reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-12 - Inflation protection

Current through July 10, 2024
(a) An insurer
			 shall offer the option to purchase a policy that provides for meaningful
			 periodic benefit level increases to account for reasonably anticipated
			 increases in the costs of short term care services. Inflation protection
			 includes:
(1) Increases in benefit levels
			 annually in a manner so that the increases are compounded annually at a stated
			 interest rate;
(2) 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 stated interest rate for the period beginning with the purchase
			 of the existing benefit and extending until the year in which the offer is
			 made; or
(3) A specified percentage
			 of actual or reasonable charges, not including a maximum specified indemnity
			 amount or limit.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-14 - 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 short term care or long term
			 care policy or certificate in force or whether a short term care policy is
			 intended to replace any other accident and sickness, short term care, or long
			 term care policy or certificate presently in force. A supplementary application
			 or other form to be signed by the applicant and producer, except where the
			 coverage is sold without a producer, containing such questions may be used.
(1) Do you have a long term care or another
			 short term care insurance policy or certificate in force (including a health
			 care service contract or health maintenance organization contract)?
(2) Did you have a long term care or another
			 short 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 › 501a - Short Term Care Insurance › Section 38a-501a-15 - 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"
			 means only individual short term care insurance policies and "report" shall be
			 on a statewide and national basis.
Connecticut Administrative Code › Title 38a - Insurance Department › 501a - Short Term Care Insurance › Section 38a-501a-16 - Severability

Current through July 10, 2024
If any provision of sections
				38a-501a-1
				to
				38a-501a-15
				of the Regulations of Connecticut State Agencies or the application thereof to
				any person or circumstance is for any reason held to be invalid, the remainder
				of said regulations and the application of such provision to other persons or
				circumstances shall not be affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-1 - Purpose

Current through July 10, 2024
The purpose of this regulation is to implement Section
				38a-505
				of the Connecticut General Statutes so as to provide reasonable standardization
				and simplification of terms and coverages of individual accident and sickness
				insurance policies and fraternal benefit society certificates in order to
				facilitate public understanding and comparison and to eliminate provisions
				contained in individual accident and sickness insurance policies which may be
				misleading or confusing in connection either with the purchase of such
				coverages or with the settlement of claims and to provide for full disclosure
				in the sale of such coverages.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-3 - Applicability and scope

Current through July 10, 2024
This regulation shall apply to all individual accident and
				sickness insurance policies and fraternal benefit society certificates
				delivered or issued for delivery in this State on and after the effective date
				hereof; except, it shall not apply to individual policies or contracts issued
				pursuant to a conversion privilege under a policy or contract of group or
				individual insurance when such group or individual policy or contract includes
				provisions which are inconsistent with the requirements of this regulation, nor
				to policies being issued to employees or members as additions to franchise
				plans in existence on the effective date of this regulation. The requirements
				contained in this regulation shall be in addition to any other applicable
				regulations or bulletins previously adopted and not inconsistent
				therewith.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-4 - Effective date

Current through July 10, 2024
This regulation shall be effective on January 1, 1979 or 180
				days after the date of adoption of the regulation, whichever is later, and
				shall be applicable to all individual accident and sickness insurance policies
				and fraternal benefit society certificates delivered or issued for delivery in
				this State on and after such date which are not specifically exempt from this
				regulation.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-5 - Policy definitions

Current through July 10, 2024
Except as provided hereafter, no individual accident or
				sickness insurance policy or fraternal benefit society certificate delivered or
				issued for delivery to any person in this State shall contain definitions
				respecting the matters set forth below unless such definitions comply with the
				requirements of this section.
(A) "One
			 Period of Confinement" means consecutive days of in-hospital service received
			 as an in-patient, or successive confinements when discharged from and
			 readmission to the hospital occurs within a period of time not more than 90
			 days or three times the maximum number of days of in-hospital coverage provided
			 by the policy to a maximum of 180 days.
(B) "Hospital" may be defined in relation to
			 its status, facilities and available services or to reflect its accreditation
			 by the Joint Commission on Accreditation of Hospitals.
(1) The definition of the term "hospital"
			 shall not be more restrictive than one requiring that the hospital:
(a) Be an institution operated pursuant to
			 law; and
(b) Be primarily and
			 continuously engaged in providing or operating either on its premises or in
			 facilities available to the hospital on a prearranged basis and under the
			 supervision of a staff of duly licensed physicians, medical, diagnostic and
			 major surgical facilities for the medical care and treatment of sick or injured
			 persons on an in-patient basis for which a charge is made; and
(c) Provide 24 hour nursing service by or
			 under the supervision of registered graduate professional nurses
			 (R.N.'s).
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-6 - Separability

