reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.0687 - Applicability of provisions regarding nonforfeiture benefits and contingent benefit upon lapse

Current through June 11, 2024
1. Except as
			 otherwise provided in this section, the provisions of NAC 687B.0686 apply to
			 any long-term care insurance contract or certificate issued in this State on or
			 after October 1, 2008.
2. The
			 provisions of NAC 687B.0686 do not apply to a certificate issued on or after
			 October 1, 2008, to a group described in subsection 1 of NAC 687B.025 under a
			 group long-term care insurance contract which was in force on October 1,
			 2008.
3. The provisions of
			 subsections 5, 9 and 11 of NAC 687B.0686 do not apply to new certificates
			 issued to a group described in subsection 1 of NAC 687B.025 under a group
			 long-term care insurance contract issued on or after April 1, 2009.
4. Except as otherwise provided in
			 subsections 2, 3 and 5, the provisions of subsections 5, 9 and 11 of NAC
			 687B.0686 apply to any long-term care insurance contract or certificate issued
			 in this State on or after January 1, 2009.
5. Except as otherwise provided in
			 subsections 2 and 3, the provisions of subsections 5 and 8 to 17, inclusive, of
			 NAC 687B.0686 apply to any long-term care insurance contract or certificate
			 which was in force on or after October 1, 2011, regardless of the date of
			 issue.
Added to NAC by Comm'r of
				Insurance by R121-07, 9-18-2008, eff. 10-1-2008; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.0689 - Rescission or denial of claim upon showing of misrepresentation material to acceptance for coverage; field issuance of contract or certificate

Current through June 11, 2024
1. For a long-term care insurance contract or
			 certificate that has been in force for less than 6 months, an insurer may
			 rescind the long-term care insurance contract or certificate or deny an
			 otherwise valid long-term care insurance claim upon a showing of
			 misrepresentation that is material to the acceptance for coverage.
2. For a long-term care insurance contract or
			 certificate that has been in force for not less than 6 months but less than 2
			 years, an insurer may rescind the long-term care insurance contract or
			 certificate or deny an otherwise valid long-term care insurance claim upon a
			 showing of misrepresentation which is both material to the acceptance for
			 coverage and which pertains to the condition for which benefits are
			 sought.
3. After a long-term care
			 insurance contract or certificate has been in force for 2 years, it is not
			 contestable upon the grounds of misrepresentation alone and may be contested
			 only upon a showing that the insured knowingly and intentionally misrepresented
			 relevant facts relating to the insured's health.
4. A long-term care insurance contract or
			 certificate may be field-issued if the compensation to the field issuer is not
			 based on the number of long-term care insurance contracts or certificates
			 issued.
5. If an insurer has paid
			 benefits under a long-term care insurance contract or certificate, the benefit
			 payments must not be recovered by the insurer if the long-term care insurance
			 contract or certificate is rescinded.
6. The provisions of this section apply to
			 policies of life insurance which accelerate benefits for long-term care except
			 that, in the event of the death of the insured, this section does not apply to
			 the remaining death benefit of a policy of life insurance that accelerates
			 benefits for long-term care, and the remaining death benefits under such a
			 policy must be governed by NRS
			 NRS
			 688A.080.
7. As used in this section, "field-issued"
			 means issued by a producer or a third-party administrator pursuant to the
			 underwriting authority granted to the producer or third-party administrator by
			 an insurer, using the insurer's underwriting guidelines.
Added to NAC by Comm'r of
				Insurance by R028-10, 12-16-2010, eff. 10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.069 - Record of rescissions

Current through June 11, 2024
An insurer or other entity selling or issuing benefits for
				long-term care insurance shall maintain a record of all rescissions of its
				long-term care insurance contracts or certificates in this State or in any
				other state, except those which the insured voluntarily effectuated, and shall,
				on or before March 1 of each year, furnish this information to the Commissioner
				using form NDOI-929, which is available from the Division, or a similar form
				approved by the Commissioner.
Added to NAC by Comm'r of
				Insurance, eff. 12-15-94; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.070 - Certificate of insurance: Contents

Current through June 11, 2024
A certificate issued pursuant to a group long-term care
				insurance contract which is delivered or issued for delivery in this State must
				include:
1. A description of the
			 principal benefits and coverage provided in the group long-term care insurance
			 contract;
2. A statement of the
			 principal exclusions, reductions and limitations contained in the group
			 long-term care insurance contract; and
3. A statement that the group master
			 long-term care insurance contract determines governing contractual
			 provisions.
Added to NAC by Comm'r of
				Insurance, eff. 11-21-88; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.075 - Outline of coverage: Format; delivery; contents

