Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-008 - Required Disclosure Provisions

Current through June 17, 2024
008.01 Renewability
Individual long-term care insurance policies shall contain a
				  renewal provision. Such provision shall be appropriately captioned, shall
				  appear on the first page of the policy, and shall clearly state the duration,
				  where limited, of renewability and the duration of the term of coverage for
				  which the policy is issued and for which it may be renewed. This provision
				  shall not apply to policies which do not contain a renewability provision, and
				  under which the right to nonrenew is reserved solely to the
				  policyholder.
008.02 Riders
				and Endorsements
Except for riders or endorsements by which the insurer
				  effectuates a request made in writing by the insured under an individual
				  long-term care insurance policy, all riders or endorsements added to an
				  individual long-term care insurance policy after date of issue or at
				  reinstatement or renewal which reduce or eliminate benefits or coverage in the
				  policy shall require signed acceptance by the individual insured. After the
				  date of policy issue, any rider or endorsement which increases benefits or
				  coverage with a concomitant increase in premium during the policy term must be
				  agreed to in writing signed by the insured, except if the increased benefits or
				  coverage is required by law. Where a separate additional premium is charged for
				  benefits provided in connection with riders or endorsements, such premium
				  charge shall be set forth in the policy, rider or endorsement.
008.03 Payment of Benefits
A long-term care insurance policy which provides for the
				  payment of benefits based on standards described as "usual and customary",
				  "reasonable and customary", or words of similar import shall include a
				  definition of such terms and an explanation of such terms in its accompanying
				  outline of coverage.
008.04
				Limitations
If a long-term care insurance policy or certificate contains
				  any limitations with respect to pre-existing conditions, such limitations must
				  appear as a separate paragraph of the policy or certificate and be labeled as
				  "Pre-existing Condition Limitations."
008.05 Other Limitations or Conditions on
				Eligibility for Benefits
A long-term care insurance policy or certificate containing
				  any limitations or conditions for eligibility other than those prohibited in
Neb.Rev.Stat.
§
										44-4513(7)
				   shall set forth a description of such
				  limitations or conditions, including any required number of days of
				  confinement, in a separate paragraph of the policy or certificate and shall
				  label such paragraph "Limitations or Conditions on Eligibility for
				  Benefits."
008.06 Disclosure
				of Tax Consequences
With regard to life insurance policies which provide an
				  accelerated benefit for long-term care, a disclosure statement is required at
				  the time of application for the policy or rider and at the time the accelerated
				  benefit payment request is submitted that receipt of these accelerated benefits
				  may be taxable, and that assistance should be sought from a personal tax
				  advisor. The disclosure statement shall be prominently displayed on the first
				  page of the policy or rider and any other related documents. This subsection
				  shall not apply to qualified long-term care insurance
				  contracts.
008.07 Delivery
				Receipt
When the policy is delivered by an agent, a receipt of
				  delivery of the policy, shall be signed by the agent and applicant, at the time
				  of delivery of the policy, if hand delivered, a copy of which shall be retained
				  by the applicant.
008.08
				Refund
If a policyholder returns a policy
,
as provided by
Neb.Rev.Stat. §
44-4515, the
				  insurer or organization issuing the long-term care insurance policy shall
				  promptly refund the premium directly to the policyholder.
008.09 Benefit Triggers
Activities of daily living and cognitive impairment shall be
				  used to measure an insured's need for long-term care and shall be described in
				  the policy or certificate in a separate paragraph and shall be labeled
				  "Eligibility for the Payment of Benefits." Any additional benefit triggers
				  shall also be explained in this section. If these triggers differ for different
				  benefits, explanation of the trigger shall accompany each benefit description.
				  If an attending physician or other specified person must certify a certain
				  level of functional dependency in order to be eligible for benefits, this too
				  shall be specified.
008.10 A
				qualified long-term care insurance contract shall include a disclosure
				statement in the policy and in the outline of coverage as contained in section
				026.05, that the policy is intended to be a qualified long-term care insurance
				contract under Section 7702B(b) of the Internal Revenue Code of 1986, as
				amended.
008.11 A non-qualified
				long-term care insurance contract shall include a disclosure statement in the
				policy and in the outline of coverage as contained in section 026.05, that the
				policy is not intended to be a qualified long-term care insurance
				contract.