reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-10 - Loss ratio standards and refund or credit of premium

Current through July 10, 2024
(a)
Loss Ratio Standards
(1) A Medicare Supplement policy form or
			 certificate form shall not be delivered or issued for delivery unless the
			 policy form or certificate form can be expected, as estimated for the entire
			 period for which rates are computed to provide coverage, to return to
			 policyholders and certificate holders in the form of aggregate benefits (not
			 including anticipated refunds or credits) provided under the policy form or
			 certificate form:
(A) At least seventy-five
			 percent (75%) of the aggregate amount of premiums earned in the case of group
			 policies; or
(B) At least
			 sixty-five percent (65%) of the aggregate amount of premiums earned in the case
			 of individual policies; and
(C) The
			 provisions of subparagraphs (A) and (B) of this subsection shall be calculated
			 on the basis of incurred claims experience or incurred health care expenses
			 where coverage is provided by a health care center on a service rather than
			 reimbursement basis and earned premiums for such period and in accordance with
			 accepted actuarial principles and practices. Incurred health care expenses
			 where coverage is provided by a health care center shall not include:
(i) Home office and overhead costs;
(ii) Advertising costs;
(iii)Commissions and other acquisition
			 costs;
(iv) Taxes;
(v) Capital costs;
(vi) Administrative costs; and
(vii) Claims processing costs.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-11 - Filing and approval of policies and certificates and premium rates

Current through July 10, 2024
(a) An issuer shall not deliver or issue for
			 delivery a policy or certificate to a resident of this state unless the policy
			 form or certificate form has been filed with and approved by the commissioner
			 in accordance with filing requirements and procedures prescribed by the
			 commissioner.
(b) An issuer shall
			 file any riders or amendments to policy or certificate forms to delete
			 outpatient prescription drugs as revised by the Medicare Prescription Drug,
			 Improvement and Modernization Act of 2003 only with the commissioner in the
			 state in which the policy or certificate was issued.
(c) An issuer shall not use or change premium
			 rates for a Medicare supplement policy or certificate unless the rates, rating
			 schedule and supporting documentation have been filed with and approved by the
			 commissioner in accordance with the filing requirements and procedures
			 prescribed by the commissioner.
(d)
(1) Except as provided in subdivision (2) of
			 this subsection, an issuer shall not file for approval more than one form of a
			 policy or certificate of each type for each standard Medicare supplement
			 benefit plan.
(2) An issuer may
			 offer, with the approval of the commissioner, up to four (4) additional policy
			 forms or certificate forms of the same type for the same standard Medicare
			 supplement benefit plan, one for each of the following cases:
(A) The inclusion of new or innovative
			 benefits;
(B) The addition of
			 either direct response or agent marketing methods;
(C) The addition of either guaranteed issue
			 or underwritten coverage;
(D) The
			 offering of coverage to individuals eligible for Medicare by reason of
			 disability.
(3) For the
			 purposes of this section, a "type" means an individual policy, a group policy,
			 an individual Medicare Select policy, or a group Medicare Select
			 policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-12 - Permitted compensation arrangements

Current through July 10, 2024
(a) An issuer or
			 other entity may provide 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
			 two hundred percent (200%) 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 shall be the same as that
			 provided in the second year or period and shall be provided for no fewer than
			 five (5) renewal years.
(c) No
			 issuer or other entity shall provide compensation to its agents or other
			 producers and no agent or producer shall 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 but not
			 limited to bonuses, gifts, prizes, awards and finders' fees.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-15 - Filing requirements for advertising

Current through July 10, 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 to the commissioner for review or approval by the
				commissioner to the extent it may be required in accordance with regulations
				adopted pursuant to section
				38a-819
				of the General Statutes.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-16 - Standards for marketing

