reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 81 - Corporate Governance Annual Disclosure › Section 81-4 - Severability

Current through July 10, 2024
Authority: IC 27-1-4.1-15
Affected: IC 27-1-4.1-15
Sec. 4.
If:
(1) any section
				or portion of a section of this rule; or
(2) its applicability to any person or
				circumstance; is held invalid by a court, the remainder of the rule or the
				applicability of the provision to other persons or circumstances shall not be
				affected.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-1 - Applicability of definitions

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 1.
The definitions in this rule apply throughout this
				  rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-2 - "Actuarial method" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 2.
"Actuarial method" means the methodology used to determine
				  the required level of primary security, as described in section 16 of this
				  rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-3 - "Commissioner" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 3.
"Commissioner" means the commissioner of the department of
				  insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-4 - "Covered policies" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 4.
"Covered policies" means, subject to the exemptions
				  described in section 15 of this rule, policies, other than grandfathered
				  policies, of the following policy types:
(1) Life insurance policies with guaranteed
				nonlevel gross premiums or guaranteed nonlevel benefits, or both, except for
				flexible premium universal life insurance policies.
(2) Flexible premium universal life insurance
				policies with provisions resulting in the ability of a policyholder to keep a
				policy in force over a secondary guarantee period.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-5 - "Grandfathered policies" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 5.
"Grandfathered policies" means policies of the types
				  described in section 4 of this rule that were:
(1) issued prior to January 1, 2015;
				and
(2) ceded, as of December 31,
				2014, as part of a reinsurance treaty that would not have met one (1) of the
				exemptions set forth in section 15 of this rule had that section then been in
				effect.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-6 - "NAIC" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 6.
"NAIC" means the National Association of Insurance
				  Commissioners.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-7 - "Noncovered policies" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 7.
"Noncovered policies" means any policy that does not meet
				  the definition of "covered policies", including grandfathered policies.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-8 - "Other security" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 8.
"Other security" means any security acceptable to the
				  commissioner other than security meeting the definition of "primary
				  security".
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-9 - "Primary security" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1-3
Sec. 9.
"Primary security" means the following forms of
				  security:
(1) Cash meeting the
				requirements of IC 27-6-10.1-3(A).
(2) Securities listed by the Securities
				Valuation Office meeting the requirements of IC 27-6-10.1-3(B), but excluding a
				synthetic letter of credit, a contingent note, a credit-linked note, or other
				similar security that operates in a manner similar to a letter of credit, and
				excluding any securities issued by the ceding insurer or any of its
				affiliates.
(3) For security held
				in connection with funds-withheld and modified coinsurance reinsurance
				treaties:
(A) commercial loans in good
				standing of CM3 quality and higher;
(B) policy loans; and
(C) derivatives acquired in the normal course
				and used to support and hedge liabilities pertaining to the actual risks in the
				policies ceded under the reinsurance treaty.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-10 - "Required level of primary security" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 10.
"Required level of primary security" means the dollar amount
				  determined by applying the actuarial method to the risks ceded with respect to
				  covered policies, but not more than the total reserve ceded.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-11 - "Valuation Manual" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-1-1.5-35; IC 27-1-12.8-34; IC
				  27-6-10.1
Sec. 11.
"Valuation Manual" means the Valuation Manual described in IC
				  27-1-1.5-35 and adopted by the NAIC as described IC 27-1-12.8-34(b)(1), with
				  all amendments adopted by the NAIC that are effective for the financial
				  statement date on which credit for reinsurance is claimed.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-12 - "VM-20" defined

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1
Sec. 12.
"VM-20" refers to "VM-20: Requirements for Principle-Based
				  Reserves for Life Products", including all relevant definitions, from the
				  Valuation Manual.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-13 - Purpose

