reglab/statecodes huggingface dataset:
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.01 - Purpose

Current through Register Vol. 42, No. 9, June 28, 2024
The purpose of this chapter is to implement the Alabama
				Long-Term Care Insurance Policy Minimum Standards Act (Article 3, Chapter 19,
				Title 27, beginning with Section
				27-19-100,
Code of
				Ala. 1975
), to promote the public interest, to promote the
				availability of long-term care insurance coverage, to protect applicants for
				long-term care insurance, as defined, from unfair or deceptive sales or
				enrollment practices, to facilitate public understanding and comparison of
				long-term care insurance coverages, and to facilitate flexibility and
				innovation in the development of long-term care insurance.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.02 - Authority

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is made and promulgated by the undersigned
				Commissioner of Insurance pursuant to the authority set forth in Section
				27-2-17, and in the Alabama
				Long-Term Care Insurance Policy Minimum Standards Act (Article 3, Chapter 19,
				Title 27, beginning with Section
				27-19-100),
Code of
				Ala. 1975
.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.03 - Applicability And Scope

Current through Register Vol. 42, No. 9, June 28, 2024
Except as otherwise specifically provided, this chapter applies
				to all long-term care insurance policies, contracts, subscriber agreements,
				riders and endorsements, and certificates, including qualified long-term care
				contracts and life insurance policies that accelerate benefits for long-term
				care, delivered or issued for delivery in this state on or after the effective
				date hereof, by insurers; fraternal benefit societies; nonprofit health,
				hospital and medical service corporations; prepaid health plans; health
				maintenance organizations and all similar organizations. Certain provisions of
				this chapter apply only to qualified long-term care insurance contracts as
				noted.
Additionally, this regulation is intended to apply to policies
				having indemnity benefits that are triggered by activities of daily living and
				sold as disability income insurance, if:
(1) The benefits of the disability income
			 policy are dependent upon or vary in amount based on the receipt of long-term
			 care services.
(2) The disability
			 income policy is advertised, marketed or offered as insurance for long-term
			 care services; or
(3) Benefits
			 under the policy may commence after the policyholder has reached Social
			 Security's normal retirement age unless benefits are designed to replace lost
			 income or pay for specific expenses other than long-term care services.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.04 - Definitions

Current through Register Vol. 42, No. 9, June 28, 2024
For the purpose of this chapter, the terms "long-term care
				insurance," "qualified long-term care insurance," "group long-term care
				insurance," "commissioner," "applicant," "policy" and "certificate" shall have
				the meanings set forth in Section
				27-19-103,
Code of
				Ala. 1975
. In addition, the following definitions apply.
(a)
1.
			 "Exceptional increase" means only those increases filed by an insurer as
			 exceptional for which the commissioner determines the need for the premium rate
			 increase is justified:
(i) Due to changes in
			 laws or regulations applicable to long-term care coverage in this state;
			 or
(ii) Due to increased and
			 unexpected utilization that affects the majority of insurers of similar
			 products.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.06 - Policy Practices And Provisions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Renewability. The terms "guaranteed
			 renewable" and "noncancellable" shall not be used in any individual long-term
			 care insurance policy without further explanatory language in accordance with
			 the disclosure requirements of Rule
			 482-1-091-.08.
(a) A policy issued to an individual shall
			 not contain renewal provisions other than "guaranteed renewable" or
			 "noncancellable."
(b) The term
			 "guaranteed renewable" may be used only when the insured has the right to
			 continue the long-term care insurance in force by the timely payment of
			 premiums and when the insurer has no unilateral right to make any change in any
			 provision of the policy or rider while the insurance is in force, and cannot
			 decline to renew, except that rates may be revised by the insurer on a class
			 basis.
(c) The term
			 "noncancellable" may be used only when the insured has the right to continue
			 the long-term care insurance in force by the timely payment of premiums during
			 which period the insurer has no right to unilaterally make any change in any
			 provision of the insurance or in the premium rate.
(d) The term "level premium" may only be used
			 when the insurer does not have the right to change the premium.
(e) In addition to the other requirements of
			 this Paragraph (1), a qualified long-term care insurance contract shall be
			 guaranteed renewable, within the meaning of Section 7702B(b)(1)(C) of the
			 Internal Revenue Code of 1986, as amended.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.08 - Required Disclosure Provisions