Current through July 10, 2024
(a) An issuer,
			 directly or through its producers, shall:
(1)
			 Establish marketing procedures to assure that any comparison of policies by its
			 agents or other producers will be fair and accurate.
(2) Establish marketing procedures to assure
			 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 may 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 any such
			 insurance.
(5) Establish auditable
			 procedures for verifying compliance with this subsection (a).
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-17 - Appropriateness of recommended purchase and excessive insurance

Current through July 10, 2024
(a) In recommending the purchase or
			 replacement of any Medicare supplement policy or certificate an agent shall
			 make reasonable efforts to determine the appropriateness of a recommended
			 purchase or replacement.
(b) Any
			 sale of Medicare supplement coverage that will provide an individual more than
			 one Medicare supplement policy or certificate is prohibited.
(c) An issuer shall not issue a Medicare
			 supplement policy or certificate to an individual enrolled in Medicare Part C
			 unless the effective date of coverage is after the termination date of the
			 individual's Part C coverage.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-18 - Reporting of multiple policies

Current through July 10, 2024
(a) On or before
			 March 1 of each year, an issuer shall report to the commissioner the following
			 information for every individual resident of this state for which the issuer
			 has in force more than one Medicare supplement policy or certificate:
(1) Policy and certificate number,
			 and
(2) Date of issuance.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-19 - Prohibition against preexisting conditions, waiting periods, elimination periods and probationary periods in replacement policies or certificates

Current through July 10, 2024
(a) If a Medicare supplement policy or
			 certificate replaces another Medicare supplement policy or certificate, an
			 employee group health insurance policy or certificate, or a policy or
			 certificate issued by a health care center pursuant to a contract with the
			 federal government, 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 such time was spent under the original policy or
			 certificate.
(b) If a Medicare
			 supplement policy or certificate replaces another Medicare supplement policy or
			 certificate, an employee group health insurance policy or certificate, or a
			 policy or certificate issued by a health care center pursuant to a contract
			 with the federal government, which has been in effect for at least six (6)
			 months, the replacing policy shall 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.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-19a - Prohibition against use of genetic information. Requests for genetic testing

Current through July 10, 2024
This section applies to all policies with policy years
				beginning on or after May 21, 2009.
(a) For the purposes of this section only:
(1) "Issuer of a Medicare supplement policy
			 or certificate" includes third-party administrator, or other person acting for
			 or on behalf of such issuer.
(2)
			 "Family member" means, with respect to an individual, a first-degree,
			 second-degree, third-degree, or fourth-degree relative of such
			 individual.
(3) "Genetic
			 information" means, with respect to any individual, information about such
			 individual's genetic tests, the genetic tests of family members of such
			 individual, and the manifestation of a disease or disorder in family members of
			 such individual. "Genetic information" includes any request for or receipt of
			 genetic services, or participation in clinical research which includes genetic
			 services, by such individual or any family member of such individual. Any
			 reference to genetic information concerning an individual or family member of
			 an individual who is a pregnant woman includes genetic information of any fetus
			 carried by such pregnant woman, or with respect to an individual or family
			 member utilizing reproductive technology, includes genetic information of any
			 embryo legally held by an individual or family member. The term "genetic
			 information" does not include information about the sex or age of any
			 individual.
(4) "Genetic services"
			 means
(A) a genetic test,
(B) genetic counseling (including obtaining,
			 interpreting, or assessing genetic information),or
(C) genetic education.
(5) "Genetic test" means an analysis of human
			 DNA, RNA, chromosomes, proteins, or metabolites, that detect genotypes,
			 mutations, or chromosomal changes. The term "genetic test" does not mean an
			 analysis of proteins or metabolites that does not detect genotypes, mutations,
			 or chromosomal changes; or an analysis of proteins or metabolites that is
			 directly related to a manifested disease, disorder, or pathological condition
			 that could reasonably be detected by a health care professional with
			 appropriate training and expertise in the field of medicine involved.
(6) "Underwriting purposes" means:
(A) rules for, or determination of,
			 eligibility or continued eligibility for benefits under the policy;
(B) the computation of premium or
			 contribution amounts under the policy;
(C) the application of any pre-existing
			 condition exclusion under the policy; and
(D) other activities related to the creation,
			 renewal, or replacement of a contract of health insurance or health
			 benefits.
Connecticut Administrative Code › Title 38a - Insurance Department › 495a - Medicare Supplement Insurance › Section 38a-495a-21 - Effective date