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1-5
Sec. 13.
The purpose of this rule is to:
(1) establish among NAIC members uniform
				standards governing reserve financing arrangements that pertain to:
(A) a life insurance policy containing
				guaranteed nonlevel gross premiums;
(B) a life insurance policy containing
				guaranteed nonlevel benefits; and
(C) a universal life insurance policy with
				secondary guarantees; and
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-14 - Applicability

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1-5
Sec. 14.
(a) This
				rule applies to reinsurance treaties that cede liabilities pertaining to
				covered policies issued by any life insurance company domiciled in this
				state.
(b) This rule and
				760 IAC 1-56 both apply to the
				reinsurance treaties described in subsection (a). In the event of a direct
				conflict between the provisions of this rule and
				760 IAC 1-56, the provisions of
				this rule apply, but only to the extent of the conflict.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-15 - Exemptions

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-1-23-1; IC 27-1-36-4; IC 27-6-10.1-2; IC
				  27-6-10.1-5
Sec. 15.
This rule does not apply to the following:
(1) Reinsurance of the following:
(A) Policies that satisfy the criteria for
				exemption set forth in
				760 IAC 1-64-4(f)
				 or
				760 IAC 1-64-4(g)
				 and which are issued before the later of:
(i) the effective date of this rule;
				and
(ii) the date on which the
				ceding insurer begins to apply the provisions of VM-20 to establish the ceded
				policies' statutory reserves, but not later than January 1, 2020.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-18 - Prohibition against avoidance

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1-5
Sec. 18.
No insurer that has covered policies to which this rule
				  applies may take an action, or series of actions, or enter into a transaction
				  or arrangement, or series of transactions or arrangements, if the purpose of
				  the action, transaction, or arrangement, or series thereof, is to avoid the
				  requirements or circumvent the purpose of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 1 - GENERAL PROVISIONS › Rule 82 - Term and Universal Life Insurance Reserve Financing › Section 82-19 - Severability

Current through July 10, 2024
Authority: IC 27-6-10.1-5
Affected: IC 27-6-10.1-5
Sec. 19.
If any provision of this rule is held invalid, the remainder
				  shall not be affected.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 1 - General Provisions › Section 1-1 - Applicability and scope

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
Except as otherwise specifically provided, this article
				  applies to the following:
(1) All long
				term care insurance policies, certificates, or subscriber agreements delivered
				or issued for delivery in Indiana on or after the effective date hereof by
				insurers.
(2) Fraternal benefit
				societies.
(3) Nonprofit health,
				hospital, and medical service corporations.
(4) Prepaid health plans.
(5) Health maintenance organizations and all
				similar organizations.
Certain provisions of this article apply only to federally
				  tax-qualified long term care insurance contracts.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-1 - Policy definitions

