reglab/statecodes huggingface dataset:
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 11 - Discretionary Powers of Commissioner › Section 11-1 - Modification or suspension

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC 4-21.5; IC
				  27-8-12
Sec. 1.
The commissioner may, upon written request and after a
				  hearing under IC 4-21.5, issue an order to modify or suspend a specific
				  provision or provisions of this article with respect to a specific long term
				  care insurance policy, certificate, or subscriber agreement upon a written
				  finding of the following:
(1) The
				modification or suspension would be in the best interest of the
				insureds.
(2) The purposes to be
				achieved could not be effectively or efficiently achieved without the
				modification or suspension.
(3) Any
				of the following are necessary:
(A) The
				modification or suspension is necessary to the development of an innovative and
				reasonable approach for insuring long term care.
(B) The policy, certificate, or subscriber
				agreement 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.
(C) 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.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 12 - Reserve Standards › Section 12-1 - Reserves for policies, certificates, and riders

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 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 or certificates,
				policy reserves for such benefits shall be determined in accordance with IC
				27-1-12 - 10(2)(h)
[IC
				27-1-12-10 was repealed by
				P.L.
				276-2013,
				SECTION
				5, effective July 1, 2013.]
. Claim
				reserves must also be established in the case when such policy, certificate, or
				rider is in claim status. Reserves for policies, certificates, and riders
				subject to this section 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 take into account the
				reduction in life insurance benefits due to the payment of long term care
				benefits. However, in no event shall the reserves for the long term care
				benefit and the life insurance benefit be less than the reserves for the life
				insurance benefit assuming no long term care benefit.
(b) In the development and calculation of
				reserves for policies, certificates, and riders subject to this section, due
				regard shall be given to the applicable policy, certificate, or rider
				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.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 13 - Loss Ratio › Section 13-1 - Relevant factors

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-1-12-7; IC 27-8-12-14.5; IC
				  27-8-12-14.6
Sec. 1.
(a) Benefits
				under individual 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 that 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 the following:
(1) Statistical credibility of incurred
				claims experience and earned premiums.
(2) The period for which rates are computed
				to provide coverage.
(3)
				Experienced and projected trends.
(4) Concentration of experience within early
				policy duration.
(5) Expected claim
				fluctuation.
(6) Experience
				refunds, adjustments, or dividends.
(7) Renewability features.
(8) All appropriate expense
				factors.
(9) Interest.
(10) Experimental nature of the
				coverage.
(11) Policy
				reserves.
(12) Mix of business by
				risk classification.
(13) Product
				features, such as long elimination periods, high deductibles, and high maximum
				limits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 14 - Filing Requirements › Section 14-1 - Approval by commissioner

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12-17
Sec. 1.
(a) Prior to
				an insurer or similar organization offering group long term care insurance to a
				resident of this state under IC
				27-8-12-17, it shall file for
				approval 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.
(b) The commissioner shall
				review the policy or certificate to determine whether the policy or certificate
				complies with the requirements of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 14 - Filing Requirements › Section 14-2 - Advertising

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
(a) Every
				insurer, health care service plan, or other entity providing long term care
				insurance or benefits in Indiana shall provide a copy of any long term care
				insurance advertisement intended for use in Indiana whether through written,
				radio, or television medium to the commissioner of insurance of this state for
				review and approval by the commissioner. 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.
(b) The commissioner may exempt from
				subsection (a) any advertising form or material when, in the commissioner's
				opinion, subsection (a) may not be reasonably applied.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 15 - Marketing › Section 15-1 - Standards

