reglab/statecodes huggingface dataset:
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-011 - Requirement to Offer Inflation Protection

Current through June 17, 2024
011.01 No insurer
				may offer a long-term care insurance policy unless the insurer also offers to
				the policyholder in addition to any other inflation protection the option to
				purchase a policy that provides for benefit levels to increase with benefit
				maximums or reasonable durations which are meaningful to account for reasonably
				anticipated increases in the costs of long-term care services covered by the
				policy. Insurers must offer to each policyholder, at the time of purchase, the
				option to purchase a policy with an inflation protection feature no less
				favorable than one of the following:
011.01(A) Increases benefit levels annually
				in a manner so that the increases are compounded annually at a rate not less
				than five percent (5%);
011.01(B)
				Guarantees the insured individual the right to periodically increase benefit
				levels without providing evidence of insurability or health status so long as
				the option for the previous period has not been declined. The amount of the
				additional benefit shall be no less than the difference between the existing
				policy benefit and that benefit compounded annually at a rate of at least five
				percent (5%) for the period beginning with the purchase of the existing benefit
				and extending until the year in which the offer is made; or
011.01(C) Covers a specified percentage of
				actual or reasonable charges and does not include a maximum specified indemnity
				amount or limit.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-012 - Requirements for Application Forms and Replacement Coverage

Current through June 17, 2024
012.01 Application
				forms shall include the following questions designed to elicit information as
				to whether, as of the date of the application, the applicant has another
				long-term care insurance policy or certificate in force or whether a long-term
				care policy or certificate is intended to replace any other sickness and
				accident or long-term care policy or certificate presently in force. A
				supplementary application or other form to be signed by the applicant and
				agent, except where the coverage is sold without an agent, containing such
				questions may be used. With regard to a replacement policy issued to a group
				defined by
Neb.Rev.Stat
. §
									44-4508(1),
				the following questions may be modified only to the extent necessary to elicit
				information about health or long-term care insurance policies other than the
				group policy being replaced; provided, however, that the certificateholder has
				been notified of the replacement.
012.01(A) Do
				you have another long-term care insurance policy or certificate in force
				(including a health care service contract, and/or a health maintenance
				organization contract)?
012.01(B)
				Did you have another long-term care insurance policy or certificate in force
				during the last twelve (12) months?
012.01(B)(i) If so, with which
				company?
012.01(B)(ii) If that
				policy lapsed, when did it lapse?
012.01(C) Are you covered by
				Medicaid?
012.01(D) Do you intend
				to replace any of your medical or health insurance coverage with this policy
				[certificate]?
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-013 - Reporting Requirements

Current through June 17, 2024
013.01 Every
				insurer shall maintain records for each agent of that agent's amount of
				replacement sales as a percent of the agent's total annual sales and the amount
				of lapses of long-term care insurance policies sold by the agent as a percent
				of the agent's total annual sales.
013.02 Each insurer shall report annually by
				June 30 the ten percent (10%) of its agents with the greatest percentages of
				lapses and replacements as measured by Subsection 013.01 above.
013.03 Reported replacement and lapse rates
				do not alone constitute a violation of insurance laws or necessarily imply
				wrongdoing. The reports are for the purpose of reviewing more closely agent
				activities regarding the sale of long-term care insurance.
013.04 Every insurer shall report annually by
				June 30 the number of lapsed policies as a percent of its total annual sales
				and as a percent of its total number of policies in force as of the end of the
				preceding calendar year.
013.05
				Every insurer shall report annually by June 30 the number of replacement
				policies sold as a percent of its total annual sales and as a percent of its
				total number of policies in force as of the preceding calendar year.
013.06 Every insurer shall report annually by
				June 30, for qualified long-term care insurance contracts, the number of claims
				denied for each class of business, expressed as a percentage of claims denied.
				(Appendix E)
013.07 For purposes of
				this section
:
013.07(A) "Policy" means only long-term care
				insurance.
013.07(B) Subject to
				subsection
				013.07(3),
				"claim" means a request for payment of benefits under an enforce policy
				regardless of whether the benefit claimed is covered under the policy or any
				terms or conditions of the policy have been met.
013.07(C) "Denied" means the insurer refuses
				to pay a claim for any reason other than for claims not paid for failure to
				meet the waiting period or because of an applicable preexisting condition;
				and
013.07(D) "Report" means on a
				statewide basis.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-014 - Licensing