Current through June 11, 2024
1. An
			 outline of coverage must be delivered to a prospective applicant for a
			 long-term care insurance contract or certificate at the time of initial
			 solicitation through means that prominently direct the attention of the
			 recipient to the document and its purpose. In the case of direct-response
			 solicitations, the insurer shall deliver the outline of coverage upon the
			 prospective applicant's request, or not later than at the time the long-term
			 care insurance contract is delivered.
2. The Commissioner will prescribe a standard
			 format, including style, arrangement and overall appearance, and the content of
			 an outline of coverage.
3.
			 Notwithstanding the provisions of subsection 1, for a long-term care insurance
			 contract issued to a group described in subsection 1 of NAC 687B.025, an
			 outline of coverage need not be delivered if all the information otherwise
			 required to be included in an outline of coverage by subsection 4 is contained
			 in other materials relating to enrollment. These other materials must be made
			 available to the Commissioner upon request.
4. The outline of coverage must include:
(a) A description of the principal benefits
			 and coverage provided in the long-term care insurance contract;
(b) A statement of the principal exclusions,
			 reductions and limitations contained in the long-term care insurance
			 contract;
(c) A statement of the
			 renewal provisions, including any reservation in the long-term care insurance
			 contract of a right to change premiums and, for group coverage, specific
			 descriptions of provisions for continuation or conversion;
(d) A statement that the outline of coverage
			 is a summary of the long-term care insurance contract issued or applied for,
			 and that the long-term care insurance contract should be examined to determine
			 governing contractual provisions;
(e) A description of the terms under which
			 the long-term care insurance contract or certificate may be returned and the
			 premium refunded;
(f) A brief
			 description of the relationship of the cost of care and benefits; and
(g) A statement that discloses to the
			 policyholder or certificate holder whether the long-term care insurance
			 contract is intended to be a federally tax-qualified long-term care insurance
			 contract.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.076 - Offer to purchase protection from inflation required

Current through June 11, 2024
1. An insurer shall not offer a long-term
			 care insurance contract unless the insurer also offers to the policyholder, in
			 addition to any other protection from inflation, the option to purchase a
			 long-term care insurance contract that provides for increasing levels of
			 benefits and increasing maximum benefits at reasonable durations which account
			 for reasonably anticipated increases in the costs of services related to
			 long-term care covered by the long-term care insurance contract. An insurer
			 shall offer to each policyholder, at the time of purchase, the option to
			 purchase a long-term care insurance contract with a feature to protect against
			 inflation that is no less favorable than one of the following:
(a) Increases levels of benefits annually in
			 a manner so that the increases are compounded annually at a rate not less than
			 5 percent;
(b) Guarantees the
			 insured the right to periodically increase levels of benefits without providing
			 evidence of insurability or status of health so long as the option for the
			 previous period has not been declined. The amount of the additional benefit
			 must be no less than the difference between the existing benefit and that
			 benefit compounded annually at a rate of at least 5 percent for the period
			 beginning with the purchase of the existing benefit and extending until the
			 year in which the offer is made; or
(c) Covers a specified percentage of actual
			 or reasonable charges and does not include a maximum specified amount or limit
			 of indemnity.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.077 - Requirements for marketing

Current through June 11, 2024
An insurer, health care plan or other entity who markets,
				directly or through its agents or other producers, long-term care insurance in
				this State shall:
1. Establish
			 procedures regarding marketing to assure that any comparison of long-term care
			 insurance contracts by its agents or other producers will be fair and
			 accurate.
2. Establish procedures
			 regarding marketing to assure excessive insurance is not sold or
			 issued.
3. Display prominently by
			 type, stamp or other appropriate means, on the first page of the outline of
			 coverage and long-term care insurance contract, a statement in substantially
			 the following form:
"Notice to buyer: This contract may not cover all of the costs
				associated with long-term care incurred by the buyer during the period of
				coverage. The buyer is advised to review carefully all limitations in the
				contract."
4. Inquire and
			 otherwise make every reasonable effort to identify whether a prospective
			 applicant or enrollee for long-term care insurance already has a policy for
			 accident and sickness or a long-term care insurance contract and the types and
			 amounts of any such insurance, except that no inquiry into existing policies
			 for accident and sickness needs to be made for a prospective applicant or
			 enrollee for a qualified long-term care insurance contract.
5. Establish auditable procedures for
			 verifying compliance with this section.
6. At the time of solicitation, provide a
			 written notice to the prospective policyholder or certificate holder:
(a) Informing him or her of the availability
			 of a program which provides counseling to elderly persons concerning health
			 insurance; and
(b) Providing the
			 name, address and telephone number of the program.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.0775 - Approval of advertisement by Commissioner