Current through July 10, 2024
Sections
				38a-495a-1
				to 38a-495a-21, inclusive, of the Regulations of Connecticut State Agencies
				shall be effective when posted to the eRegulations System website by the
				Secretary of the State.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-8 - Applicability and scope

Current through July 10, 2024
Except as otherwise specifically provided, Sections 38a-501-8
				  to
				  38a-501-24,
				  inclusive, apply to all individual long-term care insurance policies delivered
				  or issued for delivery in this state on or after the effective date of this
				  regulation by any insurance company, fraternal benefit society, hospital
				  service corporation, medical service corporation or health care
				  center.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-9 - Definitions

Current through July 10, 2024
As used in Sections
				  38a-501-8
				  to
				  38a-501-24,
				  inclusive:
(a) "Long-term care policy"
				means any individual health insurance policy, or any individual subscriber
				contract, or any amendment, endorsement or rider to any such policy or
				subscriber contract delivered or issued for delivery to any resident of this
				state which is designed to provide benefits on an expense-incurred, indemnity
				or prepaid basis for necessary care or treatment of an injury, illness or loss
				of functional capacity provided by a certified or licensed health care provider
				in a setting other than an acute care hospital, for at least one year after a
				reasonable elimination period. A long-term care policy shall provide benefits
				for confinement in a nursing home or confinement in the insured's own home or
				both. Any additional benefits provided shall be related to long-term treatment
				of an injury, illness or loss of functional capacity. "Long-term care policy"
				shall not include any such policy, contract or certificate which is offered
				primarily to provide basic Medicare supplement coverage, basic medical-surgical
				expense coverage, hospital confinement indemnity coverage, major medical
				expense coverage, disability income protection coverage, accident only
				coverage, specified accident coverage or limited benefit health
				coverage.
(b) "Applicant" means the
				person who seeks to contract for insurance benefits.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-10 - Policy definitions and terms

Current through July 10, 2024
No insurance policy or subscriber contract may be advertised,
				  solicited or issued for delivery to any resident of this state as a long-term
				  care policy unless the terms used in such policy or subscriber contract conform
				  to the meanings given in this section.
(a) "Accident," "Accidental Injury," or
				"Accidental Means" shall be defined to employ "result" language and shall not
				include words which establish an "accidental" means test or use words such as
				"external, violent, visible wounds" or similar words of description or
				characterization.
(1) The definition shall not
				be more restrictive than the following: "Injury or injuries for which benefits
				are provided means accidental bodily injury sustained by the insured person
				which is the direct result of an accident, independent of disease or bodily
				infirmity or any other cause, and occurs while insurance coverage is in
				force."
(2) Such definition may be
				further modified to exclude injuries for which benefits are provided under any
				workers' compensation, employers' liability or similar law, or the basic
				reparations benefits of a no-fault motor vehicle insurance plan.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-11 - Minimum standards

Current through July 10, 2024
No individual insurance policy or subscriber contract shall
				  be advertised, solicited or issued for delivery in this state as a long-term
				  care policy which does not meet the following minimum standards. These are
				  minimum standards and do not preclude the inclusion of other provisions or
				  benefits which are not inconsistent with these standards. These standards are
				  in addition to all other requirements of Sections
				  38a-501-8
				  to
				  38a-501-24,
				  inclusive, of the Regulations of Connecticut State Agencies.
(a)
Renewability
. The terms
				"guaranteed renewable" and "noncancellable" shall not be used in any individual
				long-term care insurance policy without further explanatory language in
				accordance with the disclosure requirements of Section
				38a-501-13
				of the Regulations of Connecticut State Agencies.
(1) No individual long-term care policy shall
				contain renewal provisions other than "guaranteed renewable" or
				"noncancellable."
(2) The term
				"guaranteed renewable" shall be used only 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 any change in any
				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" shall be used only 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 any change in any
				provision of the insurance or in the premium rate.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-12 - Prohibition against pre-existing conditions and probationary periods in replacement policies