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Renewability. Individual long-term care
			 insurance policies shall contain a renewability provision.
(a) The provision shall be appropriately
			 captioned, shall appear on the first page of the policy, and shall clearly
			 state the duration, where limited, of renewability and the duration of the term
			 of coverage for which the policy is issued and for which it may be renewed.
			 This provision shall not apply to policies that do not contain a renewability
			 provision, and under which the right to nonrenew is reserved solely to the
			 policyholder.
(b) 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.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.09 - Prohibition Against Post-Claims Underwriting

Current through Register Vol. 42, No. 9, June 28, 2024
(1) All applications for long-term care
			 insurance policies or certificates except those that are guaranteed issue shall
			 contain clear and unambiguous questions designed to ascertain the health
			 condition of the applicant.
(2)
(a) If an application for long-term care
			 insurance contains a question that asks whether the applicant has had
			 medication prescribed by a physician, it must also ask the applicant to list
			 the medication that has been prescribed.
(b) If the medications listed in the
			 application were known by the insurer, or should have been known at the time of
			 application, to be directly related to a medical condition for which coverage
			 would otherwise be denied, then the policy or certificate shall not be
			 rescinded for that condition.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.10 - Minimum Standards For Home Health And Community Care Benefits In Long-Term Care Insurance Policies

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 A long-term care insurance policy or certificate shall not, if it provides
			 benefits for home health care or community care services, limit or exclude
			 benefits as follows:
(a) By requiring that
			 the insured or claimant would need care in a skilled nursing facility if home
			 health care services were not provided.
(b) By requiring that the insured or claimant
			 first or simultaneously receive nursing or therapeutic services, or both, in a
			 home, community or institutional setting before home health care services are
			 covered.
(c) By limiting eligible
			 services to services provided by registered nurses or licensed practical
			 nurses.
(d) By requiring that a
			 nurse or therapist provide services covered by the policy that can be provided
			 by a home health aide, or other licensed or certified home care worker acting
			 within the scope of his or her licensure or certification.
(e) By excluding coverage for personal care
			 services provided by a home health aide.
(f) By requiring that the provision of home
			 health care services be at a level of certification or licensure greater than
			 that required by the eligible service.
(g) By requiring that the insured or claimant
			 have an acute condition before home health care services are covered.
(h) By limiting benefits to services provided
			 by Medicare-certified agencies or providers.
(i) By excluding coverage for adult day care
			 services.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.11 - Requirement To Offer Inflation Protection

Current through Register Vol. 42, No. 9, June 28, 2024
(1) No insurer may offer a long-term care
			 insurance policy unless the insurer also offers to the policyholder in addition
			 to any other inflation protection the option to purchase a policy that provides
			 for benefit levels to increase with benefit maximums or reasonable durations
			 which are meaningful to account for reasonably anticipated increases in the
			 costs of long-term care services covered by the policy.
Insurers must offer to each policyholder, at the time of
				purchase, the option to purchase a policy with an inflation protection feature
				no less favorable than one of the following:
(a) Increases benefit levels annually in a
			 manner so that the increases are compounded annually at a rate not less than
			 five percent (5%).
(b) 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.
(c) Covers a specified percentage of actual
			 or reasonable charges and does not include a maximum specified indemnity amount
			 or limit.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.12 - Requirements For Application Forms And Replacement Coverage

