reglab/statecodes huggingface dataset:
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.579 - Availability of new services or providers

Current through May 31, 2024
(a) An insurer
				  shall notify policyholders of the availability of a new long-term policy series
				  that provides coverage for new long-term care services or providers material in
				  nature and not previously available through the insurer to the general public.
				  The notice shall be provided not later than 12 months after the date the new
				  policy series is made available for sale in this state.
(b) Notwithstanding (a) of this section,
				  notification is not required for a policy issued before March 27, 2022 or to a
				  policyholder or certificate holder who is currently eligible for benefits,
				  within an elimination period or on a claim, or who previously had been in claim
				  status, or who would not be eligible to apply for coverage due to issue age
				  limitations under the new policy. The insurer may require that policyholders
				  meet all eligibility requirements, including underwriting and payment of the
				  required premium to add new services or providers.
(c) The insurer shall make the new coverage
				  available in one of the following ways:
(1) by
				  adding a rider to the existing policy and charging a separate premium for the
				  new rider based on the insured's attained age;
(2) by exchanging the existing policy or
				  certificate for one with an issue age based on the present age of the insured
				  and recognizing past insured status by granting premium credits toward the
				  premiums for the new policy or certificate. The premium credits shall be based
				  on premiums paid or reserves held for the prior policy or
				  certificate;
(3) by exchanging the
				  existing policy or certificate for a new policy or certificate in which
				  consideration for past insured status shall be recognized by setting the
				  premium for the new policy or certificate at the issue age of the policy or
				  certificate being exchanged, the cost for the new policy or certificate may
				  recognize the difference in reserves between the new policy or certificate and
				  the original policy or certificate; or
(4) by an alternative program developed by
				  the insurer that meets the purpose intent of this section if the program is
				  filed with and approved by the director.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.580 - Right to reduce coverage and lower premiums

Current through May 31, 2024
(a) Every long-term
				  care insurance policy and certificate must include a provision that allows the
				  policyholder or certificate holder to reduce coverage and lower the policy or
				  certificate premium in at least one of the following ways;
(1) reducing the maximum benefit;
(2) reducing the daily, weekly, or monthly
				  benefit amount; or
(3) other
				  coverage reduction options that are consistent with the policy or certificate
				  design or the insurance carrier's administrative processes; if the reduction in
				  coverage involves the reduction or elimination of the inflation protection
				  provision, the insurer shall allow the policyholder to continue the benefit
				  amount in effect at the time of the reduction.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.582 - Nonforfeiture benefit requirement

Current through May 31, 2024
(a) This section
				  does not apply to life insurance policies or riders containing accelerated
				  long-term care benefits.
(b) To
				  comply with the requirement to offer a nonforfeiture benefit under the
				  provisions of
				  AS
				  21.53.064;
(1) a policy or certificate offered with
				  nonforfeiture benefits must have coverage elements, eligibility, benefit
				  triggers, and benefit length that are the same as coverage to be issued without
				  nonforfeiture benefits; the nonforfeiture benefit included in the offer must be
				  the benefit described in (h) of this section; and
(2) the offer shall be in writing if the
				  nonforfeiture benefit is not otherwise described in the Outline of Coverage or
				  other materials given to the prospective policyholder.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.583 - Standards for benefit triggers

Current through May 31, 2024
(a) A long-term
				  care insurance policy must condition the payment of benefits on a determination
				  of the insured's ability to perform activities of daily living and on cognitive
				  impairment. Eligibility for the payment of benefits may not be more restrictive
				  than requiring either a deficiency in the ability to perform not more than
				  three of the activities of daily living or the presence of cognitive
				  impairment.
(b) Insurers may use
				  activities of daily living to trigger covered benefits in addition to those
				  contained in this subsection if they are defined in the policy. Activities of
				  daily living must include at least the following as defined in 3 AAC 28.551 and
				  in the policy:
(1) bathing;
(2) continence;
(3) dressing;
(4) eating;
(5) toileting; and
(6) transferring;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.584 - Additional standards for benefit triggers for qualified long-term, care insurance contracts