Current through July 10, 2024
If a long-term care policy replaces another long-term care
				  policy or certificate, the replacing insurer shall waive any time periods
				  applicable to pre-existing 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 or
				  certificate.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-13 - Required disclosure provisions

Current through July 10, 2024
(a)
Renewability.
Individual long-term care insurance policies shall
				contain a renewability provision. Such provision shall be appropriately
				captioned, shall appear on the first page of the policy, and shall clearly
				state the duration of the term of coverage for which the policy is issued and
				for which it may be renewed.
(b)
Riders and Endorsements.
Except for riders or endorsements by
				which the insurer effectuates a request made in writing by the insured or
				exercises a specifically reserved right under a long-term care policy, all
				riders or endorsements added to a long-term care policy after date of issue or
				at reinstatement or renewal shall require a signed acceptance by the insured.
				After date of policy issue, any rider or endorsement which increases benefits
				or coverage with a concomitant increase in premium during the policy term shall
				be agreed to in writing signed by the insured, except if the increased benefits
				or coverage is required by law. Where a separate additional premium is charged
				for benefits provided in connection with riders or endorsements, such premium
				charge shall be set forth in the policy, rider or endorsement.
(c)
Limitations.
If a long-term
				care insurance policy contains any limitation with respect to pre-existing
				conditions, such limitation shall appear as a separate paragraph of the policy
				and shall be labeled "PRE-EXISTING CONDITIONS LIMITATION."
(d)
Other Limitations or Conditions on
				Eligibility for Benefits.
A long-term care insurance policy shall set
				forth a description of any limitations or conditions for eligibility, including
				any required number of days of confinement, in a separate paragraph of the
				policy and shall label such paragraph "Limitations or Conditions on Eligibility
				for Benefits."
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-14 - Prohibition against post claims underwriting

Current through July 10, 2024
(a) All
				applications for long-term care insurance policies except those which are
				guaranteed issue shall 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 which 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 such
				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 shall not be rescinded for that
				condition.
(c) Except for policies
				which are guaranteed issue:
(1) The following
				language shall be set out conspicuously and in close conjunction with the
				applicant's signature block on an application for a long-term care insurance
				policy:
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, shall be
				set out conspicuously on the long-term care insurance policy at the time of
				delivery:
Caution: The issuance of this long-term care insurance
				  policy is based upon your responses to the questions on your application. A
				  copy of your application (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)
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-15 - Filing requirements

Current through July 10, 2024
(a) All filings of
				rates and rating schedules shall be accompanied by an actuarial certification
				demonstrating that expected claims in relation to premiums comply with the loss
				ratio required by subsection (b) of Section
				38a-501
				of the General Statutes when combined with actual experience to date. Filings
				of rate revisions shall also demonstrate that the anticipated loss ratio over
				the entire future period for which the revised rates are computed to provide
				coverage can be expected to meet the required loss ratio standard.
(b) Insurers shall submit a description of
				the method used to determine the standard for the payment of policy benefits
				with each policy form subject to subsection (o) of Section
				38a-501-11
				which they file for approval.
(c)
				Every insurer, fraternal benefit society, hospital service corporation, medical
				service corporation or health care center providing individual long-term care
				insurance in this State shall provide a copy of any long-term care insurance
				advertisement intended for use in this state whether through written, radio or
				television medium to the Commissioner of Insurance for review or approval to
				the extent this may be required in accordance with regulations adopted pursuant
				to Section
				38a-819
				of the General Statutes. All such advertisements shall be retained as provided
				in Section
				38a-819-18
				of these regulations.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-16 - Standards for marketing