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Application
			 forms shall include the following questions designed to elicit information as
			 to whether, as of the date of the application, the applicant has another
			 long-term care insurance policy or certificate in force or whether a long-term
			 care policy or 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 the
			 questions may be used. With regard to a replacement policy issued to a group
			 defined by Paragraph a. of Subdivision (4) of Section
			 27-19-103,
Code of
			 Ala. 1975
, the following questions may be modified only to the
			 extent necessary to elicit information about health or long-term care insurance
			 policies other than the group policy being replaced, provided, that the
			 certificateholder has been notified of the replacement.
(a) Do you have another long-term care
			 insurance policy or certificate in force (including health care service
			 contract, health maintenance organization contract)?
(b) Did you have another long-term care
			 insurance policy or certificate in force during the last twelve (12) months?
1. If so, with which company?
2. If that policy lapsed, when did it
			 lapse?
(c) Are you
			 covered by Medicaid?
(d) Do you
			 intend to replace any of your medical or health insurance coverage with this
			 policy [certificate]?
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.13 - Discretionary Powers Of Commissioner

Current through Register Vol. 42, No. 9, June 28, 2024
The Commissioner may upon written request and after an
				administrative hearing, issue an order to modify or suspend a specific
				provision or provisions of this chapter with respect to a specific long-term
				care insurance policy or certificate upon a written finding of all of the
				following:
(a) The modification or
			 suspension would be in the best interest of the insureds.
(b) The purposes to be achieved could not be
			 effectively or efficiently achieved without the modification or
			 suspension.
(c) Any one of the
			 following:
1. The modification or suspension
			 is necessary to the development of an innovative and reasonable approach for
			 insuring long-term care.
2. The
			 policy or certificate is to be issued to residents of a life care or continuing
			 care retirement community or some other residential community for the elderly
			 and the modification or suspension is reasonably related to the special needs
			 or nature of such a community.
3.
			 The modification or suspension is necessary to permit long-term care insurance
			 to be sold as part of, or in conjunction with, another insurance product.
Author:
Reyn Norman, Associate
				Counsel
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.14 - Reserve Standards

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
(a) When long-term care benefits are provided
			 through the acceleration of benefits under group or individual life policies or
			 riders to such policies, policy reserves for such benefits shall be determined
			 in accordance with Chapter 36A of Title 27,
Code of Ala.
			 1975
. Claim reserves must also be established when such a policy
			 or rider is in claim status.
(b)
			 Reserves for policies and riders subject to this Paragraph (1) should be based
			 on the multiple decrement model utilizing all relevant decrements except for
			 voluntary termination rates. Single decrement approximations are acceptable if
			 the calculation produces essentially similar reserves, if the reserve is
			 clearly more conservative, or if the reserve is immaterial. The calculations
			 may include the reduction in life insurance benefits due to the payment of
			 long-term care benefits. However, the reserves for the longterm care benefit
			 and the life insurance benefit may not be less than the reserves for the life
			 insurance benefit assuming no long-term care benefit.
(c) In the development and calculation of
			 reserves for policies and riders subject to this Paragraph (1), due regard
			 shall be given to the applicable policy provisions, marketing methods,
			 administrative procedures, and all other considerations which have an impact on
			 projected claim costs, including, but not limited to, the following:
1. Definition of insured events.
2. Covered long-term care
			 facilities.
3. Existence of home
			 convalescence care coverage.
4.
			 Definition of facilities.
5.
			 Existence or absence of barriers to eligibility.
6. Premium waiver provision.
7. Renewability.
8. Ability to raise premiums.
9. Marketing method.
10. Underwriting procedures.
11. Claims adjustment procedures.
12. Waiting period.
13. Maximum benefit.
14. Availability of eligible
			 facilities.
15. Margins in claim
			 costs.
16. Optional nature of
			 benefit.
17. Delay in eligibility
			 for benefit.
18. Inflation
			 protection provisions.
19.
			 Guaranteed insurability option.
(d) Any applicable valuation morbidity table
			 shall be certified as appropriate as a statutory valuation table by a member of
			 the American Academy of Actuaries.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.15 - Loss Ratio

