53.070
AS
						21.53.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.574 - Filing requirements for advertising

Current through May 31, 2024
(a) Every insurer,
				  health care service plan, or other entity providing long-term care insurance or
				  benefits in this state shall provide a copy of a long-term care insurance
				  advertisement intended for use in this state whether through written, radio,
				  television, or other electronic advertising medium to the director for review
				  or approval to the extent it may be required under state law. In addition, all
				  advertisements shall be retained by the insurer, health care service plan, or
				  other entity for at least three years from the date the advertisement was first
				  used.
(b) The director may exempt
				  from the requirements of (a) of this section an advertising form or material
				  if, in the director's opinion, the requirement; may not be reasonably
				  applied.
Authority:
AS
						21.06.090
AS
						21.36.030
AS
						21.53.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.575 - Standards for marketing

Current through May 31, 2024
(a) Every insurer,
				  health care service plan, or other entity marketing long-term care insurance
				  coverage in this state, directly or through its producers, shall
(1) establish marketing procedures and agent
				  training requirements to assure that
(A)
				  marketing activities, including a comparison of policies, by its agents or
				  other producers will be fair and accurate; and
(B) excessive insurance is not sold or
				  issued;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.576 - Association standards for marketing

Current through May 31, 2024
(a) With respect to
				  the obligations set out in (a) of this section, the primary responsibility of
				  an association, as defined in
				  AS
				  21.53.200(3)(B), when
				  endorsing or selling long-term care insurance is to educate its members
				  concerning long-term care issues in general so that its members can make
				  informed decisions. An association shall provide objective information
				  regarding long-term care insurance policies or certificates endorsed or sold by
				  the association to ensure that members of the association receive a balanced
				  and complete explanation of the features in the policies or certificates that
				  are being endorsed or sold. The insurer shall file with the division the
				  following material:
(1) the policy and
				  certificate;
(2) a corresponding
				  outline of coverage; and
(3) all
				  advertisements requested by the division.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.577 - Suitability

Current through May 31, 2024
(a) This section does not apply to life
				  insurance policies that accelerate benefits for long-term care.
(b) Every insurer, health care service plan,
				  or other entity marketing long-term care insurance shall
(1) develop and use suitability standards to
				  determine whether the purchase or replacement of long-term care insurance is
				  appropriate for the needs of the applicant;
(2) tram its agents in the use of its
				  suitability standards; and
(3)
				  maintain a copy of its suitability standards and make them available for
				  Inspection upon request by the director.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.578 - Prohibition against preexisting conditions and probationary periods in replacement policies or certificates

Current through May 31, 2024
If a long-term care insurance policy or certificate
					 replaces another long-term care policy or certificate, the replacing insurer
					 shall waive the time periods applicable to preexisting conditions and
					 probationary periods in the new long-term care policy for similar benefits to
					 the extent that similar exclusions have been satisfied under the original
					 policy.
Authority:
AS
						21.06.090
AS
						21.53.030
AS
						21.53.090