Current through July 10, 2024
If any provision of this regulation (Secs.
				38a-505-1 -38a-505-5) or
				the application thereof to any person or circumstances is for any reason held
				to be invalid, the remainder of the regulation and the application of such
				provision to other persons or circumstances shall not be affected
				thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-7 - Prohibited policy provisions

Current through July 10, 2024
(A) Except as
			 provided in Section
			 38a-505-5(E),
			 no policy shall contain provisions establishing a probationary or waiting
			 period during which no coverage is provided under the policy subject to the
			 further exception that a policy may specify a probationary or waiting period
			 not to exceed six (6) months for specified diseases or conditions and losses
			 resulting therefrom for hernia, disorder of reproductive organs, varicose
			 veins, adenoids, appendix and tonsils. However, the permissible six (6) months
			 exception shall not be applicable where such specified diseases or conditions
			 are treated on an emergency basis. Accident policies shall not contain
			 probationary or waiting periods.
(B) No policy or rider for additional
			 coverage may be issued as a dividend unless an equivalent cash payment is
			 offered to the policyholder as an alternative to such dividend policy or rider.
			 No such dividend policy or rider shall be issued for an initial term of less
			 than six (6) months. The initial renewal subsequent to the issuance of any
			 policy or rider as a dividend shall clearly disclose that the policyholder is
			 renewing the coverage that was provided as a dividend for the previous term and
			 that such renewal is optional with the policyholder.
(C) No policy shall exclude coverage for a
			 loss due to a pre-existing condition for a period greater than twelve (12)
			 months following policy issue where the application for such insurance does not
			 seek disclosure of prior illness, disease or physical conditions or prior
			 medical care and treatment and such pre-existing condition is not specifically
			 excluded by the terms of the policy.
(D) A disability income policy may contain a
			 "return of premium" or "cash value benefit" so long as:
(1) The insurance policy is non-cancellable
			 or, if the benefit is added by rider, it is attached to a non-cancellable
			 policy.
(2) The forms provide for
			 the payment of surrender value upon (a) the written request of the insured, and
			 surrender of the policy, (b) lapse of the policy, (c) death of the insured, or
			 (d) on the termination date of the contract.
(3) the surrender value is based on policy
			 duration, premiums paid by the insured and benefits paid by the company. A
			 refund is available after a policy has been in force a minimum of three years
			 (two years on policies issued on ages 46-50).
(4) The form is not issued beyond age
			 50.
(5) The insurer includes a
			 detailed statement of the method of computing the premium rates, the tables of
			 cash value, and the estimated loss ratio.
(6) The insurer includes a demonstration of
			 the fiscal integrity of the product and the company.
(7) The form is not on the basis of the 10
			 year roll-over concept.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-8 - Separability

Current through July 10, 2024
If any provision of this regulation (Sec.
				38a-505-7
				) or the application thereof to any person or circumstances is for any reason
				held to be invalid, the remainder of the regulation and the application of such
				provision to other persons or circumstances shall not be affected
				thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 505 - Individual Accident and Sickness Insurance Minimum Standards › Section 38a-505-12 - Separability

Current through July 10, 2024
If any provision of this regulation (Secs.
				38a-505-9
				-38a-505-11) or the application thereof to any person or circumstances is for
				any reason held to be invalid, the remainder of the regulation and the
				application of such provision to other persons or circumstances shall not be
				affected thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-2 - Group health prohibited policy provisions