Current through June 11, 2024
1. Except as
			 otherwise provided in subsection 2, every insurer or other organization that
			 markets or offers long-term care insurance contracts or certificates in this
			 State shall:
(a) Provide to the Commissioner
			 for review and approval a copy of any written, radio or television
			 advertisement for the sale of long-term care insurance intended for use in this
			 State; and
(b) Retain any such
			 advertisement for at least 3 years after the date the advertisement was first
			 used.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.078 - Restriction on use of certain terms in marketing

Current through June 11, 2024
An insurer, health care plan or other entity marketing
				long-term care insurance in this State, directly or through its agents or other
				producers, shall not use the terms "noncancellable" or "level premium" in
				reference to a long-term care insurance contract or certificate unless the
				long-term care insurance contract or certificate provides that the insured may
				continue the long-term care insurance by the timely payment of premiums during
				which period the insurer may not unilaterally make any change in any provision
				of the insurance or in the premium rate.
Added to NAC by Comm'r of
				Insurance, eff. 12-15-94; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.079 - Prohibition of certain marketing practices

Current through June 11, 2024
1. An insurer,
			 health care plan or other entity marketing long-term care insurance in this
			 State, directly or through its agents or other producers, shall not engage in
			 the following acts or practices:
(a) High
			 pressure tactics, including:
(1) Any method of
			 marketing having the effect of or tending to induce the purchase of insurance
			 through force, fright or threat, whether explicit or implied; and
(2) Undue pressure to purchase or recommend
			 the purchase of insurance.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.080 - Definition of terms in contracts

Current through June 11, 2024
A long-term care insurance contract delivered or issued for
				delivery in this State may not use the following terms unless the terms are
				defined in the long-term care insurance contract as follows:
1. "Activities of daily living" must be
			 defined as including, without limitation, bathing, continence, dressing,
			 eating, toileting and transferring.
2. "Acute condition" must be defined as a
			 condition making a person medically unstable and requiring frequent monitoring
			 of the person by providers of health care, including, but not limited to,
			 physicians and registered nurses, in order to maintain his or her status of
			 health.
3. "Adult day care" must be
			 defined as a program, for six or more persons, of social and health-related
			 services provided during the day in a community group setting for the purpose
			 of supporting frail, impaired, elderly or disabled adults who can benefit from
			 care in a group setting outside the home.
4. "Bathing" must be defined as washing
			 oneself by sponge bath or in a tub or shower, including, without limitation,
			 the task of getting into or out of the tub or shower.
5. "Cognitive impairment" must be defined as
			 a deficiency in:
(a) The short or long-term
			 memory of the person;
(b)
			 Orientation as to person, place and time;
(c) Deductive or abstract reasoning;
			 or
(d) Judgment as it relates to
			 safety awareness.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.081 - Notification of availability of new series of contracts

Current through June 11, 2024
1. The provisions of this section do not
			 apply to a policy of life insurance or a rider or endorsement to a policy of
			 life insurance that contains accelerated benefits for long-term care.
2. Except as otherwise provided in
			 subsections 3, 6 and 7, an insurer shall notify each policyholder or
			 certificate holder of the availability of any new series of long-term care
			 insurance contracts that provides material coverage for long-term care services
			 or providers that was not previously available through the insurer to the
			 general public, not later than 12 months after the date the new series of
			 long-term care insurance contracts is made available for sale in this
			 State.
3. The notification required
			 by subsection 2 is not required for any long-term care insurance contract or
			 certificate issued:
(a) Before October 1,
			 2008; or
(b) To any policyholder or
			 certificate holder who:
(1) Is currently
			 eligible for benefits;
(2) Is
			 within an elimination period;
(3)
			 Is on a claim;
(4) Previously
			 received benefits under the long-term care insurance contract or certificate;
			 or
(5) Is not eligible to apply for
			 the new coverage because of limitations under the new long-term care insurance
			 contract relating to the issue age of the insured.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.082 - Notification regarding partnership status

