reglab/statecodes huggingface dataset:
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 13 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Chapter 31.13.03 - Standards for Credit Involuntary Unemployment Benefit Insurance › Section 31.13.03.23 - Clerical Errors

Current through Register Vol. 51, No. 14, July 12, 2024
A. Excess Insurance.
(1) If a policy of credit involuntary unemployment benefit insurance limits the involuntary unemployment benefits to stated policy maximums, the policy and certificates of insurance issued under a group policy shall provide that if the insured has been charged premiums for insurance in excess of the stated maximums, the insurer may terminate the excess insurance and refund all premiums paid by the debtor for the excess insurance.
(2) The notice of termination of the excess insurance shall state that the premium paid by the debtor for the excess coverage shall be refunded to the person entitled to it.
(3) A single premium credit involuntary unemployment benefit insurance policy and certificate shall further provide that excess insurance shall remain in force if the insurer does not terminate the excess insurance within 60 days after the effective date of coverage or if the debtor suffers a covered loss within the 60-day period but before notification by the insurer of termination of the excess coverage.
(4) A monthly premium credit involuntary unemployment benefit insurance policy and certificate shall further provide that the excess insurance shall be in force for the period for which a premium was charged unless the excess insurance is cancelled before the occurrence of a loss.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 13 - CREDIT LIFE AND CREDIT HEALTH INSURANCE › Chapter 31.13.03 - Standards for Credit Involuntary Unemployment Benefit Insurance › Section 31.13.03.24 - Change of Insurers Reporting Requirements Coverage and Rates

Current through Register Vol. 51, No. 14, July 12, 2024
A. Insurers That Cease to Offer Credit Involuntary Unemployment Benefit Insurance. Within 90 days after an insurer ceases to offer credit involuntary unemployment benefit insurance through a case, the insurer shall notify the Commissioner of:
(1) The name or code number of the creditor;
(2) Each coverage no longer offered;
(3) The date on which the coverage ceased to be offered; and
(4) The current approved premium rate applicable to each coverage no longer offered.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.01 - Applicability and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
Except as otherwise specifically provided, this chapter applies to all long-term care insurance policies delivered or issued for delivery in this State on or after the effective date by insurers, nonprofit health service plans, and health maintenance organizations. These regulations are not intended to supersede other applicable insurance laws or regulations which do not conflict with this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.03 - Policy Terms

Current through Register Vol. 51, No. 14, July 12, 2024
A. A long-term care policy shall define "skilled nursing care", "intermediate care", "domiciliary care", "custodial care", "personal care", "home care", "specialized care", "assisted living care", and other services in relation to the level of skill required, the nature of the care, and the setting in which care shall be delivered.
B. Definitions in Contracts Regarding Providers of Services.
(1) A long-term care insurance policy shall define all providers of services, including, but not limited to, "skilled nursing facility", "extended care facility", "convalescent nursing home", "personal care facility", "specialized care providers", "assisted living facility", and "home care agency" in relation to the services and facilities required to be available and the licensure, certification, registration, or degree status of those providing or supervising the services.
(2) When the definition of a type of provider requires that the provider be appropriately licensed, certified, or registered, the definition shall also state what requirements a provider must meet instead of licensure, certification, or registration when the state in which the service is to be furnished:
(a) Does not require a provider of these services to be licensed, certified or registered; or
(b) Licenses, certifies, or registers the provider of services under another name.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.04 - Policy Practices and Provisions

Current through Register Vol. 51, No. 14, July 12, 2024
A. Renewability and Premium Charges.
(1) Renewability Provision.
(a) Individual long-term care insurance policies shall contain an appropriately captioned renewability provision on the first page of the policy form.
(b) The renewability provision shall clearly state that the coverage is guaranteed renewable or noncancellable.
(c) Section A(1)(a) of this regulation is not applicable to policies that do not contain a renewability provision and under which the right to nonrenew is reserved solely to the policyholder.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.05 - Disclosure

Current through Register Vol. 51, No. 14, July 12, 2024
A. Riders and Endorsements.
(1) Except for riders or endorsements by which the insurer fulfills a request made in writing by the policyholder under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after the date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage of the policy shall require signed acceptance by the policyholder.
(2) After the date of policy issue, any rider or endorsement which increases benefits or coverage and which will require an increase in premium shall be agreed to in writing and signed by the insured, unless the increased benefits are required by law.
(3) When a separate additional premium is charged for benefits provided in connection with riders or endorsements, the additional premium charge shall be set forth in the policy or in the rider or endorsement.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.06 - Requirements for Applications