Current through July 10, 2024
(a) Every insurer,
				fraternal benefit society, hospital service corporation, medical service
				corporation or health care center marketing long-term care insurance coverage
				in this state, directly or through its producers shall:
(1) Establish marketing procedures to assure
				that any comparison of policies by its agents or other producers will be fair
				and accurate.
(2) Establish
				marketing procedures to assure excessive insurance is not sold or
				issued.
(3) Display prominently by
				type, stamp or other appropriate means on the first page of the outline of
				coverage and policy the following:
"Notice to buyer: This policy may not cover all of the costs
				  associated with long-term care incurred by the buyer during the period of
				  coverage. The buyer is advised to review carefully all policy
				  limitations."
(4) Inquire
				and otherwise make every reasonable effort to identify whether a prospective
				applicant or enrollee for long-term care insurance already has accident and
				sickness or long-term care insurance and the types and amounts of any such
				insurance.
(5) Every insurer or
				other entity marketing long-term care insurance shall establish auditable
				procedures for verifying compliance with this subsection.
(6) Provide, at solicitation, written notice
				to the prospective policyholder of the availability of any insurance
				counselling program that may be provided or approved by any state agency for
				this purpose, together with the name, address and telephone number of such
				program.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-17 - Suitability of recommended purchase

Current through July 10, 2024
(a) An agent who
				recommends the purchase or replacement of a long-term care policy or
				certificate shall have reasonable grounds for believing that the recommendation
				is suitable for the applicant upon the basis of the facts, if any, disclosed by
				the applicant concerning his or her health and financial
				circumstances.
(b) Before selling
				any individual long-term care policy, an agent shall make reasonable efforts to
				obtain information concerning the applicant's health and financial
				circumstances.
(c) Before issuing
				any individual long-term care policy, a direct response insurer shall have
				reasonable grounds for believing that the purchase of such policy, whether or
				not it involves the replacement of existing coverage, is suitable for the
				applicant upon the basis of the facts, if any, disclosed by the applicant
				concerning his or her health and financial circumstances.
(d) Every direct response insurer shall
				include questions on its applications for long-term care insurance that are
				reasonably designed to obtain information concerning the applicant's health and
				financial circumstances.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-18 - Requirement to deliver shopper's guide

Current through July 10, 2024
A long-term care insurance shopper's guide approved by the
				  Commissioner shall be provided to all prospective applicants for a long-term
				  care insurance policy.
(a) In the case
				of agent solicitations, an agent shall deliver the shopper's guide prior to the
				presentation of an application.
(b)
				In the case of direct response solicitations, the shopper's guide shall be
				presented in conjunction with any application.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-20 - Requirement to offer inflation protection

Current through July 10, 2024
(a) No insurer
				shall offer for sale a long-term care insurance policy unless the insurer also
				offers the applicant the option to purchase a policy that provides for
				meaningful periodic benefit level increases to account for reasonably
				anticipated increases in the costs of long-term care services. Insurers shall
				offer each applicant, 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 (5%);
(2) Guarantees the insured individual the
				right to periodically increase benefit levels without providing evidence of
				insurability or health status so long as the option for the previous period has
				not been declined. The amount of the additional benefit shall be no less than
				the difference between the existing policy benefit and that benefit compounded
				annually at a rate of at least five percent (5%) 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.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-22 - Replacement

Current through July 10, 2024
(a) Application forms shall include the
				following questions 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 is intended
				to replace any other 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 such questions may be used.
(1) Do you have another long-term care
				insurance policy or certificate in force (including a health care service
				contract or health maintenance organization contract)?
(2) Did you have another long-term care
				insurance policy or certificate in force during the last twelve (12) months? If
				so, with which company? If that policy lapsed, when did it lapse?
(3) Are you covered by Medicaid?
(4) Do you intend to replace any of your
				medical or health insurance coverage with this policy?
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-23 - Reporting requirements