Current through June 11, 2024
1. Except as
			 otherwise provided in subsection 3, after the Division approves a filing
			 associated with the partnership status of a form, the insurer or similar
			 organization issuing the form shall notify each policyholder and certificate
			 holder with a long-term care insurance contract or certificate issued or
			 delivered in this State:
(a) If the long-term
			 care insurance contract or certificate requires no additional features to make
			 it a partnership contract or partnership certificate, that the long-term care
			 insurance contract or certificate is now intended to be a partnership contract
			 or partnership certificate.
(b) If
			 the long-term care insurance contract requires additional features to make it a
			 partnership contract or partnership certificate, of an offer, subject to the
			 conditions described in subsection 4, to upgrade the long-term care insurance
			 contract or certificate with the intention to make it a partnership contract or
			 partnership certificate.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.0825 - Activities of daily living and cognitive impairment to be used to measure needs of insured and to be described in contract or certificate; benefit triggers

Current through June 11, 2024
1. Activities of
			 daily living and cognitive impairment must be used to measure the needs of an
			 insured for long-term care and must be described in a long-term care insurance
			 contract or certificate in a separate paragraph that must be labeled as
			 "Eligibility for the Payment of Benefits." Any additional benefit triggers must
			 also be explained and must include, without limitation, whether:
(a) Any such benefit triggers differ for
			 different benefits; and
(b) An
			 attending physician or other specified person is required to certify a certain
			 level of functional dependency for the insured to be eligible for
			 benefits.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.083 - Contract or certificate to condition payment of benefits on insured's ability to perform daily activities and cognitive impairment

Current through June 11, 2024
1. A long-term care insurance contract or
			 certificate must condition the payment of benefits on a determination of the
			 ability of the insured to perform activities of daily living and on the
			 cognitive impairment of the insured. Eligibility for the payment of benefits
			 must not be more restrictive than requiring a determination that the insured:
(a) Is unable to perform more than three of
			 the activities of daily living; or
(b) Has a cognitive impairment.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.084 - Requirements relating to qualified long-term care insurance contract

Current through June 11, 2024
1. A qualified long-term care insurance
			 contract must pay only for qualified long-term care services:
(a) Received by a chronically ill individual;
			 and
(b) Provided pursuant to a plan
			 of care prescribed by a licensed health care practitioner.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.0845 - Required statement as to whether contract intended to be qualified long-term care insurance contract under federal provisions

Current through June 11, 2024
1. A qualified long-term care insurance
			 contract must include a disclosure statement in the qualified long-term care
			 insurance contract and in the outline of coverage that the qualified long-term
			 care insurance contract is intended to be a qualified long-term care insurance
			 contract under
			 26 U.S.C. §
									7702 B(b).
2. A long-term care insurance contract that
			 is not a qualified long-term care insurance contract must include a disclosure
			 statement in the long-term care insurance contract and in the outline of
			 coverage that the long-term care insurance contract is not intended to be a
			 qualified long-term care insurance contract under
			 26 U.S.C. §
									7702 B(b).
Added to NAC by Comm'r of
				Insurance by R121-07, 9-18-2008, eff. 10-1-2008; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.085 - Terms for renewal of contracts

Current through June 11, 2024
1. The terms
			 "guaranteed renewable" and "noncancellable" may not be used in any individual
			 long-term care insurance contract without further explanatory language
			 conforming to the disclosure requirements of NAC 687B.100.
2. No individual long-term care insurance
			 contract may contain renewal provisions other than "guaranteed renewable" or
			 "noncancellable."
3. The term
			 "guaranteed renewable" may be used only when the insured has the right to
			 continue the long-term care insurance by the timely payment of premiums and the
			 insurer has no unilateral rights to make any change in any provision of the
			 long-term care insurance contract while the insurance is in force, and cannot
			 decline to renew the long-term care insurance contract, except that the rates
			 may be revised by the insurer on a class basis.
4. The term "noncancellable" may be used only
			 when the insured has the right to continue the long-term care insurance by the
			 timely payment of premiums during which period the insurer has no right to
			 unilaterally make any change in any provision of the insurance or in the
			 premium rate.
5. The term "level
			 premium" may be used only when the insurer has no right to change the
			 premium.
6. In addition to the
			 other requirements of this section, a qualified long-term care insurance
			 contract must be guaranteed renewable in conformance with the provisions of
			 26 U.S.C. §
									7702 B(b)(1)(c).
Added to NAC by Comm'r of
				Insurance, eff. 11-21-88; A 12-15-94; R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.090 - Exclusions from and limitations on coverage