Current through May 31, 2024
(a) A qualified long-term care insurance
				  contract may pay only for qualified long-term care services received by a
				  chronically ill individual provided under a plan of care prescribed by a
				  licensed health care practitioner.
(b) A qualified long-term care insurance
				  contract must condition the payment of benefits on a determination of the
				  insured's inability to perform activities of daily living for an expected
				  period of at least 90 days due to a loss of functional capacity or to severe
				  cognitive impairment.
(c)
				  Certifications regarding activities of daily living and cognitive impairment
				  required under (b) of this section shall be performed by the following licensed
				  or certified professionals:
(1) Physicians
				  within the meaning given in
				  42 U.S.C.
				  1395 x(r)(l) (see 1861 (r)(l), social
				  security Act);
(2) registered
				  professional nurses;
(3) licensed
				  social workers; or
(4) other
				  individuals who meet requirements prescribed by the Secretary of the
				  Treasury.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.585 - Appealing an insurer's determination that the benefit trigger is not met

Current through May 31, 2024
(a) For
				  purposes of this section, "authorized representative" is authorized to act as
				  the covered person's personal representative within the meaning of
				  45
				  C.F.R. 164.502(g) and means
				  the following:
(1) a person to whom a covered
				  person has given express written consent to represent the covered person in an
				  external review;
(2) a person
				  authorized by law to provide substituted consent for a covered person;
				  or
(3) a family member of the
				  covered person or the covered person's treating health care professional only
				  when the covered person is unable to provide consent.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.586 - Prompt payment of clean claims

Current through May 31, 2024
(a) Not later than
				  30 days after receipt of a claim for benefits under a long-term care insurance
				  policy or certificate, an insurer shall pay the claim if it is a clean claim,
				  or send a written notice acknowledging the date of receipt of the claim and one
				  of the following;
(1) the insurer is declining
				  to pay all or part of the claim and the specific reason or reasons for denial;
				  or
(2) that additional information
				  is necessary to determine if all or a part of the claim is payable and the
				  specific additional information that is necessary.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.588 - Standard format outline of coverage

Current through May 31, 2024
An outline of coverage to a prospective applicant for
					 long-term care insurance must follow a standard format and content for an
					 outline of coverage, subject to the following standards:
(1) the outline of coverage must be a
				  free-standing document, using no smaller than 10 point type;
(2) the outline of coverage may not contain
				  advertising material;
(3) text that
				  is capitalized or underscored in the standard format outline of coverage may be
				  emphasized by other means that provide prominence equivalent to the
				  capitalization or underscoring;
(4)
				  use of the text and sequence of text of the standard format outline of coverage
				  is mandatory, unless otherwise specifically indicated; and
(5) the outline of coverage must follow the
				  format as prescribed by the director.
Authority:
AS
						21.06.090
AS
						21.53.050
AS
						21.53.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.590 - Requirement to deliver shopper's guide

Current through May 31, 2024
(a) A long-term
				  care insurance shopper's guide in the format developed by the National
				  Association of Insurance Commissioners, or a guide developed or approved by the
				  director, shall be provided to all prospective applicants of a long-term care
				  insurance policy or certificate. The shopper's guide is subject to the
				  following:
(1) in the case of agent
				  solicitations, an agent shall deliver the shopper's guide before the
				  presentation of an application or enrollment form; or
(2) in the case of direct response
				  solicitations, the shopper's guide shall be presented in conjunction with an
				  application or enrollment form.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.592 - Permitted compensation arrangements

Current through May 31, 2024
(a) An insurer,
				  hospital or medical service corporation, or fraternal benefit society may
				  provide commission or other compensation to an agent for the sale of a
				  long-term care insurance policy or certificate only if the first year
				  commission or other first year compensation is not more than 200 percent of the
				  commission or other compensation paid for selling or servicing the policy or
				  certificate in the second year or period.
(b) The commission or other compensation
				  provided in renewal years must be the same as that provided in the second year
				  or period and must be provided for a reasonable number of renewal
				  years.
(c) An entity may not
				  provide compensation to its agents or other producers and an agent or producer
				  may not receive compensation greater than the renewal compensation payable by
				  the replacing Insurer on renewal policies.
(d) For purposes of this section,
				  "compensation" includes pecuniary or non-pecuniary remuneration relating to the
				  sale or renewal of the policy or certificate including bonuses, gifts, prizes,
				  awards, and finder's fees.
Authority:
AS
						21.06.090
AS
						21.53.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.595 - Penalties

Current through May 31, 2024
In addition to other penalties provided by the laws of this
					 state, an insurer and an agent found to have violated a requirement of this
					 state relating to the regulation of long-term care insurance or the marketing
					 of long-term care insurance are subject to a fine of up to three times the
					 amount of the commissions paid for each policy involved in the violation or up
					 to $10, 000, whichever is greater.
Authority:
AS
						21.06.090
AS
						21.36.020
AS 21.06.025
AS
						21.53.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.599 - Definitions

