reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0604 - EXEMPTIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Unless
				otherwise stated in Chapter 58 of the North Carolina General Statutes, this
				Section shall not apply to transactions involving:
(1) Credit life insurance;
(2) Group life insurance or group annuities
				where there is no direct solicitation of individuals by an insurance producer.
				Direct solicitation does not include any group meeting held by an insurance
				producer solely for the purpose of educating or enrolling individuals or, when
				initiated by an individual member of the group, assisting with the selection of
				investment options offered by a single insurer in connection with enrolling
				that individual. Group life insurance or group annuity certificates marketed
				through direct response solicitation is subject to the provisions of
				11 NCAC
				12 .0608;
(3) Group life insurance and annuities used
				to fund prearranged funeral contracts;
(4) An application to the existing insurer
				that issued the existing policy or contract when a contractual change or a
				conversion privilege is being exercised; or, when the existing policy or
				contract is being replaced by the same insurer pursuant to a program filed with
				and approved by the Commissioner; or, when a term conversion privilege is
				exercised among corporate affiliates;
(5) Proposed life insurance that is to
				replace life insurance under a binding or conditional receipt issued by the
				same company;
(6) Policies or
				contracts used to fund:
(A) An employee
				pension or welfare benefit plan that is covered by the Employee Retirement and
				Income Security Act (ERISA);
(B) A
				plan described by Sections 401(a), 401(k) or 403(b) of the Internal Revenue
				Code, where the plan, for purposes of ERISA, is established or maintained by an
				employer;
(C) A governmental or
				church plan defined in Section 414 of the Internal Revenue Code, a governmental
				or church welfare benefit plan, or a deferred compensation plan of a state or
				local government or tax exempt organization under Section 457 of the Internal
				Revenue Code; or
(D) As described
				in the Internal Revenue Code, a nonqualified deferred compensation arrangement
				established or maintained by an employer or plan sponsor.
(7) Where new coverage is provided under a
				life insurance policy or annuity contract and the cost is borne wholly by the
				insured's employer or by an association of which the insured is a
				member;
(8) Existing life insurance
				that is a non-convertible term life insurance policy that will expire in five
				years or less and cannot be renewed;
(9) Immediate annuities that are purchased
				with proceeds from an existing contract. Immediate annuities purchased with
				proceeds from an existing policy are not exempt from the rules in this Section;
				or
(10) Structured
				settlements.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0606 - DUTIES OF THE EXISTING INSURER

Current through Register Vol. 39, No. 2, July 15, 2024
Where a replacement is involved in the transaction, the
				  existing insurer shall:
(1) Retain and
				be able to produce all replacement notifications received, indexed by replacing
				insurer, for at least five years or until the conclusion of the next regular
				examination conducted by the Insurance Department of its state of domicile,
				whichever is later.
(2) Send a
				letter to the policy or contract owner of the right to receive information
				regarding the existing policy or contract values including, if available, an in
				force illustration. If an in force illustration cannot be produced within five
				business days after receipt of a notice that an existing policy or contract is
				being replaced, the insurer shall provide a policy summary. The information
				shall be provided within five business days after receipt of the request from
				the policy or contract owner.
(3)
				Upon receipt of a request to borrow, surrender or withdraw any policy values,
				send a notice advising the policy owner that the release of policy values may
				affect the guaranteed elements, non-guaranteed elements, face amount or
				surrender value of the policy from which the values are released. The notice
				shall be sent separate from the check if the check is sent to anyone other than
				the policy owner. When consecutive automatic premium loans are made, the
				insurer is only required to send the notice at the time of the first
				loan.
Authority
				  G.S.
				  58-2-40;
				  58-3-115;
				  58-58-1;
				  58-58-40;
Eff. October
				  1, 1985;
Amended Eff. August 1, 2004;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0607 - DUTIES OF INSURERS THAT USE PRODUCERS

Current through Register Vol. 39, No. 2, July 15, 2024
Each insurer shall:
(1) Maintain a system of supervision and
				control to insure compliance with the requirements of the rules in this section
				that shall include the following:
(a)
				Information to its producers of the requirements of the rules in this section
				and incorporation of the requirements of the rules in this Section into all
				relevant producer training manuals prepared by the insurer;
(b) Provision to each producer of a written
				statement of the company's position with respect to the acceptability of
				replacements providing guidance to its producer as to the appropriateness of
				these transactions;
(c) A system to
				review the appropriateness of each replacement transaction that the producer
				does not indicate is in accord with Sub-item (1)(b) of this Rule.
(d) Procedures to confirm that the
				requirements of the rules in this Section have been met; and
(e) Procedures to detect transactions that
				are replacements of existing policies or contracts by the existing insurer, but
				that have not been reported as such by the applicant or producer. Compliance
				may include systematic customer surveys, interviews, confirmation letters, or
				programs of internal monitoring;
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0608 - DUTIES OF INSURERS WITH RESPECT TO DIRECT RESPONSE SOLICITATIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) In the case of an application that is
				initiated as a result of a direct response solicitation, the insurer shall
				require, with or as part of each completed application for a policy or
				contract, a statement asking whether the applicant, by applying for the
				proposed policy or contract, intends to replace, discontinue, or change an
				existing policy or contract. If the applicant indicates a replacement or change
				is not intended or if the applicant fails to respond to the statement, the
				insurer shall send the applicant, with the policy or contract, a notice
				regarding replacement as required in
				11 NCAC
				12 .0611.
(b) If the insurer has proposed the
				replacement or if the applicant indicates a replacement is intended and the
				insurer continues with the replacement, the insurer shall:
(1) Provide to applicants or prospective
				applicants with the policy or contract a notice, as required in
				11 NCAC
				12 .0611. In these instances, the insurer may
				delete the reference to producer, including the producer's signature, and
				references not applicable to the product being sold or replaced, without having
				to obtain approval of the form from the Commissioner. The insurer's obligation
				to obtain the applicant's signature shall be satisfied if it can demonstrate
				that it has made a diligent effort to secure a signed copy of the notice
				referred to in this Paragraph. The requirement to make a diligent effort shall
				be deemed satisfied if the insurer includes in the mailing a self-addressed
				postage prepaid envelope with instructions for the return of the signed notice
				referred to in this Section; and
(2) Comply with the requirements of
				11 NCAC
				12 .0612(a)(2), if the
				applicant furnishes the names of the existing insurers, and the requirements of
				11 NCAC
				12 .0612(a)(3), 12
				.0612(a)(4), and 12 .0612(b).
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0609 - VIOLATIONS AND PENALTIES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any
				failure to comply with the rules in this Section shall be considered a
				violation of
				G.S.
				58-63-15(1). Violations
				include:
(1) Any deceptive or misleading
				information set forth in sales material;
(2) Failing to ask the applicant in
				completing the application the pertinent questions regarding the possibility of
				financing or replacement;
(3) The
				intentional incorrect recording of an answer;
(4) Advising an applicant to respond
				negatively to any question regarding replacement in order to prevent notice to
				the existing insurer; or
(5)
				Advising a policy or contract owner to write directly to the company in such a
				way as to attempt to obscure the identity of the replacing producer or
				company.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0610 - SEVERABILITY