Current through June 11, 2024
1. A
			 long-term care insurance contract may not be delivered or issued for delivery
			 in this State as long-term care insurance if the long-term care insurance
			 contract limits or excludes coverage by type of illness, treatment, medical
			 condition or accident, except for:
(a)
			 Preexisting conditions or diseases.
(b) Mental or nervous disorders. This
			 exception does not allow a limitation of benefits or exclusion of coverage on
			 the basis of Alzheimer's Disease.
(c) Alcoholism and drug addiction.
(d) Any illness, treatment or medical
			 condition arising out of:
(1) A war or an act
			 of war, whether declared or undeclared.
(2) Participation in a felony, riot or
			 insurrection.
(3) Service in the
			 Armed Forces or units auxiliary thereto.
(4) Suicide, attempted suicide or
			 intentionally self-inflicted injury.
(5) Aviation. This exclusion applies only to
			 passengers who do not pay fares.
(e) Treatment provided in a governmental
			 facility, unless otherwise required by law, services for which benefits are
			 available under Medicare or another governmental program, except Medicaid, and
			 treatment received pursuant to any state or federal program for workers'
			 compensation, employer's liability or occupational disease.
(f) Treatment provided pursuant to any law
			 governing no-fault insurance for motor vehicles.
(g) Services provided by a member of the
			 insured person's immediate family.
(h) Services for which no charge is normally
			 made in the absence of insurance.
(i) Services or items available from or paid
			 by another long-term care insurance contract.
(j) In the case of a qualified long-term care
			 insurance contract, expenses for services or items to the extent that the
			 expenses are reimbursable under Medicare or would be so reimbursable but for
			 the application of a deductible or coinsurance amount.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.095 - Extension of benefits; continuation or conversion of coverage

Current through June 11, 2024
1. Any termination of long-term care
			 insurance must be without prejudice to any benefits payable for
			 institutionalization if the institutionalization began while the long-term care
			 insurance was in force and continues without interruption after
			 termination.
2. Such an extension
			 of benefits beyond the period the long-term care insurance is in force may be
			 limited to the duration of the benefit period, if any, or to payment of the
			 maximum benefits, and may be subject to any waiting period contained in the
			 long-term care insurance contract or any other applicable provision of the
			 long-term care insurance contract.
3. An insurer or similar organization issuing
			 a group long-term care insurance contract shall include in the group long-term
			 care insurance contract:
(a) The basis for
			 continuation of coverage; or
(b)
			 The basis for conversion of coverage.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.105 - Prohibited provisions

Current through June 11, 2024
No long-term care insurance contract may:
1. Be cancelled, nonrenewed or otherwise
			 terminated on the grounds of the age or the deterioration of the mental or
			 physical health of the insured or the certificate holder;
2. Contain a provision establishing a new
			 waiting period if existing coverage is converted to or replaced by a new form
			 within the same company, except with respect to an increase in benefits
			 voluntarily selected by the insured or group policyholder; or
3. Provide coverage for skilled nursing care
			 only or provide significantly more coverage for skilled care provided in a
			 facility than coverage for lower levels of care.
Added to NAC by Comm'r of
				Insurance, eff. 11-21-88; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.106 - Required provisions for reducing coverage and lowering premium; notice

Current through June 11, 2024
1. The provisions of this section do not
			 apply to a policy of life insurance or a rider or endorsement to a policy of
			 life insurance that contains accelerated benefits for long-term care.
2. Each long-term care insurance contract or
			 certificate must include a provision that allows the policyholder or
			 certificate holder to reduce coverage and lower the premium by reducing:
(a) The maximum benefit; or
(b) The daily, weekly or monthly benefit
			 amount.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.1065 - Insurer to file for approval any increase in a premium rate schedule for certain contracts

Current through June 11, 2024
1. The provisions
			 of this section do not apply to:
(a) A
			 long-term care insurance contract or certificate issued before October 1,
			 2008;
(b) A policy of life
			 insurance or a rider or endorsement to a policy of life insurance that contains
			 accelerated benefits for long-term care;
(c) An annuity contract or a rider or
			 endorsement to an annuity contract that contains benefits for long-term care;
			 or
(d) A long-term care insurance
			 contract or certificate which is subject to the provisions of NAC
			 687B.107.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.107 - Insurer to request approval of any increase in premium rate schedule for contracts and certificates issued on or after October 1, 2011