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Benefits
			 under long-term care insurance policies shall be deemed reasonable in relation
			 to premiums provided the expected loss ratio is at least sixty percent (60%),
			 calculated in a manner which provides for adequate reserving of the long-term
			 care insurance risk. In evaluating the expected loss ratio, due consideration
			 shall be given to all relevant factors, including:
(a) Statistical credibility of incurred
			 claims experience and earned premiums.
(b) The period for which rates are computed
			 to provide coverage.
(c)
			 Experienced and projected trends.
(d) Concentration of experience within early
			 policy duration.
(e) Expected claim
			 fluctuation.
(f) Experience
			 refunds, adjustments or dividends.
(g) Renewability features.
(h) All appropriate expense
			 factors.
(i) Interest.
(j) Experimental nature of the
			 coverage.
(k) Policy
			 reserves.
(l) Mix of business by
			 risk classification.
(m) Product
			 features such as long elimination periods, high deductibles and high maximum
			 limits.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.16 - Filing Requirement

Current through Register Vol. 42, No. 9, June 28, 2024
Prior to an insurer or similar organization offering group
				long-term care insurance to a resident of this state pursuant to Section
				27-19-104,
Code of
				Ala. 1975
, it shall file with the Commissioner evidence that the
				group policy or certificate thereunder has been approved by a state having
				statutory or regulatory long-term care insurance requirements substantially
				similar to those adopted in this state.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.18 - Requirement To Deliver Shopper's Guide

Current through Register Vol. 42, No. 9, June 28, 2024
(1) 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 Commissioner, shall be
			 provided to all prospective applicants of a long-term care insurance policy or
			 certificate.
(a) In the case of agent
			 solicitations, an agent must deliver the shopper's guide prior to the
			 presentation of an application or enrollment form.
(b) In the case of direct response
			 solicitations, the shopper's guide must be presented in conjunction with any
			 application or enrollment form.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.19 - Reporting Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Every
			 insurer shall maintain records for each agent of that agent's amount of
			 replacement sales as a percent of the agent's total annual sales and the amount
			 of lapses of long-term care insurance policies sold by the agent as a percent
			 of the agent's total annual sales.
(2) Each insurer shall report annually by
			 June 30 the ten percent (10%) of its agents with the greatest percentages of
			 lapses and replacements as measured by Paragraph (1) of this rule. (Appendix
			 G)
(3) Reported replacement and
			 lapse rates do not alone constitute a violation of insurance laws or
			 necessarily imply wrongdoing. The reports are for the purpose of reviewing more
			 closely agent activities regarding the sale of long-term care
			 insurance.
(4) Every insurer shall
			 report annually by June 30 the number of lapsed policies as a percent of its
			 total annual sales and as a percent of its total number of policies in force as
			 of the end of the preceding calendar year. (Appendix G)
(5) Every insurer shall report annually by
			 June 30 the number of replacement policies sold as a percent of its total
			 annual sales and as a percent of its total number of policies in force as of
			 the preceding calendar year. (Appendix G)
(6) Every insurer shall report annually by
			 June 30, for qualified long-term care insurance contracts, the number of claims
			 denied for each class of business, expressed as a percentage of claims denied.
			 (Appendix E)
(7) For purposes of
			 this rule:
(a) "Policy" means only long-term
			 care insurance;
(b) Subject to
			 Subparagraph (c), "claim" means a request for payment of benefits under an in
			 force policy regardless of whether the benefit claimed is covered under the
			 policy or any terms or conditions of the policy have been met;
(c) "Denied" means the insurer refuses to pay
			 a claim for any reason other than for claims not paid for failure to meet the
			 waiting period or because of an applicable preexisting condition; and
(d) "Report" means on a statewide
			 basis.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.20 - Permitted Compensation Arrangements

Current through Register Vol. 42, No. 9, June 28, 2024
No entity shall provide compensation to its agents or other
				producers, and no agent or producer shall receive compensation, greater than
				the renewal compensation payable by the replacing insurer on renewal policies
				or certificates if an existing policy or certificate is replaced unless
				benefits of the new policy or certificate are clearly and substantially greater
				than the benefits under the replaced policy. Insurers have the burden to
				determine the standards to judge whether the new policy is an improvement over
				the replaced policy.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.21 - Filing Requirements For Advertising