Current through June 17, 2024
No agent is authorized to market, sell, solicit or otherwise
				  contact any person for the purpose of marketing long-term care insurance unless
				  the agent has demonstrated his or her knowledge of long-term care insurance and
				  the appropriateness of such insurance by passing a test required by this state
				  and maintaining appropriate licenses.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-015 - Discretionary Powers of Director

Current through June 17, 2024
The Director may upon written request and after an
				  administrative hearing, issue an order to modify or suspend a specific
				  provision or provisions of this regulation with respect to a specific long-term
				  care insurance policy or certificate upon a written finding that:
015.01 The modification or suspension would
				be in the best interest of the insureds; and
015.02 The purposes to be achieved could not
				be effectively or efficiently achieved without the modification or suspension;
				and
015.03
015.03(A) The modification or suspension is
				necessary to the development of an innovative and reasonable approach for
				insuring long-term care; or
015.03(B) The 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 such a
				community; or
015.03(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.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-016 - Reserve Standards

Current through June 17, 2024
016.01 When
				long-term care benefits are provided through the acceleration of benefits under
				group or individual life policies or riders to such policies, policy reserves
				for such benefits shall be determined in accordance with
Neb.Rev.Stat.
§
									44-404.
				Claim reserves must also be established in the case when such policy or rider
				is in claim status.
Reserves for policies and riders subject to this subsection
				  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.
In the development and calculation of reserves for policies
				  and riders subject to this subsection, 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:
016.01(A) Definition of insured
				events;
016.01(B) Covered long-term
				care facilities;
016.01(C)
				Existence of home convalescence care coverage;
016.01(D) Definition of facilities;
016.01(E) Existence or absence of barriers to
				eligibility;
016.01(F) Premium
				waiver provision;
016.01(G)
				Renewability;
016.01(H) Ability to
				raise premiums;
016.01(I) Marketing
				method;
016.01(J) Underwriting
				procedures;
016.01(K) Claims
				adjustment procedures;
016.01(L)
				Waiting period;
016.01(M) Maximum
				benefit;
016.01(N) Availability of
				eligible facilities;
016.01(O)
				Margins in claim costs;
016.01(P)
				Optional nature of benefit;
016.01(Q) Delay in eligibility for
				benefit;
016.01(R) Inflation
				protection provisions; and
016.01(S) Guaranteed insurability option.
Any applicable valuation morbidity table shall be certified
				  as appropriate as a statutory valuation table by a member of the American
				  Academy of Actuaries.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-017 - Loss Ratio

Current through June 17, 2024
017.01 Benefits
				under 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 which 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:
017.01(A) Statistical credibility of incurred
				claims experience and earned premiums;
017.01(B) The period for which rates are
				computed to provide coverage;
017.01(C) Experienced and projected
				trends;
017.01(D) Concentration of
				experience within early policy duration;
017.01(E) Expected claim
				fluctuation;
017.01(F) Experience
				refunds, adjustments or dividends;
017.01(G) Renewability features;
017.01(H) All appropriate expense
				factors;
017.01(I)
				Interest;
017.01(J) Experimental
				nature of the coverage;
017.01(K)
				Policy reserves;
017.01(L) Mix of
				business by risk classification; and
017.01(M) Product features such as long
				elimination periods, high deductibles and high maximum limits.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-018 - Filing Requirement

Current through June 17, 2024
Prior to an insurer or similar organization offering group
				  long-term care insurance to a resident of this state pursuant to
Neb.Rev.Stat.
§
									44-4511,
				  it shall file with the Director 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.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-019 - Filing Requirements for Advertising