Current through July 10, 2024
(a) Except as
			 provided in section 38a-513-4(g)(4), no policy or certificate shall contain
			 provisions establishing a probationary or waiting period during which no
			 coverage is provided under the policy or certificate except the policy or
			 certificate may specify a probationary or waiting period not to exceed six (6)
			 months for specified diseases or conditions and losses resulting therefrom for
			 hernia, disorder of reproductive organs, varicose veins, adenoids, appendix and
			 tonsils. However, the permissible six (6) months exception shall not be
			 applicable where such specified diseases or conditions are treated on an
			 emergency basis. Accident policies shall not contain probationary or waiting
			 periods.
(b) No policy or
			 certificate shall exclude coverage for a loss due to a pre-existing condition
			 for a period greater than twelve (12) months following policy issue where the
			 application for such insurance does not seek disclosure of prior illness,
			 disease or physical conditions or prior medical care and treatment.
(c) A disability income policy or certificate
			 may contain a "return of premium" or "cash value benefit" so long as:
(1) The insurance policy is non-cancellable
			 or, if the benefit is added by rider, it is attached to a non-cancellable
			 policy.
(2) The forms provide for
			 the payment of surrender value upon:
(A) The
			 written request of the insured, and surrender of the policy or
			 certificate,
(B) Lapse of the
			 policy or certificate,
(C) Death of
			 the insured, or
(D) On the
			 termination date of the contract.
(3) The surrender value is based on policy
			 duration, premiums paid by the insured and benefits paid by the company and a
			 refund is available after a certificate has been in force for a minimum of
			 three (3) years (two (2) years on certificates issued on insureds forty-six
			 (46) to fifty (50) years old).
(4)
			 The form is not issued beyond age fifty (50).
(5) The insurer includes a detailed statement
			 of the method of computing the premium rates, the tables of cash value, and the
			 estimated loss ratio.
(6) The
			 insurer includes a demonstration of the fiscal integrity of the product and the
			 company.
(7) The form is not on the
			 basis of the ten (10) year roll-over concept.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-5 - Drug formulary annual filing requirements

Current through July 10, 2024
Insurers that deliver, issue for delivery, renew, amend or
				continue any group health insurance policy or certificate that includes
				prescription drug coverage and utilizes a formulary shall submit an annual
				report to the Commissioner regarding the development and use of formularies and
				P&T committees. Such report shall be in a form prescribed by the
				Commissioner and shall be submitted with the annual form
				filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-6 - Minimum standards for drug formularies

Current through July 10, 2024
No individual or group health insurance plan or certificate
				that offers prescription drug coverage that is subject to a formulary shall be
				delivered or issued for delivery in this state if the formulary does not meet
				the following required minimum standards:
(1) The formulary shall be easily searchable
			 and posted online, accessible to members and non-members.
(2) The medications within the formulary
			 shall be grouped in alphabetical order by therapeutic class.
(3) Definitions or explanations, or both, of
			 each prescription drug tier, including specialty drug tiers, shall be clearly
			 stated.
(4) Definitions for
			 utilization controls, including, but not limited to, quantity or dosage
			 controls, prior authorization, and step therapy shall be clearly
			 stated.
(5) Tier coverage and
			 utilization controls for each medication (by dosage, if applicable) shall be
			 clearly stated.
(6) The formulary
			 shall include information on how to obtain drugs that are off
			 formulary.
(7) The formulary shall
			 specify if and how drugs may be obtained through mail order pharmacy.
(8) The formulary shall clearly state when it
			 was created, when it was last updated, and when the next anticipated update
			 will be.
(9) The formulary shall
			 provide customer service contact information.
(10) The formulary shall meet all additional
			 requirements set forth by the Commissioner.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-7 - Minimum standards for pharmaceutical and therapeutics committees

Current through July 10, 2024
(a)
(1) No
			 insurer shall utilize a P&T committee that does not have appropriate
			 membership.
(A) The majority of P&T
			 committee members shall be practicing physicians, pharmacists, and other
			 professionals who are licensed to prescribe drugs.
(B) P&T committee members shall represent
			 a sufficient number of clinical specialties to adequately meet the needs of
			 enrollees.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-8 - Notice to insureds regarding formulary changes