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-4-1-4; IC 27-8-12
Sec. 1.
(a) Every
				insurer, health care service plan, or other entity marketing long term care
				insurance coverage in this state, directly or through its producers, shall do
				the following:
(1) Establish marketing
				procedures to assure that any comparison of policies by its insurance producers
				will be fair and accurate.
(2)
				Establish marketing procedures to assure excessive insurance is not sold or
				issued.
(3) Display prominently by
				type, stamp, or other appropriate means, on the first page of the outline of
				coverage and policy, certificate, or subscriber agreement the following:
				"Notice to buyer: This [policy] [certificate] [subscriber agreement] 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] [certificate] [subscriber agreement] limitations.".
(4) Inquire and otherwise make every
				reasonable effort to identify whether a prospective applicant or enrollee for
				long term care insurance already has accident and sickness or long term care
				insurance and the types and amounts of any such insurance.
(5) Every insurer or entity marketing long
				term care insurance shall establish auditable procedures for verifying
				compliance with this subsection.
(6) Every insurer shall, at solicitation,
				provide written notice to the prospective policyholder or certificate holder
				about the existence and availability of the following programs:
(A) The Senior Health Insurance Information
				Program administered by the department along with the name, address, and
				telephone number of the program.
(B) The Indiana Long Term Care Insurance
				Program along with the name, address, and telephone number of the
				program.
(7) For long
				term care health insurance policies and certificates, use the terms
				"noncancellable" or "guaranteed renewable" only when the policy or certificate
				conforms to
				760 IAC 2-3-1.
(8) Provide an explanation of contingent
				benefit upon lapse provided for in
				760 IAC
				2-16.1-1(d).
(9) Provide copies of the disclosure forms
				required by
				760 IAC
				2-4-2(e).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 15.5 - Suitability › Section 15.5-1 - Suitability

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-8-12
Sec. 1.
(a) This
				section shall not apply to life insurance policies that accelerate benefits for
				long term care.
(b) Every insurer,
				health care service plan, or other entity marketing long term care insurance
				(the "issuer") shall do the following:
(1)
				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.
(2) Train its insurance
				producers in the use of its suitability standards.
(3) Maintain a copy of its suitability
				standards and make them available for inspection upon request by the
				commissioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 16 - Purchase or Replacement › Section 16-1 - Appropriateness of recommended purchase

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
In recommending the purchase or replacement of any long term
				  care insurance policy, certificate, or subscriber agreement, an insurance
				  producer shall make reasonable efforts to determine the appropriateness of a
				  recommended purchase or replacement.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 16 - Purchase or Replacement › Section 16-2 - Prohibition against preexisting conditions and probationary periods in replacement policies or certificates

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
If a long term care insurance policy, certificate, or
				  subscriber agreement replaces another long term care policy, certificate, or
				  subscriber agreement, the replacing insurer shall waive any time periods
				  applicable to preexisting conditions and probationary periods in the new long
				  term care policy, certificate, or subscriber agreement for similar benefits to
				  the extent that similar exclusions have been satisfied under the original
				  policy, certificate, or subscriber agreement.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 16.1 - Nonforfeiture Benefit Requirement › Section 16.1-2 - Standards for benefit triggers

Current through July 10, 2024
Authority: IC
				  27-8-12-7; IC
				  27-8-12-14
Affected: IC
				  27-8-12
Sec. 2.
(a) 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.
(b) Insurers may use additional activities of
				daily living to trigger covered benefits as long as they are defined in the
				policy.
(c) An insurer may use
				additional provisions for the determination of when benefits are payable under
				a policy or certificate; however, the provisions shall not restrict, and are
				not in lieu of, the requirements contained in subsections (a) and
				(b).
(d) For purposes of this
				section, the determination of a deficiency shall not be more restrictive than
				the following:
(1) The hands-on assistance of
				another person to perform the prescribed activities of daily living.
(2) If the deficiency is due to the presence
				of a cognitive impairment, supervision, or verbal cuing by another person in
				order to protect the insured or others.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 16.1 - Nonforfeiture Benefit Requirement › Section 16.1-3 - Standards for benefit triggers for federally tax-qualified long term care insurance contracts