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
(a) No long
				term care insurance policy, certificate, or subscriber agreement delivered, or
				issued for delivery, in Indiana shall contain the terms set forth in this rule,
				unless the terms are defined in the policy and the definitions satisfy the
				requirements in this section.
(b)
				All providers of services, including, but not limited to:
(1) skilled nursing facility;
(2) extended care facility;
(3) intermediate care facility;
(4) convalescent nursing home;
(5) personal care facility; and
(6) home care agency;
shall be defined in relation to the services and facilities
				  required to be available and the licensure or degree status of those providing
				  or supervising the services. The definition may require that the provider be
				  appropriately licensed or certified.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-1.5 - "Activities of daily living" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.5.
"Activities of daily living" means, at a minimum, the
				  following:
(1) Bathing.
(2) Continence.
(3) Dressing.
(4) Eating.
(5) Toileting.
(6) Transferring.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-2 - "Acute condition" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
"Acute condition" means that the individual is medically
				  unstable. Such an individual requires frequent monitoring by medical
				  professionals, such as physicians and registered nurses, in order to maintain
				  his or her health status.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3 - "Adult day care" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.
"Adult day care" means a program for six (6) or more
				  individuals, of social and health related services provided during the day in a
				  community group setting for the purpose of supporting frail, impaired, elderly,
				  or other adults with disabilities who can benefit from care in a group setting
				  outside the home.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.1 - "Bathing" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.1.
"Bathing" means washing oneself by sponge bath or in either
				  a tub or shower, including the task of getting into or out of the tub or
				  shower.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.2 - "Cognitive impairment" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.2.
"Cognitive impairment" means a deficiency in:
(1) a person's short term or long term
				memory;
(2) orientation as to
				person, place, and time;
(3)
				deductive or abstract reasoning; or
(4) judgment;
as it relates to safety awareness.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.3 - "Continence" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.3.
"Continence" means the ability to maintain control of bowel
				  and bladder functions or, when unable to maintain control of bowel or bladder
				  function, the ability to perform associated personal hygiene, including caring
				  for catheter or colostomy bag.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.4 - "Department" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.4.
"Department" means the department of insurance.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.5 - "Dressing" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.5.
"Dressing" means putting on and taking off all items of
				  clothing and any necessary braces, fasteners, or artificial limbs.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.6 - "Eating" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.6.
"Eating" means feeding oneself by getting food into the
				  body:
(1) from a receptacle, such as a
				plate or cup;
(2) by a feeding
				tube; or
(3)
				intravenously.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.7 - "Federally tax-qualified long term care insurance contract" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.7.
(a)
				"Federally tax-qualified long term care insurance contract" means an individual
				or group insurance contract that meets the requirements of Section 7702B(b) of
				the Internal Revenue Code of 1986, as amended, as follows:
(1) The only insurance protection provided
				under the contract is coverage of qualified long term care services. A contract
				shall not fail to satisfy this requirement by reason of payments being made on
				a per diem or other periodic basis without regard to the expenses incurred
				during the period to which the payments relate.
(2) The contract does not pay or reimburse
				expenses incurred for services or items to the extent that the expenses are
				reimbursable under Title XVIII of the Social Security Act, as amended, or would
				be so reimbursable but for the application of a deductible or coinsurance
				amount. The requirements of this section do not apply to expenses that are
				reimbursable under Title XVIII of the Social Security Act only as a secondary
				payor. A contract shall not fail to satisfy the requirements of this section by
				reason of payments being made on a per diem or other periodic basis without
				regard to the expenses incurred during the period to which the payments
				relate.
(3) The contract is
				guaranteed renewable, within the meaning of Section 7702B(b)(1)(C) of the
				Internal Revenue Code of 1986, as amended.
(4) The contract does not provide for a cash
				surrender value or other money that can be paid, assigned, pledged as
				collateral for a loan, or borrowed except as provided in subdivision
				(5).
(5) All refunds of premiums,
				and all policyholder dividends or similar amounts, under the contract are to be
				applied as a reduction in future premiums or to increase future benefits,
				except that a refund on the event of the death of the insured or a complete
				surrender of cancellation of the contract cannot exceed the aggregate premiums
				paid under the contract.
(6) The
				contract meets the consumer protection provisions set forth in Section 7702B(g)
				of the Internal Revenue Code of 1986, as amended.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-3.8 - "Hands-on assistance" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.8.
"Hands-on assistance" means physical assistance (minimal,
				  moderate, or maximal) without which the individual would not be able to perform
				  the activities of daily living.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-4 - "Home health care services" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 4.
"Home health care services" means medical and nonmedical
				  services provided to ill, disabled, or infirm persons in their residences. Such
				  services may include, but are not limited to, the following:
(1) Home health nursing services.
(2) Home health aide services.
(3) Homemaker services.
(4) Assistance with activities of daily
				living.
(5) Respite care
				services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-5 - "Medicare" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 5.
"Medicare" means "The Health Insurance for the Aged Act,
				  Title XVIII of the Social Security Amendments of 1965 as Then Constituted or
				  Later Amended", or "Title I, Part I of
				  Public Law
				  89-97, as Enacted by the Eighty-Ninth Congress of
				  the United States of America and popularly known as the Health Insurance for
				  the Aged Act, as then constituted and any later amendments or substitutes
				  thereof", or words of similar import.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-6 - "Mental or nervous disorder" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 6.
"Mental or nervous disorder" includes only neurosis,
				  psychoneurosis, psychopathy, psychosis, or mental or emotional disease or
				  disorder.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-7 - "Personal care" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 7.
"Personal care" means the provision of hands-on services to
				  assist an individual with activities of daily living (such as bathing, eating,
				  dressing, transferring, and toileting).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 2 - Definitions › Section 2-8 - "Skilled nursing care", "intermediate care", "personal care", "home care", and "other services" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 8.
"Skilled nursing care", "intermediate care", "personal
				  care", "home care", and "other services" shall be defined in relation to the
				  level of skill required, the nature of the care, and the setting in which care
				  must be delivered.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-1 - Individual long term care policies

