Mississippi Administrative Code › Title 19 - Department of Insurance › Part 3 - Accident and Health › Chapter 8 - (90-102) Long-Term Care Insurance Regulation › Rule 19-3-8.04 - Definitions

Current through June 25, 2024
For the purpose of this regulation, the following terms shall
				  have the following meanings:
A. "Long-term care insurance" means any insurance policy or
				  rider advertised, marketed, offered or designed to provide coverage for not
				  less than twelve (12) consecutive months for each covered person on an expense
				  incurred, indemnity, prepaid or other basis; for one or more necessary or
				  medically necessary diagnostic, preventive, therapeutic, rehabilitative, or
				  maintenance or personal care services, provided in a setting other than an
				  acute care unit of a hospital. Such term includes group and individual
				  annuities and life insurance policies or riders which provide directly or which
				  supplement long-term care insurance. Such term also includes a policy or rider
				  which provides for payment of benefits based upon cognitive impairment or the
				  loss of functional capacity. Long-term care insurance may be issued by
				  insurers; fraternal benefit societies; nonprofit health, hospital, and medical
				  service corporations; prepaid health plans; health maintenance organizations or
				  any similar organization to the extent they are otherwise authorized to issue
				  life or health insurance. Long-term care insurance shall not include any
				  insurance policy which is offered primarily to provide basic Medicare
				  supplement coverage, basic hospital expense coverage, basic medical-surgical
				  expense coverage, hospital confinement indemnity coverage, major medical
				  expense coverage, disability income or related asset protection coverage,
				  accident only coverage, specified disease or specified accident coverage, or
				  limited benefit health coverage.
B. "Applicant" means:
1. In the case of an individual long-term care insurance
				  policy, the person who seeks to contract for benefits, and
2. In the case of a group long-term care insurance policy,
				  the proposed certificate holder.
C. "Certificate" means, for the purposes of this Regulation,
				  any certificate issued under a group long-term care insurance policy, which
				  policy has been delivered or issued for delivery in this state.
D. "Commissioner" means the Insurance Commissioner of this
				  state.
E. "Group long-term care insurance" means a long-term care
				  insurance policy which is delivered or issued for delivery in this state and
				  issued to:
1. One or more employers or labor organizations, or to a
				  trust or to the trustees of a fund established by one or more employers or
				  labor organizations, or a combination thereof, for employees or former
				  employees or a combination thereof or for members or former members or a
				  combination thereof, of the labor organizations; or
2. Any professional, trade or occupational association for
				  its members or former or retired members, or combination thereof, if such
				  association:
a. Is composed of individuals all of whom are or were
				  actively engaged in the same profession, trade or occupation; and
b. has been maintained in good faith for purposes other than
				  obtaining insurance; or
3. An association or a trust or the trustee(s) of a fund
				  established, created or maintained for the benefit of members of one or more
				  associations. Prior to advertising, marketing or offering such policy within
				  this state, the association or associations, or the insurer of the association
				  or associations, shall file evidence with the Commissioner that the association
				  or associations have at the outset a minimum of 100 persons and have been
				  organized and maintained in good faith for purposes other than that of
				  obtaining insurance, have been in active existence for at least one year; and
				  have a constitution and bylaws which provide that:
a. The association or associations hold regular meetings not
				  less than annually to further purposes of the members;
b. Except for credit unions, the association or associations
				  collect dues or solicit contributions from members; and
c. The members have voting privileges and representation on
				  the governing board and committees.
d. Thirty (30) days after such filing the association or
				  associations will be deemed to satisfy such organizational requirements, unless
				  the Commissioner makes a finding that the association or associations do not
				  satisfy those organizational requirements.
4. A group other than as described in Subsections E(1), E(2)
				  and E(3), subject to a finding by the Commissioner that:
a. The issuance of the group policy is not contrary to the
				  best interest of the public;
b. The issuance of the group policy would result in economies
				  of acquisition or administration; and
c. The benefits are reasonable in relation to the premiums
				  charged.
F. "Policy" means, for the purposes of this Regulation, any
				  policy, contract, subscriber agreement, rider or endorsement delivered or
				  issued for delivery in this state by an insurer; fraternal benefit society;
				  nonprofit health, hospital, or medical service corporation; prepaid health
				  plan; health maintenance organization or any similar
				  organization.
Miss Code Ann §
										83-5-1
				  (Rev. 2011)