Current through May 31, 2024
In this chapter,
(1) "applicant" has the meaning given in
				  AS
				  21.53.200(1);
(2) "benefit trigger", for the purposes of
				  independent review, means a contractual provision in the insured's policy of
				  long-term care insurance conditioning the payment of benefits on a
				  determination of the insured's ability to perform activities of daily living
				  and on cognitive impairment for purposes of a tax-qualified long-term care
				  insurance contract within the meaning given in
				  26 U.S.C.
				  7702B(b) (Internal Revenue
				  Code), (a) "benefit trigger'' does not occur without a determination by a
				  licensed health care practitioner that an insured is a chronically ill
				  individual;
(3) "certificate" has
				  the meaning given in
				  AS
				  21.53.200(2):
(4) "group long-term" care insurance has the
				  meaning given in
				  AS
				  21.53.200(3);
(5) "independent review organization" means
				  an organization that conducts independent reviews of long-term care benefit
				  trigger decisions;
(6) "licensed
				  health care professional" means an individual qualified by education and
				  experience in an appropriate field, to determine, by record review, an
				  insured's actual functional or cognitive impairment;
(7) "long-term care insurance" has the
				  meaning given in
				  AS
				  21.53.200(4);
(8) "qualified actuary" means a member in
				  good standing of the American Academy of Actuaries;
(9) "qualified long-term care insurance"
				  means an insurance contract that pays only for qualified long-term care
				  services within the meaning given in 3 AAC 28.584(f)(1);
(10) "similar policy forms" means all of the
				  long-term care insurance policies and certificates issued by an insurer in the
				  same long-term care benefit classification as the policy form being considered;
				  certificates of groups that meet the definition in
				  AS
				  21.53.200(3)(A) are not
				  considered similar to certificates or policies otherwise issued as long-term
				  care insurance, but are similar to other comparable certificates with the same
				  long-term care benefit classification; for purposes of this paragraph,
				  long-term care benefit classifications are defined as follows:
(A) institutional long-term care benefits
				  only;
(B) non-institutional
				  long-term care benefits only; or
(C) comprehensive long-term care
				  benefits.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.600 - Individual and group annuity mortality tables

Current through May 31, 2024
The 1983 Table "a", the 1983 GAM Table, the Annuity 2000
					 Mortality Table, the 2012 lAR Table, and the 1994 GAR Table for mortality rates
					 are adopted by reference and are recognized for use in determining the minimum
					 standard of valuation for annuity and pure endowment contracts.
Click here to view 2012 lAR
					 Table
The 1983 Table "a", the 1983 GAM Table, the Annuity 2000
						Mortality Table, the 2012 lAR Table, and the 1994 GAR Table referenced in
						3 AAC 28.600 may be obtained from the Society of
						Actuaries; 475 N. Martingale Road, Suite 600; Schaumburg, Illinois 60173;
						telephone number (847) 706-3500.
Authority:
AS
						21.06.090
AS 21.18.110
AS
						21.18.160
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.605 - Individual annuity or pure endowment contracts

Current through May 31, 2024
(a) Except as
				  provided in (b) and (c) of this section, the 1983 Table "a" is recognized and
				  approved as an individual annuity mortality table for valuation and, at the
				  option of the insurance company, may be used to determine the minimum standard
				  of valuation for any individual annuity or pure endowment contract issued on or
				  after July 1, 1978.
(b) Except as
				  provided in (c) of this section, either the 1983 Table "a" or the Annuity 2000
				  Mortality Table must be used to determine the minimum standard of valuation for
				  any individual annuity or pure endowment contract issued on or after December
				  31, 1985.
(c) Except as provided in
				  (d) of this section, the Annuity 2000 Mortality Table must be used to determine
				  the minimum standard of valuation for any individual annuity or pure endowment
				  contract issued on or after March 11, 1998.
(d) Except as provided in (e) of this
				  section, the 2012 lAR Table must be used to determine the minimum standard of
				  valuation for any individual annuity or pure endowment contract issued on or
				  after January 1. 2015.
(e) The 1983
				  Table "a" without projection must be used to determine the minimum standard of
				  valuation for an individual annuity or pure endowment contract issued on or
				  after March 11, 1998, if the contract is based on life contingencies and is
				  issued to fund periodic benefits arising from
(1) a settlement of a claim pertaining to a
				  court settlement or arising out of a court settlement from tort
				  actions;
(2) a settlement involving
				  an action similar to a tort, such as a workers' compensation claim;
				  or
(3) a settlement of a long term
				  disability claim where a temporary or life annuity has been used instead of
				  continuing disability payments.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.607 - Group annuity or pure endowment contracts