Current through July 10, 2024
(a) Every insurer
				shall report annually by June 30 the number of policies lapsed in the previous
				calendar year, the average total number of policies in force during the
				preceding calendar year, and the resulting ratio.
(b) Every insurer shall report annually by
				June 30 the number of replacement policies sold in the previous calendar year,
				the total number of policies sold during the preceding calendar year, and the
				resulting ratio.
(c) Every insurer
				shall report annually by June 30 the number of replacement policies sold in the
				previous calendar year, the average total number of policies in force during
				the preceding calendar year, and the resulting ratio.
(d) Every insurer shall report annually by
				June 30 the number of rescissions of policies, except those voluntarily
				effectuated by an insured, in the previous calendar year.
(e) For purposes of this section, "policies"
				shall mean only individual long-term care insurance policies and "report" shall
				mean on a statewide and national basis.
Connecticut Administrative Code › Title 38a - Insurance Department › 501 - Long-Term Care Insurance › Individual Long-Term Care Insurance › Section 38a-501-24 - Effective date; separability

Current through July 10, 2024
(a) The effective
				date of Sections
				38a-501-8
				to 38a-501-24, inclusive, shall be September 30, 1994.
(b) If any provision of Sections
				38a-501-8
				to 38a-501-24, inclusive, or the application thereof to any person or
				circumstance is for any reason held to be invalid, the remainder of these
				regulations and the application of such provision to other persons or
				circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-1 - Applicability and scope

Current through July 10, 2024
Except as otherwise specifically provided, Sections 38a-501a-1
				to
				38a-501a-16,
				inclusive, of the Regulations of Connecticut State Agencies apply to all
				individual short term care insurance policies delivered or issued for delivery
				in this state on or after the effective date of said sections by any
				insurer.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-2 - Definitions

Current through July 10, 2024
As used in Sections
				38a-501a-1
				to
				38a-501a-15,
				inclusive, of the Regulations of Connecticut State Agencies:
(a) "Short term care policy" means any
			 individual health insurance policy, or any individual subscriber contract, or
			 any amendment, endorsement or rider to any such policy or subscriber contract
			 delivered or issued for delivery to any resident of this state that is designed
			 to provide benefits on an expense-incurred, indemnity or prepaid basis for
			 necessary care or treatment of an injury, illness or loss of functional
			 capacity provided by a certified or licensed health care provider in a setting
			 other than an acute care hospital, for a period not to exceed three hundred
			 (300) days. A short term care policy shall provide benefits for confinement in
			 a nursing home or confinement in the insured's own home or both. "Short term
			 care policy" does not include any such policy or contract that is offered
			 primarily to provide basic Medicare supplement coverage, basic medical-surgical
			 expense coverage, hospital confinement indemnity coverage, major medical
			 expense coverage, disability income protection coverage, accident only
			 coverage, specified accident coverage or limited benefit health
			 coverage.
(b) "Applicant" means the
			 person who seeks to contract for insurance benefits.
(c) "Insurer" means an insurance company,
			 fraternal benefit society, hospital service corporation, medical service
			 corporation or health care center.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-3 - Policy definitions and terms

Current through July 10, 2024
No insurance policy or subscriber contract may be advertised,
				solicited or issued for delivery to any resident of this state as a short term
				care policy unless the terms used in such policy or subscriber contract conform
				to the meanings given in this section.
(a) "Accident," "Accidental Injury," or
			 "Accidental Means" shall be defined to employ "result" language and shall not
			 include words that establish an "accidental" means test or use words such as
			 "external, violent, visible wounds" or similar words of description or
			 characterization.
(1) The definition shall not
			 be more restrictive than the following: "Injury or injuries for which benefits
			 are provided means accidental bodily injury sustained by the insured person
			 that is the direct result of an accident, independent of disease or bodily
			 infirmity or any other cause, and occurs while insurance coverage is in
			 force."
(2) Such definition may be
			 further modified to exclude injuries for which benefits are provided under any
			 workers' compensation, employers' liability or similar law, or the basic
			 reparations benefits of a no-fault motor vehicle insurance plan.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-4 - Minimum standards