Current through Register Vol. 51, No. 14, July 12, 2024
A. If the application for a long-term care insurance policy is to be made part of the policy or certificate, the insurer shall print:
(1) Conspicuously and in close conjunction with the applicant's signature block on the application form for the policy or certificate:
(2) On the first page of the policy or certificate the following or substantially similar language:
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.07 - Person To Be Notified

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as provided in §E of this regulation, an insurer may not issue an individual long-term care insurance policy or certificate to an insured until the insurer has received from the applicant either a written:
(1) Designation of at least one person in addition to the insured who is to receive notice of termination of the policy or certificate for nonpayment of premium; or
(2) Waiver dated and signed by the applicant electing not to designate additional persons to receive notice of nonpayment of premium.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.08 - Applicant's Options

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as provided in §§B and C of this regulation, the application for a long-term care insurance policy or certificate, or a form attached to the policy or certificate, shall contain a statement to be signed separately by the applicant to the effect that the:
(1) Applicant has been informed of the applicant's right to:
(a) Designate a person to receive any notice of termination;
(b) Purchase:
(i) Inflation protection,
(ii) Home health care if not included in the policy, and
(iii) Nonforfeiture benefits; and
(c) Choose the form of nonforfeiture benefit if the policy provides a choice; and
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.09 - Prohibition Against Post-Claims Underwriting

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except in a case of guaranteed issue, application forms for long-term care insurance policies or certificates shall contain clear and unambiguous questions designed to ascertain the condition of health of the applicant.
B. Medical Condition-Medication.
(1) If an application for long-term care insurance contains a question which asks whether the applicant has had medication prescribed by a physician, it shall also ask the applicant to name the medication which has been prescribed.
(2) A long-term care insurance policy or certificate may not be rescinded for failure by the applicant to list in the application for the policy or certificate a medical condition, if the medications listed in the application were known or should have been known by the insurer at the time of application to be directly related to a medical condition for which coverage would otherwise be denied.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.10 - Preexisting Condition and Waiting Period Provisions in Replacement Policies

Current through Register Vol. 51, No. 14, July 12, 2024
If a long-term care insurance policy or certificate replaces other long-term care coverage, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy or certificate for similar benefits to the extent that corresponding time periods have been satisfied under the original policy.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.11 - Minimum Standards for Home Health Care Benefits in Long-Term Insurance Policies

Current through Register Vol. 51, No. 14, July 12, 2024
A. Optional Home Health Care Benefit.
(1) An insurer issuing a long-term care insurance policy shall offer the applicant for the policy the option to purchase a policy that provides for home health care benefits in addition to the benefits provided for nursing home care.
(2) The benefits required to be offered for home health care under this section are as follows:
(a) If the benefit for nursing home care is on a scheduled or indemnity-type basis, the daily limit for home health care benefits shall be at least 50 percent of the daily benefit for nursing home care;
(b) The period of eligibility for home health care benefits shall be at least equal to the period of eligibility for benefits for nursing home care; and
(c) If the policy provides for an overall lifetime limit, the benefits for home health care shall be at least equal to 50 percent of the overall lifetime limit.
(3) The minimum benefits required in §A(2) of this regulation do not apply to policies or certificates issued to residents of continuing care retirement communities.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.12 - Requirement To Offer Inflation Protection

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer issuing a long-term care insurance policy shall offer the applicant for the policy the option to purchase a policy that provides for benefit levels to increase at a rate not less than 5 percent compounded annually.
B. Instead of the requirement of §A of this regulation, the insurer may offer a policy that guarantees the policyholder the right to increase periodically benefit levels without providing evidence of insurability of health status as long as the option for the preceding period has not been declined, with the amount of the additional benefit being not less than the difference between the existing policy benefit and the amount of the benefit which would have been payable if the policy provided the option described in §A of this regulation.
C. Instead of the requirement of §A of this regulation, the insurer may offer a policy that provides a specified percentage, not less than 50 percent, of actual and reasonable charges and does not include a maximum specified indemnity amount or limit.
D. In a policy issued to an employer-employee group, the offer required in §A, B, or C of this regulation shall be made to the group policyholder. In a policy issued to any other group, the offer shall be made to each proposed certificate holder.
E. The offer in §A of this regulation may not be required of life insurance policies or riders on life insurance policies containing accelerated death benefits for long-term care.
F. In connection with the offer to provide inflation protection, the insurer shall provide the applicant with:
(1) A graphic comparison and a table illustrating for at least the first 20 policy years the benefits or the reasonably anticipated benefits which would be available if the inflation protection is purchased, in comparison with a policy which does not provide inflation protection; and
(2) Any expected premium increases or additional premiums to pay for automatic or optional benefit increases.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.13 - Nonforfeiture Benefit Requirement