Current through June 11, 2024
1. An insurer shall request approval of any
			 increase in a premium rate schedule, including an exceptional increase, from
			 the Commissioner at least 60 days before providing notice of the increase to
			 the policyholders and shall include in the request:
(a) The information required by NAC
			 687B.0585;
(b) Certification by a
			 qualified actuary that:
(1) If the requested
			 rate increase is implemented and the underlying assumptions which reflect
			 moderately adverse conditions are materialized, no further rate increases are
			 anticipated; and
(2) The premium
			 rate filing is in compliance with the provisions of this section;
(c) An actuarial memorandum
			 justifying the rate increase that includes:
(1) Lifetime projections of earned premiums
			 and incurred claims based on the filed rate increase which include the method
			 and assumptions used in determining the projected values and reflection of any
			 assumptions that deviate from those used for pricing other forms currently
			 available for sale, including, without limitation:
(I) Separate actual and projected annual
			 values for the 5 years before and the 3 years after the valuation
			 date;
(II) The development of the
			 lifetime loss ratio, unless the rate increase is an exceptional
			 increase;
(III) A demonstration of
			 compliance with subsection 2;
(IV)
			 For an exceptional increase, projections that are limited to the increases in
			 claims expenses attributable to the approved reasons for the exceptional
			 increase; and
(V) For an
			 exceptional increase, if the Commissioner determines that offsets may exist,
			 projections which use the appropriate net projected experience;
(2) Disclosure of how reserves
			 have been incorporated in this rate increase whenever the rate increase will
			 trigger contingent benefits upon lapse;
(3) Disclosure of the analysis performed to
			 determine why a rate increase is necessary, which pricing assumptions were not
			 realized and why, and what other actions taken by the company have been relied
			 on by the actuary;
(4) A statement
			 that policy design, underwriting and claims adjudication practices have been
			 taken into consideration; and
(5)
			 If it is necessary to maintain consistent premium rates for new certificates
			 and certificates receiving a rate increase, information concerning composite
			 rates reflecting projections of new certificates;
(d) A statement that renewal premium rate
			 schedules are not greater than new business premium rate schedules except for
			 differences attributable to benefits, unless sufficient justification is
			 provided to the Commissioner; and
(e) Sufficient information for review and
			 approval of the rate increase by the Commissioner.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.1075 - Exceptional increases

Current through June 11, 2024
1. Except as
			 otherwise provided in NAC 687B.107, an exceptional increase is subject to the
			 same requirements as other premium rate schedule increases.
2. The Commissioner may request a review by
			 an independent actuary or a professional actuarial body of the basis for a
			 request that a premium rate increase be considered an exceptional
			 increase.
3. The Commissioner, in
			 determining whether the necessary basis for an exceptional increase exists,
			 will also determine any potential offsets to higher claims costs.
Added to NAC by Comm'r of
				Insurance by R028-10, 12-16-2010, eff. 10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.108 - Prohibited increases in premiums

Current through June 11, 2024
1. The premium
			 charged to an insured for long-term care insurance must not increase because
			 of:
(a) The increasing age of the insured
			 beyond 65 years of age; or
(b) The
			 duration the insured has been covered under the policy.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.111 - Coverage for preexisting conditions

Current through June 11, 2024
1. A long-term care
			 insurance contract or certificate, other than a long-term care insurance
			 contract or certificate issued to a group described in subsection 1 of NAC
			 687B.025, may not:
(a) Define "preexisting
			 condition" in a more restrictive manner than as a condition for which medical
			 advice or treatment was recommended by, or received from a provider of health
			 care within the 6 months preceding the effective date of coverage of the
			 insured.
(b) Exclude coverage for a
			 loss or confinement which is the result of a preexisting condition unless the
			 loss or confinement begins within the 6 months following the effective date of
			 coverage of the insured.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.112 - Monthly report to certain insureds

Current through June 11, 2024
If an insured is receiving benefits for long-term care through
				the acceleration of benefits under a group or individual policy of life
				insurance, a rider to that policy or an annuity contract, the insurer shall
				provide a monthly report to the insured. The report must include, without
				limitation:
1. A statement of any
			 benefits for long-term care paid during that month;
2. An explanation of any changes to the
			 policy or contract, including, without limitation, any change to the death
			 benefit or cash value of the policy or contract resulting from the payment of
			 any benefits for long-term care; and
3. The amount of any remaining benefits for
			 long-term care.
Added to NAC by Comm'r of
				Insurance by R121-07, 9-18-2008, eff. 10-1-2008
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.113 - Delivery of shopper's guide to long-term care insurance