Current through July 10, 2024
No individual insurance policy or subscriber contract shall be
				advertised, solicited or issued for delivery in this state as a short term care
				policy that does not meet the following minimum standards. These are minimum
				standards and do not preclude the inclusion of other provisions or benefits
				that are not inconsistent with these standards.
(a) Renewability. The terms "guaranteed
			 renewable" and "noncancellable" shall not be used in any individual short term
			 care policy without further explanatory language in accordance with the
			 disclosure requirements of this section.
(1)
			 No individual short term care policy shall contain renewal provisions other
			 than "guaranteed renewable" or "noncancellable."
(2) The term "guaranteed renewable" shall be
			 used only when the insured has the right to continue the short term care
			 insurance in force by the timely payment of premiums and when the insurer has
			 no unilateral right to make any change in any 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" shall be used
			 only when the insured has the right to continue the short term care insurance
			 in force by the timely payment of premiums during which period the insurer has
			 no right to unilaterally make any change in any provision of the insurance or
			 in the premium rate.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-5 - Prohibition against pre-existing conditions and probationary periods in replacement policies

Current through July 10, 2024
If a short term care policy replaces another short term care or
				long term care policy or certificate, the replacing insurer shall waive any
				time periods applicable to pre-existing conditions and probationary periods in
				the new short term care policy for similar benefits to the extent that similar
				exclusions have been satisfied under the original policy or
				certificate.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-6 - Required disclosure provisions

Current through July 10, 2024
(a)
Renewability
. Individual short term care policies shall contain a
			 renewability provision. Such provision shall be appropriately captioned, shall
			 appear on the first page of the policy, and shall clearly state the duration of
			 the term of coverage for which the policy is issued and for which it may be
			 renewed.
(b)
Riders and
			 Endorsements.
Except for riders or endorsements by which the insurer
			 effectuates a request made in writing by the insured or exercises a
			 specifically reserved right under a short term care policy, all riders or
			 endorsements added to a short term care policy after date of issue or at
			 reinstatement or renewal shall require a signed acceptance by the insured.
			 After date of policy issue, 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 signed by the insured, except if the increased benefits or
			 coverage is required by law. Where a separate additional premium is charged for
			 benefits provided in connection with riders or endorsements, such premium
			 charge shall be set forth in the policy, rider or endorsement.
(c)
Limitations.
If a short term
			 care policy contains any limitation with respect to pre-existing conditions,
			 such limitation shall appear as a separate paragraph of the policy and shall be
			 labeled "PRE-EXISTING CONDITIONS LIMITATION."
(d)
Other Limitations or Conditions on
			 Eligibility for Benefits.
A short term care policy shall set forth a
			 description of any limitations or conditions for eligibility, including any
			 required number of days of confinement, in a separate paragraph of the policy
			 and shall label such paragraph "Limitations or Conditions on Eligibility for
			 Benefits."
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-7 - Prohibition against post claims underwriting

Current through July 10, 2024
(a) All
			 applications for short term care policies except those that are guaranteed
			 issue shall contain clear and unambiguous questions designed to ascertain the
			 health condition of the applicant.
(b) If an application for short term care
			 insurance contains a question that asks whether the applicant has had
			 medication prescribed, it shall also ask the applicant to list the medication
			 that has been prescribed. If the medications listed in such 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 shall not be rescinded for that condition.
(c) Except for policies that are guaranteed
			 issue:
(1) The following language shall be set
			 out conspicuously and in close conjunction with the applicant's signature block
			 on an application for a short term care policy:
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, shall be
			 set out conspicuously on the short term care policy at the time of delivery:
Caution: The issuance of this short term care insurance
				policy is based upon your responses to the questions on your application. A
				copy of your application (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).
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-8 - Filing requirements