Current through June 17, 2024
019.01 Every
				insurer, health care service plan or other entity providing long-term care
				insurance or benefits in this state shall provide a copy of any long-term care
				insurance advertisement intended for use in this state whether through written,
				radio or television medium to the Director of this state for review or approval
				by the Director to the extent it may be required under state law. 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.
019.02 The Director
				may exempt from these requirements any advertising form or material
				when
,
in the Director's opinion, this requirement may
				not be reasonably applied.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-020 - Standards for Marketing

Current through June 17, 2024
020.01 Every
				insurer, health care service plan or other entity marketing long-term care
				insurance coverage in this state, directly or through its producers, shall:
020.01(A) Establish marketing procedures to
				assure that any comparison of policies by its agents or other producers will be
				fair and accurate.
020.01(B)
				Establish marketing procedures to assure excessive insurance is not sold or
				issued.
020.01(C) Display
				prominently by type, stamp or other appropriate means, on the first page of the
				outline of coverage and policy the following:
"Notice to buyer: This policy may not cover all 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
				  limitations."
020.01(D)
				Inquire and otherwise make every reasonable effort to identify whether a
				prospective applicant or enrollee for long-term care insurance already has
				sickness and accident or long-term care insurance and the types and amounts of
				any such insurance except that in the case of qualified long-term care
				insurance contracts, an inquiry into whether a prospective applicant or
				enrollee for long-term care insurance has accident and sickness insurance is
				not required.
020.01(E) Every
				insurer or entity marketing long-term care insurance shall establish auditable
				procedures for verifying compliance with this subsection 020.01.
020.01(F) If the state in which the policy or
				certificate is to be delivered or issued for delivery has a senior insurance
				counseling program approved by the Director, the insurer shall, at
				solicitation, provide written notice to the prospective policyholder and
				certificateholder that such a program is available and the name, address and
				telephone number of the program.
020.01(G) For long term care health insurance
				policies and certificates, use the terms "noncancellable" or "level premium"
				only when the policy or certificate conforms to section
				006.01(C) of this
				regulation.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-021 - Suitability

Current through June 17, 2024
21.01 This section
				shall not apply to life insurance policies that accelerate benefits for
				long-term care.
21.02 Every
				insurer, health care service plan or other entity marketing long-term care
				insurance (the "issuer") shall:
021.02(A)
				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;
021.02(B) Train its
				agents in the use of its suitability standards; and
021.02(C) Maintain a copy of its suitability
				standards and make them available for inspection upon request by the
				Director.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-022 - Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates

Current through June 17, 2024
If a long-term care insurance policy or certificate replaces
				  another long-term care or certificate, the replacing insurer shall waive any
				  time periods applicable to preexisting conditions and probationary periods in
				  the new long-term care policy for similar benefits to the extent that similar
				  exclusions have been satisfied under the original policy.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-023 - Nonforfeiture Benefit Requirement

Current through June 17, 2024
023.01 This section
				does not apply to life insurance policies or riders containing accelerated
				long-term care benefits.
023.02 To
				comply with the requirement to offer a nonforfeiture benefit pursuant to the
				provisions of
Neb.Rev.Stat
. §
									44-4517.02:
023.02(A) A policy or certificate offered
				with nonforfeiture benefits shall have coverage elements, eligibility, benefit
				triggers and benefit length that are the same as coverage to be issued without
				nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
				be the benefit described in subsection 023.05; and
023.02(B) The offer shall be in writing if
				the nonforfeiture benefit is not otherwise described in the Outline of Coverage
				or other materials given to the prospective policyholder.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-024 - Standards for Benefit Triggers

Current through June 17, 2024
024.01 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.
024.02 Activities of daily living
024.02(A) Activities of daily living shall
				include at least the following as defined in section 005 and in the policy:
024.02(A)(1) Bathing;
024.02(A)(2) Continence;
024.02(A)(3) Dressing;
024.02(A)(4) Eating;
024.02(A)(5) Toileting; and
024.02(A)(6) Transferring.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-025 - Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts

Current through June 17, 2024
025.01 For purposes
				of this section the following definitions apply:
025.01(A) "Qualified long-term care services"
				means services that meet the requirements of Section 7702(c)(1) of the Internal
				Revenue Code as of 1986, as amended, as follows: necessary diagnostic,
				preventive, therapeutic, curative, treatment, mitigation and rehabilitative
				services, and maintenance or personal care services which are required by a
				chronically ill individual, and are provided pursuant to a plan of care
				prescribed by a licensed health care practitioner.
025.01(B)
025.01(B)(1) "Chronically ill individual" has
				the meaning prescribed for this term by section 7702B(c)(2) of the Internal
				Revenue Code of 1986, as amended. Under this provision, a chronically ill
				individual means any individual who has been certified by a "licensed health
				care practitioner" as:
025.01(B)(1)(i) Being
				unable to perform (without substantial assistance from another individual) at
				least two (2) activities of daily living for a period of at least ninety (90)
				days due to a loss of functional capacity; or
025.01(B)(1)(ii) Requiring substantial
				supervision to protect the individual from threats to health and safety due to
				severe cognitive impairment.
025.01(B)(2) The term "chronically ill
				individual" shall not include an individual otherwise meeting these
				requirements unless within the preceding twelve-month period a licensed health
				care practitioner has certified that the individual meets these
				requirements.
025.01(C)
				"Licensed health care practitioner" means a physician, as defined in Section
				1861(r)(1) of the Social Security Act, a registered professional nurse,
				licensed social worker or other individual who meets requirements prescribed by
				the Secretary of the Treasury.
025.01(D) "Maintenance or personal care
				services" means any care the primary purpose of which is the provision of
				needed assistance with any of the disabilities as a result of which the
				individual is a chronically ill individual (including the protection from
				threats to health and safety due to severe cognitive impairment). A qualified
				long term care insurance contract shall pay only for qualified long term care
				services received by a chronically ill individual provided pursuant to a plan
				of care prescribed by a licensed health care practitioner.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-027 - Requirement to Deliver Shopper's Guide

Current through June 17, 2024
027.01 A long-term
				care insurance shopper's guide in the format developed by the National
				Association of Insurance Commissioners, or a guide developed or approved by the
				Director, shall be provided to all prospective applicants of a long-term care
				insurance policy or certificate.
027.01(A) In
				the case of agent solicitations, an agent must deliver the shopper's guide
				prior to the presentation of an application or enrollment form.
027.01(B) In the case of direct response
				solicitations, the shopper's guide must be presented in conjunction with any
				application or enrollment form.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-028 - Penalties

Current through June 17, 2024
In addition to any other penalties provided by the laws of
				  this state any insurer and any agent found to have violated any requirement of
				  this state relating to the regulation of long-term care insurance or the
				  marketing of such insurance shall be subject to a fine of up to three (3) times
				  the amount of any commissions paid for each policy involved in the violation or
				  up to $10,000, whichever is greater.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-029 - Severability

Current through June 17, 2024
If any section or portion of a section of this Regulation, or
				  the applicability thereof to any person or circumstance, is held invalid by a
				  court, the remainder of this regulation, or the applicability of such provision
				  to other persons, shall not be affected thereby.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-030 - Effective Date

Current through June 17, 2024
The operative date of this regulation is October 1,
				  2000.
This regulation shall apply to all long-term care insurance
				  policies and certificates delivered or issued for delivery in this state by an
				  insurer on or after October 1, 2001.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Appendix A - RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES

Current through June 17, 2024
FOR THE STATE OF ___________________
FOR 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 Claims/s Submitted
Date of Rescission
Detailed reason for rescission:
____________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
___________________________
Signature
___________________________
Name and Title (please type)
___________________________
Date
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Appendix C - Things You Should Know Before You Buy Long-Term Care Insurance

