Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.60 - Required Disclosure Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
a) Renewability. Individual long-term care
			 insurance policies shall contain a renewability provision. The provision shall
			 be appropriately captioned, shall appear on the first page of the policy, and
			 shall clearly state that the coverage is guaranteed renewable or
			 noncancellable. This provision shall not apply to policies which do not contain
			 a renewability provision and under which the right to nonrenew is reserved
			 solely to the policyholder as long as required premiums are paid on time. A
			 long-term care insurance policy or certificate, other than one where the
			 insurer does not have the right to change the premium, shall include a
			 statement that premium rates may change.
b) Riders and Endorsements. Except for riders
			 or endorsements by which the insurer effectuates a request made in writing by
			 the insured under an individual long-term care insurance policy, all riders or
			 endorsements added to an individual long-term care insurance policy after date
			 of issue or at reinstatement or renewal which reduce or eliminate benefits or
			 coverage in the policy shall require signed acceptance by the individual
			 insured. After the date of policy issue, any rider or endorsement which
			 increases benefits or coverage with a concomitant increase in premium during
			 the policy term must be agreed to in writing signed by the insured, except if
			 the increased benefits or coverage are 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) Payment of
			 Benefits. A long-term care insurance policy or certificate that provides for
			 the payment of benefits based on standards described as "usual and customary,"
			 "reasonable and customary" or words of similar import shall include a
			 definition of such terms and an explanation of such terms in its accompanying
			 outline of coverage.
d)
			 Limitations: If a long-term care insurance policy or certificate contains any
			 limitations with respect to preexisting conditions, such limitations shall
			 appear as a separate paragraph of the policy or certificate and shall be
			 labeled "Preexisting Condition Limitations". Limitations to preexisting
			 conditions shall be in accordance with Section 351A-5 of the Code.
e) Other Limitations or Conditions on
			 Eligibility for Benefits. In addition to complying with Section 351A-6 of the
			 Code, beginning August 30, 1990, a long-term care insurance policy or
			 certificate containing any limitations or conditions for eligibility other than
			 those prohibited in Section 351A-6 shall set forth a description of such
			 limitations or conditions, including any required number of days of confinement
			 in a separate paragraph of the policy or certificate and shall label such
			 paragraph "Limitations or Conditions on Eligibility for Benefits".
f) Disclosure Requirements for Accelerated
			 Life Products
1) Policy Summary
At the time of policy delivery, a policy summary shall be
				delivered for an individual life insurance policy that provides long-term care
				benefits within the policy or by rider. This requirement does not apply to
				qualified long-term care insurance contracts. In the case of direct response
				solicitations, the insurer shall deliver the policy summary upon the
				applicant's request, but regardless of request shall make delivery no later
				than at the time of policy delivery. In addition to complying with all
				applicable requirements, the summary shall also include:
A) an explanation of how the long-term care
			 benefit interacts with other components of the policy, including deductions
			 from death benefits;
B) an
			 illustration of the amount of benefits, the length of benefit, and the
			 guaranteed lifetime benefits if any, for each covered person;
C) any exclusion, reductions and limitations
			 on benefits of long-term care; and
D) if applicable to the policy type, the
			 summary shall also include:
i) disclosure of
			 the effects of exercising other rights under the policy;
ii) disclosure of guarantees related to
			 long-term care costs of insurance charges; and
iii) current and projected maximum lifetime
			 benefits.