Current through July 10, 2024
Authority: IC
				  27-8-12-7; IC
				  27-8-12-14
Affected: IC
				  27-8-12
Sec. 3.
(a) For
				purposes of this section the following definitions apply:
(1) "Federally tax-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 necessary:
(A) diagnostic;
(B) preventive;
(C) therapeutic;
(D) curative;
(E) treatment;
(F) mitigation;
(G) rehabilitative; and
(H) maintenance or personal care;
services that are required by a chronically ill individual
				  and are provided under a plan of care prescribed by a licensed health care
				  practitioner.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 18 - Shopper's Guide › Section 18-1 - Delivery

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12-14.5
Sec. 1.
(a) A long
				term care insurance shopper's guide in a 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. Delivery shall be as follows:
(1) For insurance producer solicitations, an
				insurance producer must deliver the shopper's guide prior to the presentation
				of an application or enrollment form.
(2) For direct response solicitations, the
				shopper's guide must be presented in conjunction with any application or
				enrollment form.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 19 - Penalties › Section 19-1 - Civil penalties

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 1.
In addition to any other penalties provided by the laws or
				  rules of this state, the commissioner may impose a civil penalty against an
				  insurer which has violated the laws or rules. A penalty imposed under this
				  section shall be the greater of:
(1)
				three (3) times the amount of the commissions paid for each policy involved in
				the violation; or
(2) ten thousand
				dollars ($10,000).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 19 - Penalties › Section 19-2 - Other sanctions

Current through July 10, 2024
Authority: IC
				  27-8-12-7
Affected: IC
				  27-8-12
Sec. 2.
In addition to any other sanction provided under the laws or
				  rules of this state, the commissioner may impose a penalty against the
				  insurance producer who has violated the laws or rules. The penalty shall be the
				  greater of the following:
(1) Three
				(3) times the amount of the commissions paid for each policy involved in the
				violation.
(2) Two thousand five
				hundred dollars ($2,500).
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 19.5 - Standard Forms › Section 19.5-3 - Disclosure form

Current through July 10, 2024
Authority: IC 27-8-12-7
Affected: IC 27-8-12
Sec. 3.
The form required by
				  760 IAC 2-15.5-1(i)
				   is as follows:
Things You Should Know Before You Buy Long Term Care
				  Insurance
* A long term care insurance policy may pay most of the costs
				  for your care in a nursing home. Many policies also pay for care at home or
				  other community settings. Since policies can vary in coverage, you should read
				  this policy and make sure you understand what it covers before you buy
				  it.
* [You should not buy this insurance policy unless you can
				  afford to pay the premiums every year.] [Remember that the company can increase
				  premiums in the future.]
Drafting Note: For single premium policies, delete this
				  bullet; for noncancellable policies, delete the second sentence only.
* The personal worksheet includes questions designed to help
				  you and the company determine whether this policy is suitable for your
				  needs.
Medicare
* Medicare does not pay for most long term care.
Medicaid
* Medicaid will generally pay for long term care if you have
				  very little income and few assets. You probably should not buy this policy if
				  you are now eligible for Medicaid.
* Many people become eligible for Medicaid after they have
				  used up their own financial resources by paying for long term care
				  services.
* When Medicaid pays your spouse's nursing home bills, you
				  are allowed to keep your house and furniture, a living allowance, and some of
				  your joint assets.
* Your choice of long term care services may be limited if
				  you are receiving Medicaid. To learn more about Medicaid, contact your local or
				  state Medicaid agency.
Shopper's Guide
* Make sure the insurance company or agent gives you a copy
				  of a book called the National Association of Insurance
Commissioners' "Shopper's Guide to Long Term Care Insurance".
				  Read it carefully. If you have decided to apply for long term care insurance,
				  you have the right to return the policy within thirty (30) days and get back
				  any premium you have paid if you are dissatisfied for any reason or choose not
				  to purchase the policy.
Counseling
* Free counseling and additional information about long term
				  care insurance are available through your state's insurance counseling program.
				  Contact your state insurance department or department on aging for more
				  information about the senior health insurance counseling program in your
				  state.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-1 - Authority