Current through June 17, 2024
Long-Term Care
* A long-term care insurance
				  policy may pay most of the costs for
Insurance
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
* Make sure the insurance company or
				  agent gives you a copy of a
Guide
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 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.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Appendix D - Long-Term Care Insurance Suitability Letter

Current through June 17, 2024
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
				  with your application, including the booklet "Shoppers 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].
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Appendix E - Claims Denial Reporting Form Long-Term Care Insurance

Current through June 17, 2024
For the State of _______________________
For the Reporting Year of_______________
Company Name:
__________________________________
Due: June 30
				  annually
Company Address:
_____________________________________________
				  _____________________________________________
Company NAIC #:
_____________________________________________
Contact Person:
_______________________Phone #:_____________________
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. .
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.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-001 - Authority

Current through June 17, 2024
This rule is adopted under Neb.Rev.Stat. §§
									44-4308 and
				  44-4314.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-002 - Purpose

Current through June 17, 2024
The purpose of this rule is to procedures to carry out the
				  provisions of the Intergovernmental Risk Management Act.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-003 - Definitions

Current through June 17, 2024
003.01 For the purposes of this rule, in
				addition to the definitions in Neb.Rev.Stat. §
									44-4303
				and in Neb.Rev.Stat. § 44-103:
003.02 Administrator means an individual,
				partnership, corporation, unincorporated association, limited liability
				company, or other entity, engaged by a risk management pool to provide services
				in connection with the management or operation of the pool.
003.03 Dividend means a share of earned
				surplus allocated to each member participating in the pool.
003.04 Hazardous to the public shall mean
				that, based on its present or reasonably anticipated financial condition, a
				group self-insurance pool, although it may not yet be financially impaired or
				insolvent, is unlikely to be able to (a) meet obligations to policyholders with
				respect to known claims and reasonably anticipated claims or (b) pay other
				obligations in the normal course of business.
003.05 Qualified Actuary shall mean a person:
003.05A(1) Who provides services to a pool
				described in Neb.Rev.Stat. §
										44-4304(1),
				is a fellow or associate of the Casualty Actuarial Society, a member of the
				American Academy of Actuaries and independent of the insurance company electing
				to discount its reserves; or
003.05A(2) Who provides services to a pool
				described in Neb.Rev.Stat. §
										44-4304(2),
				is a fellow or associate of the Society of Actuaries, a member of the American
				Academy of Actuaries, independent of the pool and its members, and independent
				of any insurance company electing to discount its reserves, and independent of
				any reinsurance company contracted with the pool; or
003.Q5B Who meets all the following
				requirements:
003.05B(1) Has demonstrated to
				the director that he or she is possessed of the educational background and
				experience necessary for the practice of actuarial science;
003,05B(2) Is independent of the insurance
				company electing to discount its reserves, the pool and its members, and any
				reinsurance company contracted with the pool; and
003.05B(3) Has the prior written approval of
				the director to sign claim or loss reserve opinions required by this
				rule.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-004 - Application for certificate of authority