Current through Register Vol. 51, No. 14, July 12, 2024
A. This regulation does not apply to life insurance policies or riders containing accelerated death benefits for long-term care.
B. Required Option.
(1) An insurer may not deliver or issue a long-term care insurance policy in Maryland unless the the option of purchasing a policy including a nonforfeiture benefit has been offered to the:
(a) Applicant, when the policy is an individual long-term care insurance policy;
(b) Group policyholder, when the policy is an employer group long-term care insurance policy;
(c) Group policyholder, when the policy is a group long-term care insurance policy issued to a professional, trade, or occupational association for its members, former members, or retired members, or a combination of members, former members or retired members, if the association:
(i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade, or occupation; and
(ii) Has been maintained in good faith for purposes other than obtaining insurance; or
(d) Proposed certificate holder, when the group long-term care insurance policy is a policy other than one of the policies described in §B(1)(b)-(c) of this regulation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.14 - Group Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
Group long-term care insurance coverage may not be offered to a resident of this State under a group policy issued in another jurisdiction unless the coverage complies with the statutes and regulations pertaining to group long-term care insurance issued in this State.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.15 - Advertising

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer soliciting long-term care insurance in the State shall provide the Commissioner with a copy of any long-term care insurance advertisement intended for use in the State. For purposes of this regulation, "advertising" includes any material:
(1) Published, disseminated, circulated, or placed before the public in a newspaper, magazine, or other publication;
(2) In the form of a notice, circular, pamphlet, letter, or poster;
(3) Seen or heard over any radio or television station;
(4) Sent by direct mail; or
(5) Issued in any other manner intended to be seen or heard by the general public.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.16 - Standards for Marketing

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer marketing long-term care insurance coverage in Maryland, either directly or through its producers, shall:
(1) Establish marketing procedures and insurance producer requirements to ensure that:
(a) Any comparison of policies by its producers is fair and accurate; and
(b) Excessive insurance is not sold or issued;
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.17 - Appropriateness of Recommended Purchase

Current through Register Vol. 51, No. 14, July 12, 2024
A. In recommending the purchase or replacement of any long-term care insurance policy or certificate, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.
B. In recommending the purchase or replacement of any long-term care insurance policy or certificate, the insurer or its agent shall make a reasonable effort to identify whether a prospective applicant for long-term care insurance:
(1) Already has long-term care insurance, and the types and amounts of insurance;
(2) Had long-term care insurance in force during the last 12 months;
(3) Is covered or is eligible for coverage under the Medical Assistance Program (Medicaid); or
(4) Intends to replace an existing hospital, medical, surgical, or other health insurance coverage with long-term care insurance.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.18 - Outline of Coverage

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer or the agent soliciting long-term care coverage shall deliver to a prospective applicant, at the time of the initial solicitation, an outline of coverage in a manner which prominently directs the attention of the recipient to the document and its purpose.
B. Time of Delivery. In the case of:
(1) Solicitation by an agent, the agent shall deliver the outline of coverage before presenting an applicant or enrollment form to the prospective applicant;
(2) Direct response solicitations, the insurer shall deliver the outline of coverage in conjunction with any application or enrollment form.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.19 - Requirement To Deliver Buyer's Guide

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurer or agent shall deliver a long-term care insurance buyer's guide to prospective applicants of long-term care coverage in a format developed by the National Association of Insurance Commissioners or in a format approved by the Commissioner.
B. The insurer shall include in the buyer's guide information regarding the purchase of a long-term care insurance policy, including a reference of the right of the purchaser to return the policy for a refund during the first 30 days after the policy is delivered.
C. In the case of solicitation by an agent, the agent shall deliver the buyer's guide before presenting an application or enrollment form to the prospective applicant.
D. In the case of direct response solicitations, the insurer shall provide the buyer's guide to the applicant in conjunction with any application or enrollment form.
E. Life insurance policies or riders containing accelerated death benefits for long-term care are not required to furnish the long-term care insurance buyer's guide required by §A of this regulation, but shall furnish the policy summary required under Insurance Article, §
									18-108, Annotated Code of Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.20 - Waivers