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 1.
This rule is adopted and promulgated by the department of
				  insurance under IC
				  27-8-12-7.1.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-2 - Purpose

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-10-12; IC
				  12-15-2
Sec. 2.
The purpose of this rule is to:
(1) establish minimum standards for long term
				care insurance policies, certificates, and riders to qualify for participation
				in the Indiana long term care program;
(2) establish documentation and reporting
				requirements for issuers of policies, certificates, or riders to qualify under
				the Indiana long term care program;
(3) provide full disclosures in the sale of
				long term care insurance policies, certificates, and riders which qualify under
				the Indiana long term care program; and
(4) facilitate public understanding regarding
				long term care insurance and long term care insurance policies, certificates,
				and riders which qualify under the Indiana long term care program.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-3 - Applicability

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-10-12; IC
				  12-15-2
Sec. 3.
The requirements of this rule apply to any long term care
				  insurance policy, certificate, or rider authorized for sale by the commissioner
				  of the department of insurance as qualifying under the Indiana long term care
				  program under IC
				  27-8-12-7.1.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-4 - "Activities of daily living" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 4.
(a) As used
				in this rule, "activities of daily living" include each of the following items:
(1) Eating.
(2) Transferring.
(3) Dressing.
(4) Bathing.
(5) Toileting or continence.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-5 - "Asset disregard" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 5.
As used in this rule, "asset disregard" means the total
				  equity value of personal property, assets, and resources not exempt under
				  Medicaid regulations which at a minimum are equal to the sum of qualifying
				  insurance benefit payments made on behalf of the qualified insured in
				  determining eligibility for the Medicaid program under IC
				  12-15-2. The following are the two
				  (2) types of asset disregard:
(1)
				"Dollar-for-dollar asset disregard" means the amount of the disregard is equal
				to the sum of qualifying insurance benefit payments made on behalf of the
				qualified insured.
(2) "Total asset
				disregard" means the amount of the disregard is equal to the total sum of
				assets owned by the qualified insured once the qualified insured has exhausted
				all qualifying insurance benefits.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-6 - "Asset protection" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 6.
As used in this rule, "asset protection" means the right
				  extended by IC
				  12-15-39.6 to beneficiaries of
				  qualified long term care insurance policies and certificates to an asset
				  disregard under the Indiana long term care program.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-7 - "Authorized designee" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 7.
As used in this rule, "authorized designee" means any person
				  designated in writing to the insurance company by the policyholder or
				  certificateholder of a qualified long term care policy or certificate for
				  purposes of notification under section 36(8) of this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-8 - "Average daily private pay rate" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 8.
As used in this rule, "average daily private pay rate" means
				  the average daily rate charged by nursing facilities for persons not qualifying
				  for federal or state reimbursement, established annually on a calendar year
				  basis by OMPP for the period immediately preceding the effective date or
				  renewal date of a policy or certificate.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-9 - "Case management" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 9.
As used in this rule, "case management" includes, but is not
				  limited to, the development of a comprehensive individualized assessment and
				  care plan and, as needed, coordination of appropriate services and the
				  monitoring of the delivery of such services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-10 - "Case management agency" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 10.
As used in this rule, "case management agency" means an
				  agency or other entity approved by DDARS and OMPP as meeting DDARS case
				  management standards contained in the DDARS community and home care services
				  provider manual.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-11 - "Certificate" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 11.
As used in this rule, "certificate" means any certificate
				  delivered or issued for delivery in this state under a group long term care
