Code of Massachusetts Regulations › 211 CMR - DIVISION OF INSURANCE › Title 211 CMR 55.00 - Disclosure Requirements For Life Insurance Policies With Accelerated Benefit Provisions And Annuity Contracts With Waivers Of Surrender Charges For Early Withdrawal Of Annuity Proceeds In The Event Of Total And Permanent Disability › Section 55.04 - Definitions

Current through Register 1525, July 5, 2024
As used in
				211 CMR 55.00, the following
				words mean:
Accelerated Benefit Product
: a
				provision in, or rider to, any policy of individual or group life insurance
				delivered or issued for delivery in Massachusetts under which benefits that
				reduce the otherwise payable death benefit of the policy are payable to a
				policyholder or certificateholder, during the lifetime of the insured, in the
				event the insured becomes totally and permanently disabled, as defined in 211
				CMR 55.04.
Activities of Daily Living
: eating,
				toileting, transferring, bathing, dressing, and continence.
Carrier
: a commercial insurance
				company licensed to issue life insurance policies under M.G.L. c.175 or a
				fraternal benefit society licensed under M.G.L. c. 176.
Chronic Illness
: a condition because
				of which an individual has been certified by a licensed health care
				practitioner as:
(a) 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;
(b) having a level of disability similar to the level of
				disability described in 211 CMR 55.04:
Chronic Illness
(a); or
(c) requiring substantialsupervision to protect such individual
				from threats to health and safety due to severe cognitive impairment.
Such term shall not include conditions otherwise meeting these
				requirements unless within the preceding 12-month period a licensed health care
				practitioner has certified that such individual meets such requirements.
Commissioner
: the Commissioner of
				Insurance appointed pursuant to M.G.L. c. 26, § 6 or his or her
				designee.
Licensed Health Care Practitioner
: any
				physician (asdefined insection 1861(r)(1) of the federal Social Security Act)
				and any registered professional nurse, licensed social worker or other
				individual who meets such requirements as may be prescribedbythe federal
				Secretary of Health and Human Services, or as defined in the federal Health
				Insurance Portabilityand Accountability Act or any successor law or
				anyregulationpromulgatedthereunder. The Licensed Health Care Practitioner must
				be acting within the scope of his or her license in the state of licensure when
				providing covered services or performing actions required by the
				contract.
Medicaid
: the medical assistance
				program administered by the Massachusetts Division of Medical Assistance
				pursuant to M.G.L. c. 118E and Title XIX of the federal Social Security Act, 42
				USCS 1396,
et seq
.
Medicare
: the federal health insurance
				program established under Title XVIII of the federal Social Security Act,
				"Health Insurance for the Aged Act," 42 USCS 1395
et
				seq
.
Policy
: any policy, plan, certificate,
				contract, agreement, statement of coverage, amendment, rider or endorsement
				that provides insurance benefits.
Policyholder
:
(a) the named insured under a life insurance policy or the
				owner of the policy if not the named insured;
(b) in the case of a group life insurance policy, the group
				life insurance certificateholder; or
(c) the contract holder, in the case of an annuity
				contract.
Qualified Long-term Care Services
: the
				necessary diagnostic, preventive, therapeutic, curing, treating, mitigating and
				rehabilitative services, and maintenance or personal care services that are
				required by a chronically ill individualand are provided pursuant to a plan of
				care prescribed by a licensed health care practitioner.
Special Benefits
: benefits including,
				but not limited to:
(a) the acceleration of the death benefit in life insurance
				policies, as well as payments made over and above the accelerated benefit for
				expenses incurred for Qualified Long-Term Care Services in policies providing
				benefits for conditions of Chronic Illness only, or
(b) the waiver of the surrender charge for early withdrawal of
				annuity proceeds in annuity contracts.
Supplemental Security Income
: the
				entitlement program under Title XVI, § 1601, 42 USCS 1381,
et
				seq
.
Terminal Illness
: a condition that a
				physician certifies will reasonably be expected to result in a drastically
				limited life span as specified in the contract, for example, of 24 months or
				less.
Total and Permanent Disability
: any of
				the following conditions as specified in the policy:
(a) terminal illness, as defined in 211 CMR 55.04;
(b) chronic illness, as defined in 211 CMR 55.04;
(c) a medical condition, including but not limited to one of
				the following specifically named or described conditions, which the insured's
				physician certifies has required or will require extraordinary medical
				intervention without which the insured would have died, or will die:
1. Acquired Immune Deficiency Syndrome;
2. Coronary artery disease resulting in acute infarction or
				requiring surgery;
3. End-stage Renal Disease;
4. Major organ transplant;
5. Medical condition requiring continuous life support;
				or
6. Permanent neurological deficit resulting from cerebral
				vascular accident; or
(d) other qualifying conditions that meet the definition in 211
				CMR 55.04:
Total and Permanent Disability
(c) and that
				are approved by the Commissioner for any particular filing.