Current through Register Vol. 51, No. 14, July 12, 2024
The Commissioner may issue, upon written request and after an administrative hearing, an order to modify or suspend a specific provision or provisions of this chapter with respect to a specific long-term care insurance policy or certificate upon a written finding that:
A. The modification or suspension would be in the best interest of the insureds;
B. The purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and
C. Either the:
(1) Modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long-term care,
(2) Policy or certificate is to be issued to residents of a life-care or continuing-care retirement community or some other residential community for the elderly, and the modification or suspension is reasonably related to the special needs or nature of that community, or
(3) Modification or suspension is necessary to permit long-term care insurance to be sold as part of, or in conjunction with, another insurance product.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.23 - Replacement Notice for Direct Response Business

Current through Register Vol. 51, No. 14, July 12, 2024
The notice to an applicant with respect to direct response solicitation of individual long-term care policies or other health insurance referred to in Regulation .06F of this chapter shall read as follows:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF LONG-TERM CARE OR HEALTH INSURANCE (Insurance company's name and address) SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE
According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing long-term care or health insurance and replace it with the long-term care insurance policy issued by [company name] Insurance Company and delivered with this notice. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
You should review this new coverage carefully, comparing it with all long-term care and health insurance coverage you now have, and terminate your present policy only if, after you have thought about it, you find that purchase of this long-term care coverage is a wise decision.
_________________________________________ (Company Name)
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.24 - Reporting Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Every insurer shall maintain records for each insurance producer of the:
(1) Insurance producer's amount of replacement sales as a percent of the insurance producer's total annual sales; and
(2) 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.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.25 - Suitability

Current through Register Vol. 51, No. 14, July 12, 2024
A. This regulation does not apply to life insurance policies that accelerate the death benefits for long-term care.
B. Each insurer shall:
(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; and
(3) Maintain a copy of its suitability standards and make them available for inspection upon request by the Commissioner.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.26 - Standards for Benefit Triggers

Current through Register Vol. 51, No. 14, July 12, 2024
A. Conditions for Payment of Benefits.
(1) A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment.
(2) An insurer may not establish the eligibility criteria for the payment of benefits on a more restrictive basis than:
(a) A deficiency in the ability to perform not more than three of the activities of daily living; or
(b) The presence of cognitive impairment.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.27 - Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this regulation, the following terms have the meanings indicated.
B. Terms Defined.
(1) Chronically Ill Individual.
(a) "Chronically ill individual" means any individual who has been certified by a licensed health care practitioner as:
(i) Being unable to perform, without substantial assistance from another individual, at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity; or
(ii) Requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.28 - Penalties

Current through Register Vol. 51, No. 14, July 12, 2024
In addition to any other penalties provided by the laws of this State, any insurer and any insurance producer found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of long-term care insurance shall be subject to a penalty of up to three times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.29 - Rescission

Current through Register Vol. 51, No. 14, July 12, 2024
Reporting Form for Long-Term Care Policies. The following form is to be used for reporting rescissions made by each insurer as required by Regulation .09C of this chapter:
RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATE OFFOR THE REPORTING YEAR 20[]
Company Name: _____________________
Address: _________________
Phone Number: _____________________
Due: March 1 annually
Instructions:
The purpose of this form is to report all rescissions of long-term care insurance policies or certificates. Those rescissions voluntarily effectuated by an insured are not required to be included in this report. Please furnish one form per rescission.
Policy Form#
Policy and Certificate #
Name of Insured
Date of Policy Issuance
Date/s Claim/s Submitted
Date of Rescission
Detailed reason for rescission: _______________________________
______________________________________________________
___________________________ Signature
___________________________ Name and Title (please type)
___________________________ Date
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.31 - Long-Term Care Insurance Suitability Letter