				  policy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-12 - "Certificate form" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 12.
As used in this rule, "certificate form" means the form on
				  which the certificate is delivered or issued for delivery by the issuer.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-13 - "Certificateholder" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 13.
As used in this rule, "certificateholder" means an owner of
				  a qualified long term care insurance certificate or the beneficiary of a
				  qualified long term care certificate.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-14 - "Cognitive impairment" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 14.
As used in this rule, "cognitive impairment" means confusion
				  or disorientation resulting from a deterioration or loss of intellectual
				  capacity that is not related to or a result of mental illness but which can
				  result from Alzheimer's disease or similar forms of senility or irreversible
				  dementia. This deterioration or loss of intellectual capacity is established
				  through use of standardized tests that reliably measure impairment in the
				  following areas:
(1) Short term or
				long term memory.
(2) Orientation
				as to person, place, and time.
(3)
				Deductive or abstract reasoning.
Cognitive impairment must result in an individual requiring
				  twenty-four (24) hour a day supervision or direct assistance to maintain his or
				  her safety.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-15 - "Complex, unstable medical condition" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 15.
As used in this rule, "complex, unstable medical condition"
				  means that the individual requires twenty-four (24) hour a day professional
				  nursing observation or professional nursing intervention more than once a day
				  in a setting other than an acute care wing of a hospital.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-16 - "DDARS" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 16.
As used in this rule, "DDARS" means the Indiana division of
				  disability, aging, and rehabilitative services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-18 - "Direct assistance" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 18.
As used in this rule, "direct assistance" means that the
				  individual cannot perform an activity of daily living safely or appropriately
				  without continual help or oversight. Direct assistance may vary from requiring
				  a person to physically stand by or set up the activity to the activity being
				  totally performed by others.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-19 - "Indiana long term care program" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 19.
As used in this rule, the "Indiana long term care program"
				  means the program authorized in IC
				  27-8-12-7.1 and IC
				  12-15-39.6.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-21 - "Insured event" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 21.
(a) Except
				as specified in subsection (b), as used in this rule, "insured event" means,
				for the purposes of determining eligibility for benefits under a qualified
				policy, or certificate, or rider and for determining whether these benefits
				result in an asset disregard for a qualified insured, that any one (1) of the
				following criteria is met:
(1) The individual
				has a deficiency in two (2) or more activities of daily living.
(2) The individual has a cognitive
				impairment.
(3) The individual has
				a complex, unstable medical condition.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-21.1 - "Integrated policy" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-10-12; IC
				  12-15-2
Sec. 21.1.
As used in this rule, "integrated policy" refers to any
				  qualified long term care insurance policy or certificate which provides
				  coverage for both long term care facilities and home and community care
				  services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-22 - "Issuer" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 22.
As used in this rule, "issuer" means:
(1) insurance companies;
(2) fraternal benefit societies;
(3) prepaid health care delivery
				plans;
(4) health care service
				plans;
(5) health maintenance
				organizations; and
(6) any other
				entity;
delivering or issuing for delivery in this state, long term
				  care policies or certificates.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-22.1 - "Long term care facility" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-10-12; IC
				  12-15-2; IC 16-28
Sec. 22.1.
As used in this rule, "long term care facility" means a
				  facility licensed under IC 16-28, including nursing facilities and residential
				  care facilities.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-22.2 - "Long term care facility policy" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 22.2.
As used in this rule, "long term care facility policy"