Current through July 10, 2024
Insurers that deliver, issue for delivery, renew, amend or
				continue any group health insurance policy or certificate that includes
				prescription drug coverage and utilizes a formulary shall provide at least
				sixty (60) days' advance notice to each insured and to each participating
				provider under the policy utilizing a prescription drug within the formulary
				before the insurer may remove such prescription drug from the formulary or make
				any change to the structure of prescription drug benefits under such
				policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-9 - Timing for rate filings

Current through July 10, 2024
(a) Rate filings
			 for health insurance plans sold to small employers shall be made no later than
			 ninety (90) days prior to the date an insurer intends to market such
			 plans.
(b) For plans subject to the
			 requirements of the PPACA, rate filings shall be filed annually no later than a
			 date prescribed by the Commissioner. The Commissioner shall provide notice to
			 insurers no later than thirty (30) days prior to the prescribed date each
			 year.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-10 - Transparency of rate filings

Current through July 10, 2024
The information supplied to the Department to fulfill its
				statutory rate review requirement is not confidential. Complete rate filings
				including all correspondence and documentation are available through SERFF and
				may be posted on the Department website for review and comment by the public.
				All public comments shall be reviewed by the Department and considered as an
				additional element of the review determination.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-11 - Rate filing process

Current through July 10, 2024
(a) All rate
			 filings shall be submitted via SERFF.
(b) For filings subject to the requirements
			 of the PPACA, all fields in SERFF added for reporting requirements to the
			 federal Department of Health and Human Services in accordance with PPACA shall
			 be populated.
(c) All rate filings
			 shall be made in accordance with Department bulletins, notifications, and other
			 written guidance.
(d) Incomplete
			 submissions may be rejected.
(e) No
			 rate filing shall be approved if the Department determines that it is
			 excessive, inadequate or unfairly discriminatory.
(f) Rates shall not be approved unless the
			 policy forms to which they apply are approved.
(g) No rate may be marketed until the rates
			 are approved. The Commissioner may grant conditional approval to enhance the
			 fairness and efficiency of the marketplace.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-12 - Minimum rate filing requirements

Current through July 10, 2024
(a) All rate
			 filings shall include, at a minimum, the following:
(1) A cover letter describing all policy
			 forms affected by the requested rates or rate changes as well as the effective
			 date of the requested rates or rate changes.
(2) The detailed development for the initial
			 rate or rate increase.
(3)
			 Historical experience from inception-to-date including earned premium, paid
			 claims, incurred claims, membership, actual loss ratios and expected loss
			 ratios.
(A) Both state-specific and
			 nationwide experience shall be provided.
(B) Annual experience shall be provided for
			 all years.
(4) A
			 certification by a member of the American Academy of Actuaries that the rate
			 filing is in compliance with this section. Such certification shall include a
			 statement by a member of the American Academy of Actuaries that the rates are
			 reasonable in relation to the benefits provided, and that they are not
			 excessive, inadequate or unfairly discriminatory.
(5) Claim lag triangles.
(6) Cost for each newly mandated benefit that
			 applies to the type of insurance for which the rate filing has been
			 submitted.
(7) Any additional
			 information the Commissioner deems necessary to review the rate
			 filing.
Connecticut Administrative Code › Title 38a - Insurance Department › 513 - Group Specified Disease Health Insurance Minimum Standards › Section 38a-513-14 - Separability

Current through July 10, 2024
If any provision of sections
				38a-513-1
				to 38a-513-13, inclusive, of the Regulations of Connecticut State Agencies or
				the application thereof to any person or circumstances is for any reason held
				to be invalid, the remainder of said sections and the application of such
				provision to other persons or circumstances shall not be affected
				thereby.
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-1 - Applicability and scope

Current through July 10, 2024
Except as otherwise specifically provided, Sections 38a-528-1
				to
				38a-528-17,
				inclusive, apply to all group long-term care insurance policies, subscriber
				contracts or certificates 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-2 - Definitions