Current through June 17, 2024
A risk management pool organized pursuant to the
				  Intergovernmental Risk Management Act may apply to the director for a
				  certificate of authority to provide group self-insurance to its members. The
				  application shall include the pool's name, location of its principal office,
				  date of organization, and the name and address of each member. The following
				  information shall be submitted with the application, and shall specify the
				  types of coverage involved, where applicable:
004.01 A copy of the agreement entered into
				for the purpose of establishing and operating a risk management pool as
				required by Neb.Rev.Stat. §
									44-4306;
004.02 A copy of the pool's articles of
				incorporation, articles of association or by-laws;
004.03 Disclosure of the lines of insurance
				coverage to be provided as specified under Neb.Rev.Stat. §
				44-4304;
004.04 Pro forma financial
				statements and projections for at least the first 5 years of
				operation;
004.05 Historical and
				expected loss experience of the proposed members to the extent reasonably
				available;
004.06 Appropriate
				actuarial opinions by a qualified, independent actuary, including a
				determination of minimum premium or participation levels required to begin
				operations and to prevent the pool from being hazardous to the
				public;
004.07 A copy of the
				agreement with any administrator or service company and biographical
				information on such individuals or if an entity, the individuals providing the
				services for such entity;
004.08
				Address in Nebraska where books and records of the pool will be maintained at
				all times;
004.09 Disclosure of
				proposed standard insurance, excess insurance, excess stop-loss reinsurance
				arrangements, and reinsurance arrangements and a copy of such agreements as
				they become available;
004.10
				Disclosure of member contribution levels and the criteria used to determine the
				contribution levels;
004.11 A copy
				of any insuring agreements, forms and certificates of insurance coverage to be
				issued by the pool to each member of the pool;
004.12 Disclosure of the extent to which
				initial pool funding will be raised through the issuance of bonds;
				and
004.13 Such other information
				as the director may reasonably require.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-005 - Reserves

Current through June 17, 2024
A risk management pool shall maintain the same reserves as
				  required of a Nebraska domestic insurance company offering the same coverage as
				  the group insurance offered by a pool to its members, except that a pool may
				  discount loss reserves if the pool's annual statement is accompanied by a
				  certified statement of opinion by a qualified actuary which accurately reflects
				  the effect of discounting of claim or loss reserves on the pool's financial
				  condition. In the event a pool discounts its claim or loss reserves, the
				  certified actuarial opinion defined in this section shall include the
				  following:
005.01 An assessment of the
				adequacy of the undiscounted reserves;
005.02 An assessment of the appropriateness
				of the assumed interest rate, considering at least the following:
005.02A Valuation basis of bonds;
005.02B Yield on assets; and
005.02C The match of asset maturities to
				corresponding liabilities.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-006 - Dividends

Current through June 17, 2024
A pool may not distribute dividends to its members until it
				  has received approval by the director. A pool may not declare or pay any
				  dividends except from earned surplus, ascertained in accordance with statutory
				  insurance accounting principles. The application for approval to distribute
				  dividends shall specify the date established for payment of the dividend; a
				  statement as to whether the dividend is to be in cash or property, and if in
				  property, how valuation was determined; the dates and amounts of all previous
				  dividends; financial statements as of the month preceding the application; a
				  brief statement as to the effect of the proposed dividend upon the pool's
				  reserves and the reasonableness of surplus in relation to the pool's
				  outstanding liabilities; and, the adequacy of the surplus relative to the
				  pool's financial needs.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-007 - Surplus

Current through June 17, 2024
A pool shall maintain adequate surplus and reserves and
				  receive adequate financial contributions from its members to operate in a
				  manner which is not hazardous to the public.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-008 - Investments

Current through June 17, 2024
The surplus and other funds, of a pool shall be invested as
				  authorized by Nebraska domestic insurance companies offering the same coverage
				  as the group insurance offered by the pool to its members.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-009 - Notice to Department

Current through June 17, 2024
009.01 A pool shall
				notify the Department 30 days in advance of any assessments to cure a
				deficiency and of any changes in:
009.01A
				Contribution levels;
009.01B
				Coverages offered by the pool;
009.01C Administrator or service company, and
				any material change in such agreements with the administrator or service
				company;
009.01D The pool's
				articles of incorporation, articles of association and by-laws;
009.01E Any amendments to the agreement
				establishing in the pool;
009.01F
				Standard insurance, excess insurance, excess stop-loss insurance, excess
				stop-loss reinsurance agreements, and reinsurance agreements; or
009.01G The extent to which pool funding will
				be raised through the issuance of bonds.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-010 - Workers' compensation

Current through June 17, 2024
A pool providing group self-insurance for Worker's
				  Compensation coverage shall comply with the rules and regulations of the
				  Nebraska Workers' Compensation Court.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-012 - Annual report of affairs and examinations