				  refers to any qualified long term care insurance policy or certificate which
				  provides coverage primarily for care in a long term care facility and does not
				  provide coverage for home and community care.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-24 - "Medicaid waiver" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 24.
As used in this rule, "Medicaid waiver" refers to the home
				  and community based services waiver for the aged and disabled approved by the
				  United States Department of Health and Human Services Health Care Financing
				  Administration under the provisions of Section 1915(c) of the Social Security
				  Act which allows Indiana to provide certain community and in-home services not
				  covered in the state Medicaid plan, which are instrumental in the avoidance or
				  delay of institutionalization. Indiana's Medicaid waiver services
				  include:
(1) case
				management;
(2)
				homemaker;
(3) respite
				care;
(4) attendant care;
(5) adult day care; and
(6) other services which, independent of the
				preceding home and community based services, are essential to prevent
				institutionalization.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-25 - "OMPP" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 25.
As used in this rule, "OMPP" means the Indiana office of
				  medicaid policy and planning.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-26 - "Plan of care" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 26.
As used in this rule, "plan of care" means a written
				  individualized plan of services developed by a case management agency which
				  specifies the type and frequency of all services required by the individual,
				  the service providers, and the cost of services.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-26.5 - "Policy eligible for favorable tax status" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  27-8-12-7
Sec. 26.5.
As used in this rule, "policy eligible for favorable tax
				  status" means any long term care insurance policy or certificate meeting
				  federal standards of HIPAA 1996, including clearly disclosing in the policy and
				  in the outline of coverage that such policy is intended to be a long term care
				  insurance contract eligible for favorable tax status under Section 7702B(b) of
				  Chapter 79 of the Internal Revenue Code of 1986.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-27 - "Policy form" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 27.
As used in this rule, "policy form" means the form on which
				  the policy is delivered or issued for delivery by the issuer.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-28 - "Policyholder" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 28.
As used in this rule, "policyholder" means an owner of an
				  individual qualified long term care insurance policy or a beneficiary of a
				  qualified individual long term care insurance policy.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-29 - "Qualified insured" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-10-12; IC
				  12-15-2
Sec. 29.
As used in this rule, "qualified insured" means the
				  following:
(1) An individual who is
				either:
(A) the beneficiary of a qualified
				long term care policy, certificate, or rider approved by the department of
				insurance;
or
(B)
				enrolled in a prepaid health care delivery plan that provides long term care
				services and qualifies under this rule.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-30 - "Qualified long term care insurance policy or certificate" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6; IC
				  27-8-12-7
Sec. 30.
As used in this rule, "qualified long term care insurance
				  policy or certificate" means:
(1) any
				long term care insurance policy or certificate qualified for sale to Indiana
				residents by the department of insurance as meeting standards promulgated under
				IC 27-8-12-7 and IC
				27-8-12-7.1; or
(2) any long term care insurance policy or
				certificate owned by an Indiana resident purchased under another state's
				Partnership for Long Term Care Program if the other state's program is similar
				to the Indiana Long Term Care Program and OMPP has a reciprocity agreement with
				the other state's Medicaid program.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-30.1 - "Qualified rider" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  27-8-12-7
Sec. 30.1.
As used in this rule, "qualified rider" means any long term
				  care insurance rider qualified for sale to Indiana residents by the department
				  of insurance as meeting standards promulgated under IC
				  27-8-12-7 and IC
				  27-8-12-7.1.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-31 - "Quarterly/annually" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 31.
As used in this rule, "quarterly/annually" refers to periods
				  aligning with the state fiscal year of July 1 to June 30.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-31.1 - "Residential care facility" defined