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-8-12
Sec. 1.
(a) The
				terms "guaranteed renewable" and "noncancellable" shall be used in an
				individual long term care insurance policy only with further explanatory
				language in accordance with the disclosure requirements of
				760 IAC 2-4.
(b) A long term care insurance policy issued
				to an individual shall not contain renewal provisions other than "guaranteed
				renewable" or "noncancellable".
(c)
				The term "guaranteed renewable" may be used only when:
(1) the insured has the right to continue the
				long term care insurance in force by the timely payment of premiums;
(2) 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
(3) the insurer
				cannot decline to renew, except that rates may be revised by the insurer on a
				class basis.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-2 - Exclusions

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
A policy, certificate, or subscriber agreement may not be
				  delivered or issued for delivery in Indiana as long term care insurance if the
				  policy, certificate, or subscriber agreement limits or excludes coverage by
				  type of illness, treatment, medical condition, or accident, except as
				  follows:
(1) Preexisting conditions or
				diseases.
(2) Mental or nervous
				disorders; however, this shall not permit exclusion or limitation of benefits
				on the basis of Alzheimer's disease or related degenerative and dementing
				illnesses.
(3) Alcoholism and drug
				addiction.
(4) Illness, treatment,
				or medical condition arising out of:
(A) war
				or act of war (whether declared or undeclared);
(B) participation in a felony, riot, or
				insurrection;
(C) service in the
				armed forces or units auxiliary thereto;
(D) suicide (sane or insane), attempted
				suicide, or intentionally self-inflicted injury; or
(E) aviation (this exclusion applies only to
				nonfare paying passengers).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-3 - Termination; extension of benefits

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.
Termination of long term care insurance shall not prejudice
				  any benefits payable for institutionalization if the institutionalization began
				  while the long term care insurance was in force and which institutionalization
				  continues without interruption after termination. The extension of benefits
				  beyond the period the long term care insurance was in force may be limited to
				  the following:
(1) The duration of the
				benefit period, if any.
(2) Payment
				of the maximum benefits, if any.
Further, such extension of benefits may be subject to any
				  policy waiting period and all other applicable provisions of the
				  policy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-4 - Group long term care policies

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 4.
(a) Group
				long term care insurance policies, certificates, or subscriber agreements
				issued in Indiana on or after the effective date of this article shall provide
				covered individuals with a basis for continuation or conversion of
				coverage.
(b) As used in this
				article, "basis for continuation of coverage" means a policy provision that
				maintains coverage under the existing group policy when such coverage would
				otherwise terminate and that is subject only to the continued timely payment of
				premium. Group policies that contain incentives to use certain providers or
				facilities, or both, and group policies that provide a restricted list of
				providers or facilities, or both, shall provide continuation of benefits that
				are substantially equivalent to the benefits of the existing group policy. The
				commissioner shall make a determination as to the substantial equivalency of
				benefits. The commissioner shall consider the differences between managed care
				and nonmanaged care plans, including, but not limited to, the following:
(1) Provider system arrangements.
(2) Service availability.
(3) Benefit levels.
(4) Administrative complexity.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-5 - Replacement