Current through July 10, 2024
(a) All filings of
			 rates and rating schedules shall be accompanied by an actuarial certification
			 demonstrating that expected claims in relation to premiums comply with a loss
			 ratio of not less than fifty-five percent (55%) when combined with actual
			 experience to date. Filings of rate revisions shall also demonstrate that the
			 anticipated loss ratio over the entire future period for which the revised
			 rates are computed to provide coverage can be expected to meet the required
			 loss ratio standard.
(b) Insurers
			 shall submit with each policy form that they file for approval a description of
			 the method used to determine the standard for the payment of policy benefits,
			 including "usual and customary," "reasonable and customary" or other
			 standards.
(c) Every insurer
			 providing individual short term care insurance in this state shall provide a
			 copy of any short term care insurance advertisement intended for use in this
			 state whether through written, radio or television medium to the Insurance
			 Commissioner for review or approval to the extent this may be required in
			 accordance with regulations adopted pursuant to Section
			 38a-819
			 of the Connecticut General Statutes. All such advertisements shall be retained
			 as provided in Section
			 38a-819-18
			 of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-9 - Standards for marketing

Current through July 10, 2024
(a) Every insurer
			 marketing short term care insurance coverage in this state, directly or through
			 producers shall:
(1) Establish marketing
			 procedures to assure that any comparison of policies by its agents or other
			 producers will be fair and accurate.
(2) Establish marketing procedures to assure
			 excessive insurance is not sold or issued.
(3) Display prominently by type, stamp or
			 other appropriate means on the first page of the outline of coverage and policy
			 the following:
"Notice to buyer: This policy may not cover all of the costs
				associated with short term care incurred by the buyer during the period of
				coverage. The buyer is advised to review carefully all policy
				limitations."
(4) Inquire
			 and otherwise make every reasonable effort to identify whether a prospective
			 applicant or enrollee for short term care insurance already has accident and
			 sickness or short term care insurance and the types and amounts of any such
			 insurance.
(5) Establish auditable
			 procedures for verifying compliance with this subsection.
(6) Provide, at solicitation, written notice
			 to the prospective policyholder of the availability of any insurance counseling
			 program that may be provided or approved by any state agency for this purpose,
			 together with the name, address and telephone number of such program.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-10 - Suitability of recommended purchase

Current through July 10, 2024
(a) A producer who
			 recommends the purchase or replacement of a short term care policy or
			 certificate shall have reasonable grounds for believing that the recommendation
			 is suitable for the applicant upon the basis of the facts, if any, disclosed by
			 the applicant concerning his or her health and financial
			 circumstances.
(b) Before selling
			 any individual short term care policy, a producer shall make reasonable efforts
			 to obtain information concerning the applicant's health and financial
			 circumstances.
(c) Before issuing
			 any individual short term care policy, a direct response insurer shall have
			 reasonable grounds for believing that the purchase of such policy, whether or
			 not it involves the replacement of existing coverage, is suitable for the
			 applicant upon the basis of the facts, if any, disclosed by the applicant
			 concerning his or her health and financial circumstances.
(d) Every direct response insurer shall
			 include questions on its applications for short term care insurance that are
			 reasonably designed to obtain information concerning the applicant's health and
			 financial circumstances.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-11 - Non-forfeiture of benefits

Current through July 10, 2024
An insurer may offer the option to purchase a policy that
				provides a non-forfeiture benefit in the form of a return of premium, full
				benefits for a reduced benefit period, reduced benefits for the full benefit
				period, or another benefit that is acceptable to the Commissioner. A policy
				that provides a non-forfeiture benefit shall include a schedule of this
				benefit.