Current through July 10, 2024
As used in Sections
				38a-528-1
				to
				38a-528-17,
				inclusive:
(a) "Long-term care policy"
			 means any group health insurance policy or subscriber contract or certificate,
			 or any amendment, endorsement or rider to any such policy or subscriber
			 contract or certificate 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
			 or certificate 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" in the case of a group
			 long-term care policy or subscriber contract means the proposed
			 certificateholder.
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-3 - Policy definitions and terms

Current through July 10, 2024
No insurance policy or subscriber contract or certificate may
				be advertised, solicited or issued for delivery to any resident of this state
				as a long-term care policy or certificate unless the terms used in such policy,
				subscriber contract or certificate 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-4 - Minimum standards

Current through July 10, 2024
No group insurance policy or subscriber contract or certificate
				shall be advertised, solicited or issued for delivery in this state as a
				long-term care policy or certificate 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 this
				regulation.
(a)
Continuation
.
(1) All group
			 long-term care policies or subscriber contracts and certificates shall include
			 a provision which allows the certificateholder to continue coverage or convert
			 to an individual long-term care policy or subscriber contract in the event of
			 the cancellation, nonrenewal or termination of the group policy or contract.
			 Conversion is to be made without evidence of insurability and without
			 pre-existing conditions limitations or waiting periods, with an effective date
			 that coincides with the date coverage ceased under the group plan.
(2) Any insured individual whose eligibility
			 for group long-term care coverage is based upon his or her relationship to
			 another person, shall be entitled to continue coverage under the group policy
			 or convert to an individual long-term care policy or subscriber contract upon
			 termination of the qualifiying relationship by death or dissolution of
			 marriage. Conversion is to be made without evidence of insurability and without
			 pre-existing conditions limitations or waiting periods, with a effective date
			 that coincides with the date coverage ceased under the group plan.
(3) If a group long-term care policy or
			 subscriber contract is replaced by another policy or contract issued to the
			 same policyholder, the succeeding carrier shall offer coverage to all persons
			 covered under the previous policy or contract on the date of its termination.
			 Coverage shall be made available without evidence of insurability or
			 pre-existing conditions limitations or waiting periods and with an effective
			 date that coincides with the termination of coverage under the preceeding
			 policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-5 - Prohibition against pre-existing conditions and probationary periods in replacement coverage

Current through July 10, 2024
If a long-term care certificate replaces another long-term care
				certificate or individual policy, the replacing insurer shall waive any time
				periods applicable to preexisting conditions and probationary periods in the
				new long-term care certificate for similar benefits to the extent that similar
				exclusions have been satisfied under the original certificate or
				policy.
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-6 - Required disclosure provisions

Current through July 10, 2024
(a)
Continuation.
Group long-term care certificates shall contain a
			 provision, appropriately captioned, which describes how the coverage may be
			 continued or converted.
(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 certificate, all
			 riders or endorsements added to a long-term care certificate after date of
			 issue or at reinstatement or renewal which reduce or eliminate benefits or
			 coverage shall require a signed acceptance by the insured. Any rider or
			 endorsement added to a long-term care certificate after date of issue which
			 increases benefits or coverage with a concomitant increase in premium 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 certificate, rider or endorsement.
(c)
Limitations.
If a long-term
			 care insurance policy contains any limitation with respect to pre-existing
			 conditions, such limitations shall appear as a separate paragraph of the
			 certificate and shall be labeled "PRE-EXISTING CONDITIONS
			 LIMITATION."
(d)
Other
			 Limitations or Conditions on Eligibility for Benefits.
A long-term care
			 insurance certificate shall set forth a description of any limitations or
			 conditions for eligibility, including any required number of days of
			 confinement, in a separate paragraph labeled "Limitations or Conditions on
			 Eligibility for Benefits."
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-7 - Prohibition against post claims underwriting