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 5.
If a group long term care policy, certificate, or subscriber
				  agreement is replaced by another group long term care policy, certificate, or
				  subscriber agreement issued to the same policyholder or to the members of the
				  previous policyholder's group, the succeeding insurer shall offer coverage to
				  all persons covered under the previous group policy on its date of termination.
				  Coverage provided or offered to individuals by the insurer and premiums charged
				  to persons under the new group policy:
(1) shall not result in any exclusion for
				preexisting conditions that would have been covered under the group policy
				being replaced; and
(2) shall not
				vary or otherwise depend on the individual's health or disability status, claim
				experience, or use of long term care services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-6 - Premiums

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 6.
The premiums charged to an insured for long term care
				  insurance shall not increase due to either:
(1) the increasing age of the insured at
				sixty-five (65) years of age or beyond; or
(2) the duration the insured has been covered
				under the policy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 3 - Policy Practices and Provisions › Section 3-7 - Electronic enrollment

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 7.
(a) In the
				case of a group long term care policy, any requirement that a signature of an
				insured be obtained by an insurance producer or insurer shall be deemed
				satisfied if the following conditions are met:
(1) The consent is obtained by telephonic or
				electronic enrollment by the group policyholder or insurer. A verification of
				enrollment information shall be provided to the enrollee.
(2) The telephonic or electronic enrollment
				provides necessary and reasonable safeguards to assure:
(A) the accuracy, retention, and prompt
				retrieval of records; and
(B) that
				the confidentiality of individually identifiable information is
				maintained.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 4 - Required Disclosure Provisions › Section 4-1 - Renewability provisions

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-8-12-10.6
Sec. 1.
(a)
				Individual long term care insurance policies shall contain a renewability
				provision. The provision shall:
(1) be
				appropriately captioned;
(2) appear
				on the first page of the policy; and
(3) clearly state the duration of:
(A) renewability, where limited;
(B) the term of coverage for which the policy
				is issued; and
(C) the term of
				coverage for which the policy may be renewed.
This section shall not apply to policies that do not contain
				  a renewability provision, and under which the policies' right to nonrenew is
				  reserved solely to the policyholder. 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 the premium rate may change.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 5 - Prohibition Against Post-Claims Underwriting › Section 5-1 - Application; medication

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
(a) All
				applications for long term care insurance policies, certificates, or subscriber
				agreements except those which are guaranteed issue shall contain clear and
				unambiguous questions designed to ascertain the health condition of the
				applicant.
(b) If an application
				for long term care insurance contains a question which asks whether the
				applicant has had medication prescribed by a physician, it must also ask the
				applicant to list the medication that has been prescribed.
(c) If the medications listed in such
				application were known by the insurer, or should have been known at the time of
				application, to be directly related to a medical condition for which coverage
				would otherwise be denied, then the policy, certificate, or subscriber
				agreement shall not be rescinded for that condition.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 5 - Prohibition Against Post-Claims Underwriting › Section 5-2 - Language of application; supplemental information

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
Except for policies, certificates, or subscriber agreements
				  which are guaranteed issue, the following apply:
(1) The following language shall be set out
				conspicuously and in close conjunction with the applicant's signature block on
				an application for a long term care insurance policy, certificate, or
				subscriber agreement: "Caution: If your answers on this application are
				incorrect or untrue, [company] has the right to deny benefits or rescind your
				[policy] [certificate] [subscriber agreement].".
(2) The following language, or language
				substantially similar to the following, shall be set out conspicuously on the
				long term care insurance policy, certificate, or subscriber agreement at the
				time of delivery: "Caution: The issuance of this long term care insurance
				[policy] [certificate] [subscriber agreement] is based upon your responses to
				the questions on your application. A copy of your [application] [enrollment
				form] [is enclosed] [was retained by you when you applied]. If your answers are
				incorrect or untrue, the company has the right to deny benefits or rescind your
				[policy] [certificate] [subscriber agreement]. The best time to clear up any
				questions is now, before a claim arises! If, for any reason, any of your
				answers are incorrect, contact the company at this address: [insert
				address].".
(3) Prior to issuance
				of a policy, certificate, or subscriber agreement to an applicant eighty (80)
				years of age or older, the insurer shall obtain one (1) of the following:
(A) A report of a physical
				examination.
(B) An assessment of
				functional capacity.
(C) An
				attending physician's statement.
(D) Copies of medical records.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 5 - Prohibition Against Post-Claims Underwriting › Section 5-3 - Completed application or enrollment form