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Every insurer, health care service plan
			 or other entity providing long-term care insurance or benefits 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 of this state for review or approval by the
			 Commissioner to the extent it may be required under state law. In addition, all
			 advertisements shall be retained by the insurer, health care service plan or
			 other entity for at least three (3) years from the date the advertisement was
			 first used.
(2) The Commissioner
			 may exempt from these requirements any advertising form or material when in the
			 Commissioner's opinion, this requirement may not be reasonably applied.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.22 - Standards For Marketing

Current through Register Vol. 42, No. 9, June 28, 2024
(1) Every
			 insurer, health care service plan or other entity marketing long-term care
			 insurance coverage in this state, directly or through its producers, shall:
(a) Establish marketing procedures to assure
			 that any comparison of policies by its agents or other producers will be fair
			 and accurate.
(b) Establish
			 marketing procedures to assure excessive insurance is not sold or
			 issued.
(c) Display prominently by
			 type, stamp or other appropriate means, on the first page of the outline of
			 coverage and policy the following:
"Notice to buyer: This policy may not cover all of the costs
				associated with long-term care incurred by the buyer during the period of
				coverage. The buyer is advised to review carefully all policy
				limitations."
(d) Provide
			 copies of the disclosure forms required in Chapter
			 482-1-091-.28(3)
			 (Appendices B and F) to the applicant.
(e) 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, except that in the
			 case of qualified long-term care insurance contracts, an inquiry into whether a
			 prospective applicant or enrollee for long-term care insurance has accident and
			 sickness insurance is not required.
(f) Every insurer or entity marketing
			 long-term care insurance shall establish auditable procedures for verifying
			 compliance with this Paragraph (1).
(g) If the state in which the policy or
			 certificate is to be delivered or issued for delivery has a senior insurance
			 counseling program approved by the Commissioner, the insurer shall, at
			 solicitation, provide written notice to the prospective policyholder and
			 certificateholder that the program is available and the name, address and
			 telephone number of the program.
(h) For long-term care health insurance
			 policies and certificates, use the terms "noncancellable" or "level premium"
			 only when the policy or certificate conforms to Subparagraph (c) of Paragraph
			 (1) of Rule
			 482-1-091-.06.
(i) Provide an explanation of contingent
			 benefit upon lapse provided for in Chapter
			 482-1-091-.25(4)(c)
			 and if applicable, the additional contingent benefit upon lapse provided to
			 policies with fixed or limited premium paying periods in Chapter
			 482-1-091-.05(4)(d).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.23 - Suitability

Current through Register Vol. 42, No. 9, June 28, 2024
(1) This rule shall
			 not apply to life insurance policies that accelerate benefits for long-term
			 care.
(2) Every insurer, health
			 care service plan or other entity marketing long-term care insurance (the
			 "issuer") shall do all of the following:
(a)
			 Develop and use suitability standards to determine whether the purchase or
			 replacement of long-term care insurance is appropriate for the needs of the
			 applicant.
(b) Train its agents in
			 the use of its suitability standards.
(c) Maintain a copy of its suitability
			 standards and make them available for inspection upon request by the
			 Commissioner.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.24 - Prohibition Against Preexisting Conditions And Probationary Periods In Replacement Policies Or Certificates

Current through Register Vol. 42, No. 9, June 28, 2024
If a long-term care insurance policy or certificate replaces
				another long-term care policy or certificate, the replacing insurer shall waive
				any time periods applicable to preexisting conditions and probationary periods
				in the new long-term care policy for similar benefits to the extent that
				similar exclusions have been satisfied under the original policy.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.25 - Nonforfeiture Benefit Requirement

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 This rule does not apply to life insurance policies or riders containing
			 accelerated long-term care benefits.
(2) To comply with the requirement to offer a
			 nonforfeiture benefit pursuant to the provisions of Section
			 27-19-107,
Code of
			 Ala. 1975
:
(a) A policy or
			 certificate offered with nonforfeiture benefits shall 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 shall be the benefit described in Paragraph (5) of this
			 rule.
(b) 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.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.26 - Standards For Benefit Triggers