Current through July 10, 2024
(a) All
			 applications for long-term care insurance certificates 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
			 certificates 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 long-term care
			 insurance:
Caution: If your answers on this application are
				incorrect or untrue, (company) has the right to deny benefits or rescind your
				coverage.
(2) The
			 following language or language substantially similar to the following, shall be
			 set out conspicuously on the long-term care insurance certificate at the time
			 of delivery:
Caution: The issuance of this long-term care insurance 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 coverage. 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-8 - 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 the loss
			 ratio required by subsection (b) of Section
			 38a-528
			 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-528-4 which
			 they file for approval.
(c) Every
			 insurer, fraternal benefit society, hospital service corporation, medical
			 service corporation or health care center providing group 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-9 - 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 certificate 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 certificateholder 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-10 - 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 group long-term care certificate, an agent shall make reasonable efforts to
			 obtain information concerning the applicant's health and financial
			 circumstances.
(c) Before issuing
			 any group long-term care certificate, a direct response insurer shall have
			 reasonable grounds for believing that the purchase of such certificate, 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-11 - 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 certificate.
(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 › 528 - Group Long-Term Care Insurance › Section 38a-528-12 - Requirement to offer a non-forfeiture benefit

Current through July 10, 2024
No insurer shall offer for sale a long-term care insurance
				certificate unless the insurer also offers the applicant the option to purchase
				a certificate that provides a non-forfeiture benefit. An insurer shall meet
				this requirement by providing 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 certificate that provides a
				non-forfeiture benefit shall include a schedule of this
				benefit.
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-13 - Requirement to offer inflation protection

Current through July 10, 2024
(a) No insurer
			 shall offer for sale a long-term care insurance certificate unless the insurer
			 also offers the applicant the option to purchase a certificate 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
			 certificate 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 › 528 - Group Long-Term Care Insurance › Section 38a-528-15 - 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 certificate 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 insurance?
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-16 - Reporting requirements

Current through July 10, 2024
(a) Every insurer
			 shall report annually by June 30 the number of certificates lapsed in the
			 previous calendar year, the average total number of certificates in force
			 during the preceding calendar year, and the resulting ratio.
(b) Every insurer shall report annually by
			 June 30 the number of replacement certificates sold in the previous calendar
			 year, the total number of certificates sold during the preceding calendar year,
			 and the resulting ratio.
(c) Every
			 insurer shall report annually by June 30 the number of replacement certificates
			 sold in the previous calendar year, the average total number of certificates 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 certificates, except those voluntarily
			 effectuated by an insured, in the previous calendar year.
(e) For purposes of this section,
			 "certificates" shall mean certificates evidencing coverage under group
			 long-term care insurance policies or subscriber contracts and "report" shall
			 mean on a statewide and national basis.
Connecticut Administrative Code › Title 38a - Insurance Department › 528 - Group Long-Term Care Insurance › Section 38a-528-17 - Effective date; separability

Current through July 10, 2024
(a) The effective
			 date of Sections
			 38a-528-1
			 to 38a-528-17, inclusive, shall be September 30, 1994.
(b) If any provision of Sections
			 38a-528-1
			 to 38a-528-17, 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 › 528a - Group Short-Term Care Insurance › Section 38a-528a-1 - Applicability and scope

Current through July 10, 2024
Except as otherwise specifically provided, Sections 38a-528a-1
				to 38a-528a-16, inclusive, of the Regulations of Connecticut State Agencies
				apply to all group short-term care policies or certificates 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 › 528a - Group Short-Term Care Insurance › Section 38a-528a-2 - Definitions

Current through July 10, 2024
As used in Sections 38a-528a-1 to 38a-528a-16, inclusive, of
				the Regulations of Connecticut State Agencies:
(1) "Applicant" means the proposed
			 certificate holder.
(2) "Insurer"
			 means an insurance company, fraternal benefit society, hospital service
			 corporation, medical service corporation or health care center.
(3) "Short-term care policy" means any group
			 health insurance policy or certificate delivered or issued for delivery to any
			 resident of this state that is designed to provide, within the terms and
			 conditions of the policy or certificate, 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 exceeding three hundred days. "Short-term care policy" does not
			 include any such policy or certificate 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.
Connecticut Administrative Code › Title 38a - Insurance Department › 528a - Group Short-Term Care Insurance › Section 38a-528a-3 - Policy definitions and terms

Current through July 10, 2024
No insurance policy or certificate 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 certificate 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 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.