Current through May 31, 2024
(a) Except as
				  provided in (b) and (c) of this section, the 1983 GAM Table, the 1983 Table
				  "a", and the 1994 GAR Table are recognized and approved as group annuity
				  mortality tables for valuation and, at the option of the insurance company, any
				  one of these tables may be used to determine the minimum standard of valuation
				  for any annuity or pure endowment purchased on or after July 1, 1978 under a
				  group annuity or pure endowment contract.
(b) Except as provided in (c) of this
				  section, either the 1983 GAM Table or the 1994 GAR Table must be used to
				  determine the minimum standard of valuation for any annuity or pure endowment
				  purchased on or after December 31,1985 under a group annuity or pure endowment
				  contract.
(c) The 1994 GAR Table
				  must be used to determine the minimum standard of valuation for any annuity or
				  pure endowment purchased on or after March 11, 1998 under a group annuity or
				  pure endowment contract.
The 1983 Table "a", the 1983 GAM Table, and the 1994 GAR
						Table referenced in
						3 AAC 28.607 may be obtained from the Society of
						Actuaries; 475 N, Martingale Road, Suite 600; Schaumburg, Illinois 60173;
						telephone number (847) 706-3500.
Authority:
AS
						21.06.090
AS 21.18.110
AS
						21.18.160
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.610 - Application of the 1994 GAR Table

Current through May 31, 2024
In using the 1994 GAR Table, the mortality rate for a
					 person age x in year (1994 + n) is calculated as follows:
q
x
1
994+n = q
x
1
994 (1-AAx)
n
where q
x
1
994 and AAx are as
					 specified in the 1994 GAR Table.
The 1994 GAR Table referenced in
						3 AAC 28.610 may be obtained from the Society of
						Actuaries; 475 N. Martingale Road, Suite 600; Schaumburg, Illinois 60173;
						telephone number (847) 706-3500.
Authority:
AS
						21.06.090
AS
						21.18.110
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.611 - Application of the 2012 IAR Table

Current through May 31, 2024
In using the 2012 lAR Table, the mortality rate for a
					 person age x in year (2012 + n) is calculated as follows:
qx2012+n
					 = qx2012 (1 -
					 G2x)n
The resulting
					 qx2012+n must be rounded to
					 three decimal places per 1,000, for example, 0.741 deaths per 1,000. Also, the
					 rounding must occur according to the formula above, starting at the 2012 period
					 table rate.
For example, for a male age 30,
					 qx2012= 0.741.
qx2013 =
					 0.741 * (1 - 0.010) ^ 1 = 0.73359, which is rounded to 0.734.
qx2014 =
					 0.741 * (1 - 0.010) ^ 2 - 0.7262541, which is rounded to 0.726.
A method leading to incorrect rounding would be to
					 calculate qx2014 as
					 qx2013 * (1 - 0.010), or
					 0.734 * 0.99 - 0.727. It is incorrect to use the already rounded
					 qx2013 to calculate
					 qx2014.
The 2012 lAR Table referenced in
						3 AAC 28.611 may be obtained from the Society of
						Actuaries; 475 N. Martingale Road, Suite 600; Schaumburg, Illinois 60173;
						telephone number (847) 706-3500.
Authority:
AS
						21.06.090
AS 21.18.110
AS
						21.18.160
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.619 - Separability

Current through May 31, 2024
If any provision of
					 3 AAC 28.600 -
					 3 AAC 28.611, or
					 3 AAC 28.690, or the application of it to any person or
					 circumstances is for any reason held to be invalid, the remainder of the
					 section and the application of its provisions to other persons or circumstances
					 is not affected by that holding.
Authority:
AS
						21.06.090
AS 21.18.110
AS
						21.18.160
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.620 - Life mortality tables