Current through Register Vol. 51, No. 14, July 12, 2024
The following form is to be used for providing the disclosure required by Regulation .25G of this chapter:
Long-Term Care Insurance Suitability Letter
Dear [Applicant]:
Your recent application for long-term care insurance included a "personal worksheet," which asked questions about your finances and your reasons for buying long-term care insurance. For your protection, State law requires us to consider this information when we review your application, to avoid selling a policy to those who may not need coverage.
[Your answers indicate that long-term care insurance may not meet your financial needs. We suggest that you review the information provided along with your application, including the booklet "Shopper's Guide to Long-Term Care Insurance" and the page titled "Things You Should Know Before Buying Long-Term Care Insurance." Your state insurance department also has information about long-term care insurance and may be able to refer you to a counselor free of charge who can help you decide whether to buy this policy.]
[You chose not to provide any financial information for us to review.]
Drafting Note: Choose the paragraph that applies.
We have suspended our final review of your application. If, after careful consideration, you still believe this policy is what you want, check the appropriate box below and return this letter to us within the next 60 days. We will then continue reviewing your application and issue a policy if you meet our medical standards.
If we do not hear from you within the next 60 days, we will close your file and not issue you a policy. You should understand that you will not have any coverage until we hear back from you, approve your application and issue you a policy.
Please check one box and return in the enclosed envelope.
[] Yes, [although my worksheet indicates that long-term care insurance may not be a suitable purchase,] I wish to purchase this coverage. Please resume review of my application.
Drafting Note:
Delete the phrase in brackets if the applicant did not answer the questions about income.
[] No. I have decided not to buy a policy at this time.
___________________________________
APPLICANT'S SIGNATURE
_____________________
DATE
Please return to [issuer] at [address] by [date].
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.32 - Claims Denial Reporting Form

Current through Register Vol. 51, No. 14, July 12, 2024
The following form is to be used for reporting claim denials made by each insurer as required by Regulation .24G of this chapter:
Claims Denial Reporting Form Long-Term Care Insurance
For the State of
For the Reporting Year of
Company Name: __________________________ Due: June 30 annually
Company Address: _________________________________________
Company NAIC Number: ____________________________________
Contact Person: _________________ Phone Number: ______________
Line of Business: _____________ Individual ________ Group
Instructions
The purpose of this form is to report all long-term care claim denials under in force long-term care insurance policies. "Denied" means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.
StateData
NationwideData1
1
Total Number of Long-Term Care Claims Reported
2
Total Number of Long-Term Care Claims Denied/Not Paid
3
Number of Claims Not Paid due to Preexisting Condition Exclusion
4
Number of Claims Not Paid due to Waiting (Elimination) Period Not Met
5
Net Number of Long-Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4)
6
Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1)
7
Number of Long-Term Care Claim Denied due to:
8
"* Long-Term Care Services Not Covered under the Policy2
9
"* Provider/Facility Not Qualified under the Policy3
10
"* Benefit Eligibility Criteria Not Met4
11
"* Other
1 The nationwide data may be viewed as a more representative and credible indicator where the data for claims reported and denied for your state are small in number.
2 Example-home health care claim filed under a nursing home only policy.
3 Example-a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy.
4 Examples-a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.33 - Incontestability Period

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as provided in §G of this regulation, §§B-F of this regulation apply to each qualified long-term care insurance policy.
B. Policies In Force Less Than 6 Months.
(1) This section applies to a long-term care insurance policy that has been in force for less than 6 months.
(2) Unless the insurer demonstrates that the applicant misrepresented information on the application for the long-term insurance policy that is material to the acceptance for coverage, an insurer may not:
(a) Rescind the policy described in §B(1) of this regulation; or
(b) Deny an otherwise valid long-term care insurance claim under the policy described in §B(1) of this regulation.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.34 - Producer Training Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. An insurance producer is not authorized to sell, solicit, or negotiate with respect to long-term care insurance except as authorized by Insurance Article, Title 10, Subtitle 1, Annotated Code of Maryland.
B. An individual may not sell, solicit, or negotiate long-term care insurance unless the individual is licensed as an insurance producer for health insurance or life insurance and complies with the following training requirements:
(1) Completes a one-time training course before:
(a) The date the individual sells, solicits, or negotiates long-term care insurance in Maryland, if the individual is not licensed and selling, soliciting, or negotiating long-term care insurance on the effective date of this regulation; or
(b) September 10, 2008, if the individual is already licensed and selling, soliciting, or negotiating long-term care insurance on the effective date of this regulation; and
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.35 - Availability of New Services or Providers