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 A long-term care insurance policy shall 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 shall not
			 be more restrictive than requiring either a deficiency in the ability to
			 perform not more than three (3) of the activities of daily living or the
			 presence of cognitive impairment.
(2)
(a)
			 Activities of daily living shall include at least all of the following as
			 defined in Rule
			 482-1-091-.05 and in the policy:
1. Bathing.
2. Continence.
3. Dressing.
4. Eating.
5. Toileting.
6. Transferring.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.27 - Additional Standards For Benefit Triggers For Qualified Long-Term Care Insurance Contracts

Current through Register Vol. 42, No. 9, June 28, 2024
(1) For
			 purposes of this rule the following definitions apply:
(a) "Qualified long-term care services" means
			 services that meet the requirements of Section 7702(c)(1) of the Internal
			 Revenue Code of 1986, as amended, as follows: necessary diagnostic, preventive,
			 therapeutic, curative, treatment, mitigation and rehabilitative services, and
			 maintenance or personal care services which are required by a chronically ill
			 individual, and are provided pursuant to a plan of care prescribed by a
			 licensed health care practitioner.
(b)
1.
			 "Chronically ill individual" has the meaning prescribed for this term by
			 Section 7702B(c)(2) of the Internal Revenue Code of 1986, as amended. Under
			 this provision, a chronically ill individual means any individual who has been
			 certified by a licensed health care practitioner as either of the following:
(i) Being unable to perform (without
			 substantial assistance from another individual) at least two (2) activities of
			 daily living for a period of at least ninety (90) days due to a loss of
			 functional capacity.
(ii) Requiring
			 substantial supervision to protect the individual from threats to health and
			 safety due to severe cognitive impairment.
2. The term "chronically ill individual"
			 shall not include an individual otherwise meeting these requirements unless
			 within the preceding twelve-month period a licensed health care practitioner
			 has certified that the individual meets these requirements.
(c) "Licensed health care
			 practitioner" means a physician, as defined in Section 1861(r)(1) of the Social
			 Security Act, a registered professional nurse, licensed social worker or other
			 individual who meets requirements prescribed by the Secretary of the
			 Treasury.
(d) "Maintenance or
			 personal care services" means any care the primary purpose of which is the
			 provision of needed assistance with any of the disabilities as a result of
			 which the individual is a chronically ill individual (including the protection
			 from threats to health and safety due to severe cognitive
			 impairment).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.28 - Required Disclosure Of Rating Practices To Consumers

Current through Register Vol. 42, No. 9, June 28, 2024
(1) This rule shall apply as follows:
(a) Except as provided in Paragraph (b), this
			 rule applies to any long-term care policy or certificate issued in this state
			 on or after July 1, 2006.
(b) For
			 certificates issued on or after the effective date of this amended regulation
			 under a group long-term care insurance policy as defined in Section
			 27-19-103(4),
Code of Ala. 1975
, which policy was in force at the
			 time this amended chapter became effective, the provisions of this rule shall
			 apply on the policy anniversary following January 1, 2007.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.29 - Initial Filing Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
			 This rule applies to any long-term care policy issued in this state on or after
			 July 1, 2006.
(2) An insurer shall
			 provide the information listed in this paragraph to the commissioner [30 days]
			 prior to making a long-term care insurance form available for sale.
(a) A copy of the disclosure documents
			 required in Rule
			 482-1-091-.28; and
(b) An actuarial certification consisting of
			 at least the following:
1. A statement that
			 the initial premium rate schedule is sufficient to cover anticipated costs
			 under moderately adverse experience and that the premium rate schedule is
			 reasonably expected to be sustainable over the life of the form with no future
			 premium increases anticipated;
2. A
			 statement that the policy design and coverage provided have been reviewed and
			 taken into consideration;
3. A
			 statement that the underwriting and claims adjudication processes have been
			 reviewed and taken into consideration;
4. A complete description of the basis for
			 contract reserves that are anticipated to be held under the form, to include:
(i) Sufficient detail or sample calculations
			 provided so as to have a complete depiction of the reserve amounts to be
			 held;
(ii) A statement that the
			 assumptions used for reserves contain reasonable margins for adverse
			 experience;
(iii) A statement that
			 the net valuation premium for renewal years does not increase (except for
			 attained-age rating where permitted); and
(iv) A statement that the difference between
			 the gross premium and the net valuation premium for renewal years is sufficient
			 to cover expected renewal expenses; or is such a statement cannot be made, a
			 complete description of the situations where this does not occur;
(I) An aggregate distribution of anticipated
			 issues may be used as long as the underlying gross premiums maintain a
			 reasonably consistent relationship;
(II) If the gross premiums for certain age
			 groups appear to be inconsistent with the requirement, the commissioner may
			 request a demonstration under Rule
			 482-1-091-.29(3)
			 based on a standard age distribution; and
5.
(i) A
			 statement that the premium rate schedule is not less than the premium rate
			 schedule for existing similar policy forms also available from the insurer
			 except for reasonable differences attributable to benefits; or
(ii) A comparison of the premium schedules
			 for similar policy forms that are currently available from the insurer with an
			 explanation of the differences.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.30 - Premium Rate Schedule Increases