Current through May 31, 2024
(a) Except as provided in (g) of this
				  section, the 2001 CSO Mortality Tables are adopted by reference and are
				  recognized for use under (b) and (c) of this section in determining the minimum
				  standard of valuation for policies for which
				  AS
				  21.18.110(b)(1)(A)(iii) and
				  AS
				  21.45.300(t)(6)
				  apply.
(b) Subject to the
				  conditions under (d), (e), and (f) of this section, an insurer may elect to use
				  the 2001 CSO Mortality Tables as the minimum standard of valuation for policies
				  issued on or after January 1, 2005 and before January 1, 2009 for which
				  AS
				  21.18.110(b)(1)(A)(iii) and
				  AS
				  21.45.300(t)(6)
				  apply.
(c) Subject to the
				  conditions under (d), (e), and (f) of this section, an insurer shall use the
				  2001 CSO Mortality Tables in determining the minimum standard of valuation for
				  policies issued on or after January 1, 2009 for which
				  AS
				  21.18.110(b)(1)(A)(iii),
				  AS
				  21.45.300(t)(6), and
				  3 AAC 21.905(a) - (g) apply.
(d) If an insurance policy contains separate
				  mortality rates for smokers and nonsmokers, the insurer may use
(1) composite mortality tables to determine
				  the minimum reserve liabilities, minimum cash surrender values, and amounts of
				  paid-up nonforfeiture benefits;
(2)
				  smoker and nonsmoker mortality tables to determine the valuation net premiums
				  and additional minimum reserves required under
				  AS
				  21.18.110(b)(4) and use
				  composite mortality tables to determine the basic minimum reserves, minimum
				  cash surrender values, and amounts of paid-up nonforfeiture benefits;
				  or
(3) smoker and nonsmoker
				  mortality tables to determine minimum reserve liabilities, minimum cash
				  surrender values, and amounts of paid-up nonforfeiture benefits.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.630 - 2001 CSO Preferred Class Structure Mortality Tables

Current through May 31, 2024
(a) At the election
				  of an insurer, for each calendar year of issue, for any one or more specified
				  plans of insurance and subject to the conditions set out in (b) and (c) of this
				  section, the insurer may substitute, as the minimum valuation standard for
				  policies issued on or after January 1, 2007, the 2001 CSO Preferred Class
				  Structure Mortality Tables, which are adopted by reference, for the 2001 CSO
				  smoker and nonsmoker mortality tables specified in
				  3 AAC 28.620. For policies issued on or after January 1,
				  2005 and before January 1, 2007, with the approval of the director and subject
				  to the conditions in this section, an insurer may substitute the 2001 CSO
				  Preferred Class Structure Mortality Tables for the 2001 CSO smoker or nonsmoker
				  mortality tables specified in
				  3 AAC 28.620 as the minimum valuation standard. The
				  insurer may not elect to use the 2001 CSO Preferred Class Structure Mortality
				  Tables unless the insurer demonstrates that at least 20 percent of the business
				  to be valued on those tables is in one or more preferred classes.
(b) For each plan of insurance with separate
				  rates for preferred and standard nonsmoker lives, an insurer may use the
				  super-preferred nonsmoker, preferred nonsmoker, and residual standard nonsmoker
				  tables in place of the nonsmoker mortality table found in the 2001 CSO
				  Mortality Tables to determine minimum reserves. At the time of election and
				  annually thereafter, except for business valued under the residual standard
				  nonsmoker table, the appointed actuary shall certify that
(1) the present value of death benefits over
				  the next 10 years after the valuation date, using the anticipated mortality
				  experience without recognition of mortality improvement beyond the valuation
				  date for each class, is less than the present value of death benefits using the
				  valuation basic table corresponding to the valuation table being used for that
				  class; and
(2) the present value of
				  death benefits over the future life of the contracts, using anticipated
				  mortality experience without recognition of mortality improvement beyond the
				  valuation date for each class, is less than the present value of death benefits
				  using the valuation basic table corresponding to the valuation table being used
				  for that class.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.635 - Applicability of the 2001 CSO Mortality Tables to 3 AAC 21.900 - 3 AAC 21.949