Current through June 11, 2024
1. Except as otherwise provided in this
			 section, a shopper's guide to long-term care insurance must be furnished to
			 each prospective applicant. In the case of a group contract, the guide may be
			 delivered to the policyholder for distribution to the certificate holders. The
			 guide must be one developed and approved by the Commissioner or must be in the
			 format developed by the National Association of Insurance
			 Commissioners.
2. An agent who is
			 soliciting an application for long-term care insurance in person shall furnish
			 the prospective applicant with the shopper's guide before giving him or her an
			 application or enrollment form. In the case of a direct-response solicitation,
			 the shopper's guide must be presented in conjunction with any application or
			 enrollment form.
3. An insurer who
			 offers a life insurance policy, rider or endorsement that contains accelerated
			 long-term care benefits is not required to furnish the shopper's guide, but
			 shall furnish the policy summary required by NAC 687B.0684 within the time
			 provided by that section.
Added to NAC by Comm'r of
				Insurance, eff. 1-4-91; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.114 - Responsibilities of professional, trade or occupational association which endorses or sells contracts or certificates to members

Current through June 11, 2024
1. A
			 professional, trade or occupational association, as described in subsection 2
			 of NAC 687B.025, which endorses or sells long-term care insurance to its
			 members, shall educate its members concerning general issues involving
			 long-term care so that its members can make informed decisions regarding the
			 long-term care insurance.
2. The
			 professional, trade or occupational association shall provide objective
			 information regarding long-term care insurance contracts or certificates
			 endorsed or sold by the association and ensure that members of the association
			 receive a complete explanation of the features in the long-term care insurance
			 contracts or certificates that are being endorsed or sold.
3. The professional, trade or occupational
			 association shall disclose in any solicitation for long-term care insurance:
(a) The specific nature and amount of
			 compensation, including all fees, commissions and other forms of financial
			 support, that the association receives from endorsement or sale of long-term
			 care insurance contracts or certificates to its members; and
(b) A brief description of the process under
			 which such contracts and the insurer issuing such contracts were
			 selected.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.115 - Filing and certification requirements for insurer issuing contract or certificate to professional, trade or occupational association

Current through June 11, 2024
1. An insurer shall not issue a group
			 long-term care insurance contract or certificate to a professional, trade or
			 occupational association unless the insurer files with the Division any
			 materials required by this section or NAC 687B.114.
2. An insurer shall not issue a long-term
			 care insurance contract or certificate to a professional, trade or occupational
			 association, or continue to market such a contract or certificate, unless the
			 insurer certifies on or before December 31 of each year that the association
			 has complied with the requirements set forth in NAC 687B.114.
3. Failure to comply with the requirements
			 regarding filing and certification contained in this section constitutes an
			 undefined unfair trade practice pursuant to NRS
			 NRS
			 686A.170.
Added to NAC by Comm'r of
				Insurance, eff. 12-15-94; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.116 - Limitations on conditioning of benefits

Current through June 11, 2024
1. A long-term
			 care insurance contract delivered or issued for delivery in this State may not:
(a) Condition any benefit upon the
			 hospitalization of the insured;
(b)
			 Condition any benefit for an insured who is institutionalized upon his or her
			 receiving a higher level of institutional care; or
(c) Condition any benefit, other than a
			 waiver of premium or benefits for postconfinement care, postacute care or any
			 recuperative benefit, upon the institutionalization of the insured.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.117 - Restrictions on limitation or exclusion of benefits

Current through June 11, 2024
1. A
			 long-term care insurance contract or certificate that provides benefits for
			 services related to home health care or community care must not limit or
			 exclude benefits:
(a) By requiring that the
			 insured or claimant would need care in a skilled nursing facility if services
			 related to home health care were not provided;
(b) By requiring that the insured or claimant
			 first or simultaneously receive nursing or therapeutic services in a home,
			 community or institutional setting before services related to home health care
			 are covered;
(c) By limiting
			 eligible services provided by registered nurses or licensed practical
			 nurses;
(d) By requiring that a
			 nurse or therapist provide services covered by the long-term care insurance
			 contract that can be provided by a home health aide, or other licensed or
			 certified person providing home health care acting within the scope of his or
			 her licensure or certification;
(e)
			 By excluding coverage for services related to personal care provided by a home
			 health aide;
(f) By requiring that
			 the provision of services related to home health care be at a level of
			 certification or licensure greater than that required by the eligible
			 service;
(g) By requiring that the
			 insured or claimant have an acute condition before services related to home
			 health care are covered;
(h) By
			 limiting benefits to services provided by agencies or providers certified by
			 Medicare; or
(i) By excluding
			 coverage for services related to adult day care.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.118 - Statement of limitations or conditions upon receipt of benefits