Current through Register Vol. 42, No. 9, June 28, 2024
(1) This rule shall apply as follows:
(a) Except as provided in Rule
			 482-1-091-.30(1)(b),
			 this rule applies to any long-term care policy or certificate issued in this
			 state on or after July 1, 2006.
(b)
			 For certificates issued on or after the effective date of this amended chapter
			 under a group long-term care insurance policy as defined in Section
			 27-19-103(4),
Code of Ala. 1975
, which policy was in force at the
			 time this amended chapter became effective, the provisions of this rule shall
			 apply on the policy anniversary following January 1, 2007.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.31 - Penalties

Current through Register Vol. 42, No. 9, June 28, 2024
In addition to any other penalties provided by the laws of this
				state any insurer and any agent found to have violated any requirement of this
				state relating to the regulation of long-term care insurance or the marketing
				of such insurance shall be subject to a fine of up to three (3) times the
				amount of any commissions paid for each policy involved in the violation or up
				to $10,000, whichever is greater.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Ed Note: Rule was formerly
				  482-1-091-.28 as per
				  certification filed December 21,
				  2005.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.32 - Producer Licensing And Training Requirements

Current through Register Vol. 42, No. 9, June 28, 2024
(1) A producer is not authorized to sell,
			 solicit or negotiate with respect to long-term care insurance except as
			 authorized by Section
			 27-19-100 et seq.,
Code of Ala. 1975
.
(2)
(a) An
			 individual who is newly licensed as a producer on or after March 1, 2009, may
			 not sell, solicit or negotiate long-term care insurance unless the individual
			 is licensed as an insurance producer for accident and health or sickness or
			 life and has completed a one-time eight (8) hour training course. The training
			 shall meet the requirements set forth in paragraph (3).
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.33 - Availability Of New Services Or Providers

Current through Register Vol. 42, No. 9, June 28, 2024
(1) An insurer shall notify policyholders of
			 the availability of a new long-term care 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 within twelve (12) months of the date the new policy series
			 is made available for sale in this state.
(2) Notwithstanding Paragraph 1 above,
			 notification is not required for any policy issued prior to the effective date
			 of this rule or to any policyholder or certificateholder who is currently
			 eligible for benefits, within an elimination period or on claim, or who
			 previously has 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 such new services or
			 providers.
(3) The insurer shall
			 make the new coverage available in one of the following ways:
(a) By adding a rider to the existing policy
			 and charging a separate premium for the new rider based on the insured's
			 attained age;
(b) 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.
(c) 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
(d) By an alternative program developed by
			 the insurer that meets the intent of this rule if the program is filed with and
			 approved by the Commissioner.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.34 - Right To Reduce Coverage And Lower Premiums