Current through May 31, 2024
The 2001 CSO Mortality Tables may be used in complying with
					 3 AAC 21.900 -
					 3 AAC 21.949 subject to the following:
(1) the net level reserve premium under
				  3 AAC 21.900(2) (B) must be based on
				  the ultimate mortality rates in the 2001 CSO Mortality Tables;
(2) calculations under
				  3 AAC 21.920(a) are
made using the 2001 CSO Mortality Tables; and
(B) if elected by the insurer, the optional
				  minimum mortality standard for deficiency reserves under (4) of this section
				  with q
x+k+t-1
equal to the valuation mortality rate
				  for deficiency reserves in policy year k+t but using the unmodified select
				  mortality rates if modified select mortality rates are used in computation of
				  deficiency reserves; in this subparagraph, "q
x+k+t-1
," "k," "t" and "x" have the meanings given in
				  3 AAC 21.925(d);
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 7 - Long-term Care Insurance › 3 AAC 28.640 - Gender-blended mortality tables

Current through May 31, 2024
(a) An insurer may
				  elect to use a gender-blended mortality table for determining minimum cash
				  surrender values and amounts of paid-up nonforfeiture benefits for each plan of
				  insurance if the
(1) same premium rates and
				  charges are used for male and female lives; or
(2) insurer is prohibited by law from using
				  mortality rates that differ by gender.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 8 - Uniform Claim Forms › 3 AAC 28.700 - Applicability

Current through May 31, 2024
(a)3 AAC 28.700 -
				  3 AAC 28.725 apply to all insurers transacting health
				  insurance in this state for claims that are paid on an expense-incurred
				  basis.
(b)3 AAC 28.700 -
				  3 AAC 28.725 do not apply to claims for vision care or
				  drugs, or to benefits paid on other than an expense-incurred basis.
Authority:
AS
						21.06.085
AS 21.06.090
AS
						21.36.125
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 8 - Uniform Claim Forms › 3 AAC 28.705 - Uniform claim forms for health insurance

Current through May 31, 2024
(a) An insurer
				  shall accept a properly completed claim submitted on the applicable uniform
				  form set out in
Uniform Claim Forms for Health Insurance
,
				  dated June 23, 1995 and hereby adopted by reference. A properly completed claim
				  includes
(1) completion of a uniform claim
				  form with information consistent with the National Uniform Billing Data Element
				  Specifications, as developed by the National Uniform Billing Committee as of
				  January 8, 1993 with technical corrections as of February 19, 1993;
				  and
(2) submission of a uniform
				  claim form on electronic media.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 8 - Uniform Claim Forms › 3 AAC 28.725 - Definition

Current through May 31, 2024
For purposes of
					 3 AAC 28.700 -
					 3 AAC 28.725, "health insurance" means an individual or
					 group contract or other plan providing coverage for health care services that
					 is issued by an insurer licensed to transact the business of health insurance;
					 a health maintenance organization under AS 21.86; or a hospital service
					 corporation, medical service corporation, or combined medical and hospital
					 service corporation under AS 21.87.
Authority:
AS
						21.06.085
AS 21.06.090
AS
						21.36.125
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 8 - Uniform Claim Forms › 3 AAC 28.740 - Uniform prescription drug cards

Current through May 31, 2024
(a) A health care
				  insurer that offers, issues for delivery, delivers, or renews a health care
				  insurance plan that provides coverage for prescription drugs or devices and
				  that issues, uses, requires, or reissues a card for prescription claims
				  processing shall issue to a covered individual, subscriber, or primary insured
				  a card that contains the following information:
(1) the name or logo of the health care
				  insurer;
(2) the covered
				  individual's, subscriber's, or primary insured's name and identification
				  number;
(3) a toll-free telephone
				  number for obtaining assistance with a claim;
(4) electronic transaction routing
				  information necessary for electronic claim processing, if the health care
				  insurer processes claims electronically;
(5) any other information that is necessary
				  for processing a prescription drug claim.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 8 - Uniform Claim Forms › 3 AAC 28.745 - Compliance

Current through May 31, 2024
A health care insurer must comply with
					 3 AAC 28.740 for new policies issued on or after 12
					 months from the effective date of
					 3 AAC 28.740 and for renewal policies on the first
					 renewal date after 12 months from the effective date of
					 3 AAC 28.740.
Authority:
AS
						21.06.085
AS
						21.06.090
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.800 - Purpose of 3 AAC 28.800 - 3 AAC 28.849