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.
A copy of the completed application or enrollment form
				  (whichever is applicable) shall be delivered to the insured no later than at
				  the time of delivery of the policy, certificate, or subscriber agreement unless
				  it was retained by the applicant at the time of application.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 5 - Prohibition Against Post-Claims Underwriting › Section 5-4 - Records

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 4.
Every insurer or other entity selling or issuing long term
				  care insurance benefits shall maintain a record of all policy, certificate, or
				  subscriber agreement rescissions, both statewide and country wide, except those
				  which the insured voluntarily effectuated and shall annually furnish this
				  information to the insurance commissioner in the format prescribed by the
				  National Association of Insurance Commissioners.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 6 - Home Health Care Benefits in Long Term Care Insurance Policies › Section 6-1 - Minimum standards for home health and community care benefits

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
(a) A long
				term care insurance policy, certificate, or subscriber agreement shall not, if
				it provides benefits for home health and community care services, limit or
				exclude benefits as follows:
(1) By requiring
				that the insured/claimant need skilled care in a skilled nursing facility if
				home health care services were not provided.
(2) By requiring that the insured/claimant
				first or simultaneously receive nursing and/or therapeutic services in a home,
				community, or institutional setting before home health care services are
				covered.
(3) By limiting eligible
				services to services provided by registered nurses or licensed practical
				nurses.
(4) 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.
(5) By requiring that the insured/claimant
				have an acute condition before home health care services are covered.
(6) By limiting benefits to services provided
				by Medicare-certified agencies or providers.
(7) By excluding coverage for personal care
				services provided by a home health aide.
(8) 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.
(9) By excluding coverage for adult day care
				services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 7 - Inflation Protection Offer › Section 7-1 - General provisions

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
(a) 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 that 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 (1) of the following:
(1) Increase benefit levels annually to be
				compounded annually at a rate not less than five percent (5%).
(2) Guarantee 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 more 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.
(3) Cover a
				specified percentage of actual or reasonable charges and does not include a
				maximum specified indemnity amount or limit.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 7 - Inflation Protection Offer › Section 7-2 - Group policy; exception

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-5-17; IC
				  27-8-12
Sec. 2.
Where the policy is issued to a group, the required offer
				  under section 1 of this rule shall be made to the group policyholder; except,
				  if the policy is issued to a group defined in IC
				  27-8-5-17 other than to a
				  continuing care retirement community, the offering shall be made to each
				  proposed certificate holder.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 7 - Inflation Protection Offer › Section 7-3 - Accelerated long term care benefits

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 3.
The offer under section 1 of this rule shall not be required
				  of life insurance policies or riders containing accelerated long term care
				  benefits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 7 - Inflation Protection Offer › Section 7-4 - Outline of coverage

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 4.
Insurers shall include the following information in or with
				  the outline of coverage:
(1) A graphic
				comparison of the benefit levels of a policy that increases benefits over the
				policy period with a policy that does not increase benefits. The graphic
				comparison shall show benefit levels over at least a twenty (20) year
				period.
(2) Any expected premium
				increases or additional premiums to pay for automatic or optional benefit
				increases. If premium increases or additional premiums will be based on the
				attained age of the applicant at the time of the increase, the insurer shall
				also disclose the magnitude of the potential premiums the applicant would need
				to pay at seventy-five (75) and eighty-five (85) years of age for benefit
				increases.
(3) An insurer may use a
				reasonable hypothetical or a graphic demonstration, for the purposes of this
				disclosure.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 8 - Application Forms and Replacement Coverage › Section 8-1 - Questions