Current through July 10, 2024
Authority: IC 27-8-12-7.1
Affected: IC 12-10-12; IC 12-15-2; IC 16-28
Sec. 31.1.
As used in this rule, "residential care facility", also
				  referred to as assisted living facility and alternate care facility, means a
				  facility that:
(1) provides
				twenty-four (24) hour a day care and services sufficient to support needs
				resulting from an inability to perform activities of daily living or cognitive
				impairment;
(2) has a trained and
				ready to respond employee on duty in the facility at all times to provide
				care;
(3) provides three (3) meals
				a day and accommodates special dietary needs;
(4) has written contractual arrangements or
				otherwise ensures that residents receive the medical care services of a
				physician or nurse in case of emergency; and
(5) has appropriate methods and procedures
				for the handling and administration of prescribed medications and treatments. A
				requirement that a residential care facility be licensed under IC 16-28 and
				410 IAC 16.2-5 is optional for
				the issuer.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-32 - "Service summary" defined

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 32.
As used in this rule, "service summary" means a written
				  summary, prepared by an issuer for a qualified insured, which identifies the
				  following:
(1) The specific qualified
				policy or certificate.
(2) The
				total benefits paid for services to date.
(3) The amount of benefits qualifying for
				asset protection.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-32.5 - State-set dollar amount

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 32.5.
As used in this rule, "state-set dollar amount" means the
				  least amount of maximum benefit a policyholder or certificateholder must
				  initially purchase in a qualified policy or certificate to be eligible for a
				  total asset disregard. The state-set dollar amount begins at one hundred forty
				  thousand dollars ($140,000) for qualified policies with an effective date of
				  1998 or earlier. The state-set dollar amount will increase each year on January
				  1 by five percent (5%) compounded annually, rounded to the nearest one dollar
				  ($1) increment, and applies to new policies effective during each calendar
				  year.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-33 - Qualification of long term care insurance policies, certificates, and riders

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2
Sec. 33.
(a) No long
				term care insurance policy, or certificate, or rider shall qualify for
				participation in the Indiana long term care program unless the long term care
				insurance policy, or certificate, or rider complies with this rule.
(b) The commissioner of the department of
				insurance may not approve a long term care facility policy or certificate as a
				qualified policy or certificate for participation in the Indiana long term care
				program unless the issuer has an approved qualified integrated policy or
				certificate.
(c) The commissioner
				of the department of insurance may not approve a long term care facility policy
				or certificate eligible for favorable tax status as a qualified policy or
				certificate for participation in the Indiana long term care program unless the
				issuer has an approved qualified integrated policy or certificate eligible for
				favorable tax status.
(d) Long term
				care insurance policies, and certificates, and riders in force at the effective
				date of this rule may, with the signed acceptance of the policyholder or
				certificateholder, be amended to meet the requirements for qualification.
Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-34 - Standards for marketing

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 34.
No long term care insurance policy, certificate, or rider
				  may be advertised, solicited, or issued for delivery in this state as a
				  qualified long term care insurance policy, certificate, or rider that does not
				  meet the requirements of this article and has not been approved by the
				  commissioner of the department as a qualified long term care insurance policy,
				  certificate, or rider. Each issuer seeking to qualify a long term care policy,
				  certificate, or rider for participation in the Indiana long term care program
				  must do the following:
(1) Use
				applications to be signed by the applicant that indicate, as described as
				follows, that he or she:
(A) Received from the
				issuer the current edition of a booklet developed by OMPP titled "What you
				should know about long term care: The most commonly asked questions about the
				Indiana Long Term Care Program".
(B) Received a description of the issuer's
				qualified long term care policy or certificate benefit option meeting the
				requirements of sections 36.1(2) and 36.2(2) of this rule.
(C) Agrees to the release of information by
				the issuer to the state as may be needed to evaluate the Indiana long term care
				program and document a claim for Medicaid asset protection in the following
				format:
"CONSENT AND AUTHORIZATION
TO RELEASE INFORMATION
I hereby agree to the release of all records and information
				  pertaining to this long term care policy or certificate by the [insert issuer
				  name] to the State of Indiana for the purposes of documenting a claim for Asset
				  Protection under the State Medicaid program, evaluating the Indiana Long Term
				  Care Program and meeting Medicaid or Department of Insurance audit
				  requirements.
I understand that the information contained in these records
				  will be used for no purpose other than those stated above and will be kept
				  strictly confidential by the State of Indiana.
_______________________________
(Signature of Applicant(s))
_______________________________
Date".
(D)
				Received a graphic comparison showing the differences in premiums and benefits,
				over at least a twenty (20) year period, between a policy or certificate that
				increases benefits over the policy or certificate period and a policy or
				certificate that does not increase benefits.
(E) Agrees that, at the time of application,
				he or she is a resident of the state of Indiana.