Current through May 31, 2024
The purpose of
					 3 AAC 28.800 -
					 3 AAC 28.849 is to protect the public from false,
					 misleading, or deceptive illustrations of life insurance policies by
(1) providing formats for life insurance
				  policy illustrations;
(2)
				  specifying the disclosures that are required for life insurance policy
				  illustrations;
(3) prohibiting
				  misleading life insurance policy illustrations;
(4) minimizing the use of footnotes and
				  caveats in life insurance policy illustrations;
(5) requiring the use of language that is
				  understandable to those to whom the illustration is directed; and
(6) prescribing standards for life insurance
				  policy illustrations.
In 2010 the revisor of statutes, acting under
						AS
						01.05.031, renumbered former
						AS
						21.36.150 as
						AS
						21.36.900. As of Register 196 (January 2011),
						the regulations attorney made a conforming technical revision under
						AS
						44.62.125(b)(6), to the
						authority citation that follows
						3 AAC 28.800, so that the citation to former
						AS
						21.36.150 now refers to the renumbered
						statute, AS 21.96.900.
Authority:
AS
						21.06.090
AS 21.36.020
AS 21.36.030
AS 21.36.900
AS 21.42.120
AS
						21.42.130
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.805 - Applicability and scope of 3 AAC 28.800 - 3 AAC 28.849

Current through May 31, 2024
(a)3 AAC 28.800 -
				  3 AAC 28.849 apply to all group and individual life
				  insurance policies and certificates except
(1) variable life insurance;
(2) individual and group annuity
				  contracts;
(3) credit life
				  insurance under AS 21.57; and
(4)
				  individual and group life insurance policies that have death benefits of no
				  more than $10,000 per individual.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.815 - General rules and prohibitions

Current through May 31, 2024
(a) Failure to
				  comply with
				  3 AAC 28.800 -
				  3 AAC 28.849 is a violation of
				  AS
				  21.36.020 and
				  21.36.030.
(b) An illustration used in the sale of a
				  life insurance policy must satisfy the requirements of
				  3 AAC 28.800 -
				  3 AAC 28.849, be clearly labeled "life insurance
				  illustration," and contain the following information:
(1) the name of the insurer;
(2) the name, business address, and telephone
				  number of the person soliciting the policy, if any;
(3) the name, age, and sex of the proposed
				  insured, unless a composite illustration is permitted;
(4) the underwriting or rating classification
				  on which the illustration is based, described in sufficient detail to identify
				  the payment schedule and any other elements dependent on the
				  classification;
(5) the generic
				  name of the policy, company product name, and form number;
(6) the initial death benefit; and
(7) the dividend option election or the use
				  of non-guaranteed elements, if any.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.825 - Standards for supplemental illustrations

Current through May 31, 2024
(a) A supplemental
				  illustration may be provided if:
(1) it is
				  appended to, accompanied by, or preceded by a basic illustration that complies
				  with 3 AAC 28.800 -
				  3 AAC 28.849;
(2) the non-guaranteed elements shown in the
				  supplemental illustration are not more favorable to the policy owner than the
				  corresponding non-guaranteed elements that are based on the scale used in the
				  basic illustration;
(3) it contains
				  the statement required under
				  3 AAC 28.820(a) (13) for a
				  non-guaranteed element;
(4) the
				  contract premium underlying the supplemental illustration is equal to the
				  contract premium shown in the basic illustration, if the policy has a contract
				  premium; and
(5) the premium outlay
				  underlying the supplemental illustration is equal to the premium outlay shown
				  in the basic illustration, if the policy does not require a contract
				  premium.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.835 - Annual report; notice to policy owners

Current through May 31, 2024
(a) If a policy is
				  designated as one for which an illustration will be used, the insurer shall
				  provide each policy owner with an annual report on the status of the policy
				  that contains at least the following information:
(1) for a universal life policy, the report
				  must include
(A) the beginning and ending
				  date of the current report period;
(B) the policy value at the end of the
				  previous report period and at the end of the current report period;
(C) the total amounts that have been credited
				  or debited to the policy value during the current report period, identified by
				  type, such as interest, mortality, expense, or riders;
(D) the death benefit at the end of the
				  current report period on each life covered by the policy;
(E) the net cash surrender value of the
				  policy as of the end of the current report period; and
(F) the amount of any outstanding loans, as
				  of the end of the current report period;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.840 - Annual certification