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-5-16; IC
				  27-8-12
Sec. 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,
				  certificate, or subscriber agreement in force or whether a long term care
				  policy, certificate, or subscriber agreement is intended to replace any other
				  accident and sickness or long term care policy, certificate, or subscriber
				  agreement presently in force:
(1) Do
				you have another long term care insurance policy or certificate in force
				(including health care service contract or health maintenance organization
				contract)?
(2) Did you have another
				long term care insurance policy or certificate in force during the last twelve
				(12) months? If so:
(A) with which company;
				and
(B) if that policy lapsed, when
				did it lapse?
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 8 - Application Forms and Replacement Coverage › Section 8-2 - Any other health insurance policies

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
Insurance producers shall list the following:
(1) Any other health insurance policies they
				have sold to the applicant.
(2)
				Policies sold which are still in force.
(3) Policies sold in the past five (5) years
				that are no longer in force.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 8 - Application Forms and Replacement Coverage › Section 8-5 - Replacement; notification

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 5.
Where replacement is intended, the replacing insurer shall
				  notify, in writing, the existing insurer of the proposed replacement. The
				  existing policy, certificate, or subscriber agreement shall be identified by
				  the insurer, name of the insured, and policy number or address including zip
				  code. Such notice shall be made within five (5) working days from the date the
				  application is received by the insurer or the date the policy, certificate, or
				  subscriber agreement is issued, whichever is sooner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 8 - Application Forms and Replacement Coverage › Section 8-6 - Life insurance policies

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-8-12
Sec. 6.
Life insurance policies that accelerate benefits for long
				  term care shall comply with this rule if the policy being replaced is a long
				  term care insurance policy. If the policy being replaced is a life insurance
				  policy, the insurer shall comply with the replacement requirements of
				  760 IAC 1-16.1. If a life
				  insurance policy that accelerates benefits for long term care is replaced by
				  another such policy, the replacing insurer shall comply with both the long term
				  care and the life insurance replacement requirements.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 9 - Reporting Requirements › Section 9-1 - Reporting

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
(a) Every
				insurer shall maintain records for each insurance producer of that insurance
				producer's amount of replacement sales as a percent of the insurance producer's
				total annual sales and the amount of lapses of long term care insurance
				policies sold by the insurance producer as a percent of the insurance
				producer's total annual sales.
(b)
				Each insurer shall report annually by June 30 the ten percent (10%) of its
				insurance producers with the greatest percentages of lapses and replacements as
				measured by subsection (a).
(c)
				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 insurance producer activities regarding the sale of
				long term care insurance.
(d) Every
				insurer shall report annually by June 30 the number of the following:
(1) 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.
(2) 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.
(3) Claims denied for each class of business
				as a percentage of claims.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 10 - Licensing › Section 10-1 - Licensing

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-1-15.5-3; IC
				  27-1-15.7-2
Sec. 1.
(a) No
				insurer shall allow any long term care product to be marketed, sold, or
				solicited, or otherwise allow the contact of any person for the purpose of
				marketing long term care insurance unless the insurance producer doing so has
				met all of the following criteria:
(1) The
				insurance producer has successfully passed eight (8) hours of approved
				continuing education courses in long term care and long term care insurance. An
				insurance producer who completes the eight (8) hours of continuing education
				required by this subsection during the first two (2) years of a four (4) year
				license shall also comply with subsection (b) during the second two (2) years
				of the license.
(2) The insurance
				producer has successfully completed five (5) hours of approved continuing
				education in long term care or long term care insurance every two (2) years for
				a total of ten (10) hours in every four (4) year license renewal
				period.
(3) Has completed and
				passed the continuing education courses set out in this rule prior to accepting
				applications from the insurance producer or paying the insurance producer
				commission for the sale of long term care coverage.