Current through Register Vol. 42, No. 9, June 28, 2024
(1)
(a)
			 Every long-term care insurance policy and certificate shall include a provision
			 that allows the policyholder or certificateholder to reduce coverage and lower
			 the policy or certificate premium in at least one of the following ways:
1. Reducing the maximum benefit; or
2. amount. Reducing the daily, weekly or
			 monthly benefit
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.35 - Separability

Current through Register Vol. 42, No. 9, June 28, 2024
If any provision of this chapter or the application thereof to
				any person or circumstance is for any reason held to be invalid, the remainder
				of the chapter and the application of such provision to other persons or
				circumstances shall not be affected thereby.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Ed Note:
Rule was formerly
				  482-1-091-.29 as per
				  certification filed December 21, 2005. Rule was formerly
				  482-1-091-.32 as per
				  certification filed December 19,
				  2007.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Section 482-1-091-.36 - Effective Date

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall become effective on January 1, 2006, upon
				its approval by the Commissioner of Insurance, and upon its having been on file
				as a public document in the office of the Secretary of State for ten
				days.
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Ed Note:
Rule was formerly
				  482-1-091-.30 as per
				  certification filed December 21, 2005. Rule was formerly
				  482-1-091-.33 as per
				  certification filed December 19,
				  2007.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix A - Rescission Reporting Form

Current through Register Vol. 42, No. 9, June 28, 2024
Click to
				view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix B - Personal Worksheet

Current through Register Vol. 42, No. 9, June 28, 2024
Click to
				view image
Click to
				view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix C - Disclosure Form

Current through Register Vol. 42, No. 9, June 28, 2024
Click to
				view image
Click to
				view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix D - Response Letter

Current through Register Vol. 42, No. 9, June 28, 2024
Click to
				view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix E - Claims Denial Reporting Form

Current through Register Vol. 42, No. 9, June 28, 2024
Click to
				view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix F - Potential Rate Increase Disclosure Form

Current through Register Vol. 42, No. 9, June 28, 2024
Click to
				view image
Click to
				view image
Click
				to view image
Click
				to view image
Click
				to view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-091 - LONG TERM CARE INSURANCE › Appendix G - Replacement And Lapse Reporting Form

Current through Register Vol. 42, No. 9, June 28, 2024
Click
				to view image
Click
				to view image
Author:
Reyn Norman, Associate Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17,
				  27-19-100,
et
seq
.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-092 - (REPEALED) › Section 482-1-092 - Repealed

Current through Register Vol. 42, No. 9, June 28, 2024
Author:
Reyn Norman, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §§
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-093 - CREDIT PROPERTY AND INVOLUNTARY UNEMPLOYMENT INSURANCE › Section 482-1-093-.01 - Purpose And Authority

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter is designed to stimulate open competition among
				insurers to provide property and involuntary unemployment insurance coverage in
				the credit context at rates which are not unfairly discriminatory or excessive.
				Where such insurance is sold by a creditor in connection with the extension of
				credit, the regulating forces of open competition may not operate to control
				rates and extend benefits. The purpose of this chapter is to designate rate
				levels for certain coverages above which rates for such insurance sold in the
				credit context will be presumed excessive and unfairly discriminatory under
				statutory standards. This chapter is adopted pursuant to the provisions of
				Section 27-2-17,
Code of Ala.
				1975
.
Author:
Vincent R. Ledlow, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.
Alabama Administrative Code › Title 482 - ALABAMA DEPARTMENT OF INSURANCE › Chapter 482-1-093 - CREDIT PROPERTY AND INVOLUNTARY UNEMPLOYMENT INSURANCE › Section 482-1-093-.02 - Scope

Current through Register Vol. 42, No. 9, June 28, 2024
This chapter shall apply to the sale of the designated types of
				insurance by a creditor to a debtor with a direct charge to the debtor.
Author:
Vincent R. Ledlow, Associate
				Counsel
Statutory Authority:
Code of Ala.
				  1975
, §
										27-2-17.