Current through May 31, 2024
(a) The board of directors of an insurer
				  shall appoint one or more illustration actuaries. The illustration actuary or
				  actuaries shall annually certify that the disciplined current scale used in
				  each illustration in current use, as well as those used since the prior
				  certification, conforms with the Actuarial Standards Board Actuarial Standard
				  of Practice No. 24, and that the illustrated scales used in insurer-authorized
				  illustrations meet the requirements of
				  3 AAC 28.800 -
				  3 AAC 28.849.
(b) The illustration actuary
(1) must be a member in good standing of the
				  American Academy of Actuaries;
(2)
				  must be familiar with the standard of practice regarding life insurance policy
				  illustrations;
(3) may not have
				  been found by the director, after a hearing under
				  AS
				  21.06.170-21.06.230,
(A) to have violated any provision of, or any
				  obligation imposed by AS 21 in the course of performing the duties of an
				  illustration actuary;
(B) to be
				  guilty of a fraudulent or dishonest practice;
(C) to have demonstrated incompetence, lack
				  of cooperation, or untrustworthiness as an illustration actuary; or
(D) to have resigned or been removed as an
				  illustration actuary within the past five years as a result of one or more acts
				  or omissions indicated in any adverse report on examination or as a result of a
				  failure to adhere to generally acceptable actuarial standards; and
(4) must notify the director
				  within 30 days of an action taken by the chief insurance regulatory official in
				  another jurisdiction that is similar to an action described in (3) of this
				  subsection.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 9 - Life Insurance Policy Illustrations › 3 AAC 28.845 - Guidance in determining a disciplined current scale

Current through May 31, 2024
(a) In determining
				  the disciplined current scale, an insurer may rely on the standards established
				  by the Actuarial Standards Board if the standards
(1) conform with the requirements of
				  3 AAC 28.800 -
				  3 AAC 28.849;
(2) limit a disciplined current scale to
				  reflect only actions that have already been taken or events that have already
				  occurred;
(3) do not permit a
				  disciplined current scale to include any projected trends of improvements in
				  experience or any assumed improvements in experience beyond the illustration
				  date; and
(4) do not permit assumed
				  expenses to be less than minimum assumed expenses.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.900 - Applicability

Current through May 31, 2024
3 AAC 28.900 - 3 AAC 28.918 apply to
(1) a health care insurer that
(A) transacts health care insurance in this
				  state; and
(B) provides or performs
				  utilization review services;
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.902 - Corporate oversight of utilization review program

Current through May 31, 2024
A health care insurer shall
(1) monitor all utilization review activities
				  carried out by, or on behalf of, the health care insurer;
(2) ensure that the requirements of 3 AAC 28.900 - 3 AAC 28.918 are met; and
(3) ensure that appropriate personnel have
				  operational responsibility for the conduct of the health care insurer's
				  utilization review program.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.904 - Contracting

Current through May 31, 2024
If a health care insurer contracts to have a utilization
					 review organization or other entity perform the utilization review functions
					 required under 3 AAC 28.900 - 3 AAC 28.918, the director will
(1) hold the health care insurer responsible
				  for monitoring the activities of the utilization review organization or entity
				  with which the health care insurer contracts; and
(2) ensure that the requirements of 3 AAC 28.900 - 3 AAC 28.918 are met.
Authority:
AS
						21.06.090
AS
						21.07.005
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.906 - Scope and content of utilization review program

Current through May 31, 2024
(a) A health care
				  insurer that requires utilization review of a benefit request under a health
				  care insurance policy shall develop and implement a written utilization review
				  program that describes, at a minimum, the following utilization review
				  activities:
(1) filing of a benefit
				  request;
(2) notification to a
				  covered person or the covered person's authorized representative of a
				  utilization review and benefit determination;
(3) review of an adverse determination under
				  3 AAC 28.930 - 3 AAC 28.938,
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.908 - Operational requirements

Current through May 31, 2024
(a) A utilization
				  review program must use documented clinical review criteria that are
(1) based on sound clinical evidence;
				  and
(2) evaluated periodically by a
				  health care insurer's organizational mechanism specified under 3 AAC 28.906(b)(6) to ensure the program's effectiveness.
Alaska Administrative Code › Title 3 - Commerce, Community, and Economic Development › Part 2 - Division of Insurance › Chapter 28 - Life, Health, Variable, and Related Insurance › Article 10 - Utilization Review and Benefit Determinations › 3 AAC 28.910 - Procedures for standard utilization review and benefit determinations

Current through May 31, 2024
(a) A health care
				  insurer shall establish and maintain written procedures for
(1) receiving a benefit request from a
				  covered person or the covered person's authorized representative;
(2) making a standard utilization review and
				  benefit determination; and
(3)
				  notifying a covered person or the covered person's authorized representative of
				  the health care insurer's determination not later than the specified time
				  frames required under this section.