Current through June 17, 2024
012.01
				The report required under Neb. Rev. Stat. §
									44-4310
				shall show all contributions received by the pool for membership in the pool
				during the previous calendar year. Such annual statements shall use insurance
				statutory accounting principles and shall include an actuarial or loss reserve
				specialist opinion on claim or loss reserves and loss adjusting expense
				reserves.
012.02 A pool discounting
				claim or loss reserves shall disclose the discounting of claim or loss reserves
				in its annual and other financial statements in a manner which will accurately
				reflect the effect of discounting of claim or loss reserves on the pool's
				financial condition.
012.03 The
				reasonable expenses for examination of the business affairs, records, and
				assets of each pool conducted by the Department pursuant to Neb.Rev.Stat.
				§
									44-4310(2)
				shall be determined by the director. Each pool shall be responsible for the
				payment of the determined expenses to the director within a reasonable time
				after the receipt of the statement for such expenses. The expenses shall be
				limited to a reasonable allocation for the salary of each examiner plus actual
				expenses.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-013 - Payment to director; computation

Current through June 17, 2024
013.01 On or before
				March 1 of each year, every risk management pool shall pay to the director the
				amounts required pursuant to Neb.Rev.Stat. §
									44-4320
				and §
									48-162.02.
013.01A A pool which has a scheme of
				operations that contemplates a return of a portion of the contributions of pool
				members without such members being claimants under the pool's insuring
				agreements may deduct such return contributions from the pool's contributions
				for the purpose of calculating the payment due to the director under
				Neb.Rev.Stat. §
										44-4320
				and §
										48-162.02.
013.01B A pool which has a scheme of
				operations that includes the purchase of standard insurance subject to premium
				tax under Neb.Rev.Stat. §
										77-908
				or §
										44-5506
				may deduct the cost of such insurance from the pool's contributions for the
				purpose of calculating the payment due to the director under Neb.Rev.Stat.
				§
										44-4320
				and §
										48-162.02.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-014 - Termination of membership in the pool

Current through June 17, 2024
014.01 Within 30
				days after receiving notice of a member's voluntary termination of
				participation under Neb.Rev.Stat. §
									44-4309(1),
				the pool's governing board shall submit a written report to the Department
				which:
014.01A discloses whether the
				terminating member and remaining members of the pool have paid all
				contributions and assessments due the pool, have discharged all other
				obligations owed to the pool, and have complied with the laws of Nebraska, this
				rule, and the by-laws of the pool; and
014.01B projects the effect on the pool due
				to the member's withdrawal from the pool.
Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 47 - GROUP SELF-INSURANCE RULE IMPLEMENTING THE INTERGOVERNMENTAL RISK MANAGEMENT ACT › Section 210-47-015 - Voluntary dissolution of the pool

Current through June 17, 2024
015.01 A pool shall
				not voluntarily dissolve or cease to function unless the governing board
				obtains the approval of the director and obtains the approval of the pool's
				members in accordance with the agreement establishing the pool and the pool's
				by-laws, which shall require a two-thirds majority vote. The governing board
				may submit a written application seeking the director's approval to voluntarily
				dissolve, at least 90 days in advance of the proposed dissolution date, setting
				forth the following:
015.01A Desired date of
				pool's dissolution;
015.01B
				Resolution of the governing board to terminate the pool and seeking the
				director's approval of such termination; and
015.01C A plan of dissolution adopted by the
				governing board which describes the pool's arrangements for satisfying its
				obligations, including the insurance or reinsurance of its obligations with
				insurers under appropriate agreements approved by the director, or such
				alternative arrangements which provide for the payment of all claims,
				liabilities and debts such as a contingency or trust fund for future claims and
				obligations. Such obligations shall include both known claims and associated
				expenses and claims incurred but not reported and associated expenses. The plan
				shall provide for the distribution of any assets remaining after payment of
				claims, liabilities and debts and the return of any unearned premium
				contributions. The return of surplus contributions must be based on an
				equitable formula.