Current through June 11, 2024
Each long-term care insurance contract which provides coverage
				for postconfinement care, postacute care or recuperative services, and each
				certificate issued under such a contract, must contain a prominent statement of
				any limitations or conditions on eligibility for these benefits. The
				statement:
1. Must be contained in the
			 paragraph of the long-term care insurance contract or certificate required
			 pursuant to subsection 5 of NAC 687B.100; and
2. Must specify the length in days of any
			 period that the insured is required to be confined in an institution as a
			 condition of receiving these benefits.
Added to NAC by Comm'r of
				Insurance, eff. 1-4-91; A by R028-10, 12-16-2010, eff.
				10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.1185 - Requirements for denied claims

Current through June 11, 2024
If a claim under a long-term care insurance contract or
				certificate is denied, the issuer shall, not later than 60 days after the date
				of a written request by the policyholder, certificate holder or a
				representative thereof:
1. Provide a
			 written explanation of the reasons for the denial; and
2. Make available all information directly
			 related to the denial.
Added to NAC by Comm'r of
				Insurance by R028-10, 12-16-2010, eff. 10-1-2011
NRS
				  679B.130
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.119 - Required reserves for policy, rider or endorsement

Current through June 11, 2024
1. When benefits for long-term care are
			 provided through the acceleration of benefits under a group or an individual
			 policy of life insurance or a rider or endorsement to that policy, the reserves
			 for the benefits must be determined in accordance with the provisions of
			 paragraph (g) of subsection 2 of NRS
			 NRS
			 681B.120. Reserves for a claim must also be
			 established when a policy, rider or endorsement is in claim status.
2. Reserves for policies, riders and
			 endorsements subject to the provisions of subsection 1 must be based on a
			 multiple decrement model using all relevant decrements except those for rates
			 for voluntary termination. An approximation based upon a single decrement model
			 may be used if the calculation produces similar reserves as the multiple
			 decrement model, the reserves are more conservative than the multiple decrement
			 model or the reserves are immaterial. The calculation may take into account the
			 reduction in benefits for life insurance as the result of payment of benefits
			 for long-term care. However, the reserves for the benefit for long-term care
			 and the benefit for life insurance must not be less than the reserves for the
			 benefit for life insurance assuming no benefit for long-term care.
3. In the development and calculation of
			 reserves for policies, riders and endorsements subject to the provisions of
			 subsection 1, consideration must be given to the applicable provisions of the
			 policy, marketing methods, administrative procedures and all other factors
			 which have an impact on projected costs of claims, including, but not limited
			 to, the following:
(a) Definition of insured
			 events;
(b) Covered facilities for
			 long-term care;
(c) Existence of
			 coverage for convalescent care at home;
(d) Definition of facilities;
(e) Existence or absence of barriers to
			 eligibility;
(f) Provisions
			 regarding waiver of premiums;
(g)
			 Renewability;
(h) Ability to raise
			 premiums;
(i) Methods of
			 marketing;
(j) Procedures regarding
			 underwriting;
(k) Procedures
			 regarding adjustment of claims;
(l)
			 Waiting periods;
(m) Maximum
			 benefits;
(n) Availability of
			 eligible facilities;
(o) Margins in
			 costs of a claim;
(p) Optional
			 nature of benefits;
(q) Delay in
			 eligibility for benefits;
(r)
			 Provisions regarding protection against inflation; and
(s) Option of guaranteed insurability.
Any valuation table for morbidity consulted in the development
				and calculation of reserves must be certified as appropriate as a statutory
				valuation table by a qualified actuary.
Nevada Administrative Code › Chapter 687B - Contracts of Insurance › CONTRACTS FOR LONG-TERM CARE › Section 687B.121 - Evaluation of expected loss ratio

Current through June 11, 2024
1. For a long-term
			 care insurance contract or certificate to which subsection 2 does not apply,
			 the Commissioner shall deem the benefits reasonable in relation to premiums
			 charged if the expected loss ratio is at least 60 percent, calculated in a
			 manner which provides for the adequate reserving of the long-term care
			 insurance risk. In evaluating the expected loss ratio, due consideration will
			 be given to all relevant factors, including:
(a) The 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) The concentration of experience within
			 early contract duration;
(e)
			 Expected claim fluctuation;
(f)
			 Experience refunds, adjustments or dividends;
(g) Renewability features;
(h) All appropriate expense
			 factors;
(i) Interest;
(j) The experimental nature of the
			 coverage;
(k) Contract
			 reserves;
(l) The mix of business
			 by risk classification; and
(m)
			 Product features such as long elimination periods, high deductibles and high
			 maximum limits.