Current through Register Vol. 51, No. 14, July 12, 2024
A. Notice Requirement.
(1) Except as provided in §B of this regulation, an insurer shall notify policyholders and certificate holders of the availability of a new long-term care insurance policy series that provides coverage for new long-term care services or providers, material in nature, and not previously available through the insurer to the general public.
(2) The notice required by §A(1) of this regulation shall be provided within 12 months of the date the new policy series is made available for sale in Maryland.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.01 - Long-Term Care Insurance › Section 31.14.01.36 - Right to Reduce Coverage and Lower Premiums

Current through Register Vol. 51, No. 14, July 12, 2024
A. Unless otherwise specified, the requirements of this regulation shall apply to any long-term care policy issued in Maryland on or after September 10, 2008.
B. Required Provision in Long-Term Care Insurance Policies and Certificates.
(1) Every long-term care insurance policy and certificate shall include a provision that allows the policyholder or certificate holder to reduce coverage and lower the policy or certificate premium in at least one of the following ways:
(a) Reducing the maximum benefit; or
(b) Reducing the daily, weekly, or monthly benefit amount.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.01 - Applicability and Scope

Current through Register Vol. 51, No. 14, July 12, 2024
This chapter applies to all long-term care insurance delivered or issued for delivery in this State by insurers, nonprofit health service plans, and health maintenance organizations. This chapter is not intended to supersede other applicable insurance laws or regulations which do not conflict with this chapter.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.02 - Definitions

Current through Register Vol. 51, No. 14, July 12, 2024
A. In this chapter, the following terms have the meanings indicated.
B. Terms Defined.
(1) "Employer group long-term care insurance" means a long-term care insurance policy that is:
(a) Issued or delivered in Maryland to:
(i) One or more employers or labor organizations; or
(ii) A trust or the trustees of a fund established by one or more employers or labor organizations, or by a combination of employers or labor organizations; and
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.03 - Required Disclosure of Rating Practices to Consumers

Current through Register Vol. 51, No. 14, July 12, 2024
A. Applicability.
(1) Except as provided in §A(2) and (3) of this regulation, the provisions of this regulation apply to any long-term care policy or certificate issued in this State on or after October 1,2002.
(2) For certificates issued on or after April 1, 2002, under an employer group long-term care insurance policy that was in force on April 1, 2002, the provisions of this regulation apply on the policy anniversary following April 1,2003.
(3) The requirements of §K(2)(ii)-(iv) of this regulation shall apply to any rate increase implemented in Maryland on or after March 1, 2018.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.04 - Initial Filing Requirements

Current through Register Vol. 51, No. 14, July 12, 2024
A. Applicability.
(1) Sections B.-D. of this regulation apply to any long-term care policy issued in Maryland on or after October 1, 2002 and before September 1, 2017.
(2) Sections E.-H. of this regulation apply to any to any long-term care policy issued in Maryland on or after September 1, 2017.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.05 - Loss Ratio

Current through Register Vol. 51, No. 14, July 12, 2024
A. This regulation applies to all long-term care insurance policies or certificates except those covered under Regulations .04, .06, and .06-1 of this chapter.
B. Minimum Loss Ratios.
(1) Benefits under long-term care insurance policies shall be deemed reasonable in relation to premiums if the expected loss ratio is at least 60 percent, calculated in a manner which provides for adequate reserving of the long-term care insurance risk.
(2) In evaluating the expected loss ratio described in §B(1) of this regulation, due consideration shall be given to all relevant factors, including:
(a) Statistical credibility of incurred claims experience and earned premiums;
(b) The period for which rates are computed to provide coverage;
(c) Experienced and projected trends;
(d) Concentration of experience within early policy duration;
(e) Expected claim fluctuation;
(f) Experience refunds, adjustments, or dividends;
(g) Renewability features;
(h) All appropriate expense factors;
(i) Interest;
(j) Experimental nature of the coverage;
(k) Policy reserves;
(l) Mix of business by risk classification; and
(m) Product features such as long elimination periods, high deductibles, and high maximum limits.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.06 - Premium Rate Schedule Increases

Current through Register Vol. 51, No. 14, July 12, 2024
A. Applicability.
(1) Except as provided in §A(2) of this regulation, the provisions of this regulation apply to any long-term care policy or certificate issued in Maryland on or after October 1, 2002 and before September 1, 2017.
(2) For certificates issued on or after April 1, 2002, under an employer group long-term care insurance policy that was in force on April 1, 2002, the provisions of this regulation apply on the policy anniversary following April 1,2003.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.06-1 - Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings

Current through Register Vol. 51, No. 14, July 12, 2024
A. Applicability.
(1) Except as provided in §A(2) of this regulation, this regulation applies to any long-term care policy or certificate issued in Maryland on or after September 1, 2017.
(2) For certificates issued on or after the effective date of this amended regulation under an employer group long-term care insurance policy as defined in Regulation .02B(1) of this chapter if the policy was in force at the time this amended regulation became effective, the provisions of this regulation shall apply on the policy anniversary following March 1, 2018.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.07 - Exceptional Premium Rate Increases

Current through Register Vol. 51, No. 14, July 12, 2024
A. Except as provided in Regulation .06 of this chapter, exceptional increases are subject to the same requirements as other premium rate schedule increases.
B. The Commissioner may request a review by an independent actuary or a professional actuarial body of the basis for a request that an increase be considered an exceptional increase.
C. The Commissioner, in determining that the necessary basis for an exceptional increase exists, shall also determine any potential offsets to higher claims costs.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.10 - Reserve Standards

Current through Register Vol. 51, No. 14, July 12, 2024
A. Life Insurance Policies That Accelerate Benefits for Long-Term Care.
(1) This section applies to long-term care benefits that are provided through the acceleration of benefits under group or individual life insurance policies or riders to group or individual life insurance policies.
(2) Policy reserves for the benefits for the policies and riders subject to this section shall be determined in accordance with Insurance Article, Title 5, Subtitle 3, Annotated Code of Maryland.
(3) Claim reserves for the policies and riders subject to this section shall be established in the case when the policy or rider is in claim status.
(4) Except as permitted in §A(5) of this regulation, reserves for policies and riders subject to this section shall be based on the multiple decrement model utilizing all relevant decrements except for voluntary termination rates.
(5) An insurer may determine the reserves based on single decrement approximations, if:
(a) The calculation produces essentially similar reserves as the calculation described in §A(4) of this regulation;
(b) The calculation produces a reserve that is clearly more conservative than the calculation described in §A(4) of this regulation; or
(c) The reserve is immaterial.
(6) The calculations described in §A(4) and (5):
(a) May take into account the reduction in life insurance benefits due to the payment of long-term care benefits; and
(b) May not result in a reserve that is less than the reserve for the life insurance benefit under the policy, without a long-term care benefit.
(7) In the development and calculation of reserves for policies and riders subject to this section, due regard shall be given to the applicable policy provisions, marketing methods, administrative procedures, and all other considerations which have an impact on projected claim costs, including, but not limited to the following:
(a) Definition of insured events;
(b) Covered long-term care facilities;
(c) Existence of home convalescence care coverage;
(d) Definition of facilities;
(e) Existence or absence of barriers to eligibility;
(f) Premium waiver provision;
(g) Renewability;
(h) Ability to raise premiums;
(i) Marketing method;
(j) Underwriting procedures;
(k) Claims adjustment procedures;
(l) Waiting period;
(m) Maximum benefit;
(n) Availability of eligible facilities;
(o) Margins in claim costs;
(p) Optional nature of benefit;
(q) Delay in eligibility for benefit;
(r) Inflation protection provisions; and
(s) Guaranteed insurability option.
(8) Any applicable valuation morbidity table used by the insurer shall be certified as appropriate as a statutory valuation table by a member of the American Academy of Actuaries.
Code of Maryland Regulations › Title 31 - MARYLAND INSURANCE ADMINISTRATION › Subtitle 14 - LONG-TERM CARE › Chapter 31.14.02 - Long-Term Care Insurance-Premium Rates and Reserves › Section 31.14.02.11 - Claim Reserves

Current through Register Vol. 51, No. 14, July 12, 2024
A. General Claim Reserve Requirements.
(1) An insurer shall establish a claim reserve for all incurred but unpaid claims on all long-term care insurance.
(2) An insurer shall establish an appropriate claim expense reserve with respect to the estimated expense of settlement of all incurred but unpaid claims under long-term care insurance.
(3) An insurer shall test the long-term care claim reserve and claim expense reserve for prior valuation years for adequacy and reasonableness along the lines of claim runoff schedules in accordance with the statutory financial statement including consideration of any residual unpaid liability.
(4) In establishing claim reserve for long-term care insurance, an insurer shall include reserves for premiums expected to be waived, valuing as a minimum the valuation net premium being waived.