Current through Register Vol. 39, No. 2, July 15, 2024
If any rule or portion of a rule of this Section, or the
				  applicability thereof to any person or circumstance, is held invalid by a
				  court, the remainder of this Section, or the applicability of such provision to
				  other persons, shall not be affected thereby.
Authority
				  G.S.
				  58-2-40;
				  58-3-115;
				  58-58-1;
				  58-58-40;
Eff. October
				  1, 1985;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0611 - NOTICE REGARDING REPLACEMENT

Current through Register Vol. 39, No. 2, July 15, 2024
Notice regarding replacement shall be the most current format
				  adopted by the NAIC Life Insurance and Annuities Replacement Model Regulation.
				  A copy of the notice may be obtained at the Department's website:
				  http//www.ncdoi.com/Industry/Life/LAH/RateFilings/Annuity/AppendixABC.pdf or in
				  writing from the Life and Health Division of the North Carolina Department of
				  Insurance at 1201 Mail Service Center, Raleigh, NC
				  27699-1201.
Authority
				  G.S.
				  58-2-40;
				  58-3-115;
				  58-58-1;
				  58-58-40;
Eff. October
				  1, 1985;
Amended Eff. August 1, 2004;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0612 - DUTIES OF REPLACING INSURERS THAT USE PRODUCERS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Where
				a replacement is involved in a transaction, the replacing insurer shall:
(1) Verify that the required forms are
				received and are in compliance with the rules in this section.
(2) Notify any other existing insurer that
				may be affected by the proposed replacement within five business days of
				receipt of a completed application indicating replacement or when the
				replacement is identified if not indicated on the application, and mail a copy
				of the available illustration or policy summary for the proposed policy or
				available disclosure document for the proposed contract within five business
				days of a request from an existing insurer;
(3) Be able to produce copies of the
				notification regarding replacement required in
				11 NCAC
				12 .0605(b), indexed by
				producer, for at least five years or until the next regular examination by the
				insurance department of a company's state of domicile, whichever is later;
				and
(4) Provide to the policy or
				contract owner notice of the right to return the policy or contract within 30
				days of the delivery of the contract and receive an unconditional full refund
				of all premiums or considerations paid on it, including any policy fees or
				charges; or, in the case of a variable or market value adjustment policy or
				contract, a payment of the cash surrender value provided under the policy or
				contract plus the fees and other charges deducted from the gross premiums or
				considerations, or imposed under such policy or contract; such notice may be
				included in the notice required by
				11 NCAC
				12 .0611.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0701 - LIMITATION ON AMNT OF CR LIFE/CR ACCIDENT/HEALTH INS WRITTEN

Current through Register Vol. 39, No. 2, July 15, 2024
The amount of Credit Life and/or Credit Accident and Health
				  insurance to be written by an insurer may be limited by its underwriting
				  practices.
Authority
				  G.S.
				  58-2-40;
				  58-57-15;
Eff. May 1,
				  1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0702 - INSURER LIABILITY: PREMIUM ACCEPTED FROM INELIGIBLE DEBTOR

Current through Register Vol. 39, No. 2, July 15, 2024
If any premium is received for Credit Life and Credit
				  Accident and Health insurance on an insured debtor who is not eligible under
				  the terms of the policy, or for excess insurance not covered by the policy, the
				  liability of the insurer may be limited to a refund of the premium or excess
				  premium to the creditor policyholder or the insured debtor. Such refund shall
				  be promptly paid or credited to the person entitled thereto, and the insured
				  debtor shall be notified of such refund and termination of such excess or
				  ineligible insurance; provided, however, that the insurer shall be liable for
				  any valid claims arising prior to such refund of premium and notification to
				  the insured debtor.
Authority
				  G.S.
				  58-2-40;
				  58-57-15;
Eff. May 1,
				  1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0703 - CALCULATION - UNEARNED PREMIUM REFUNDS: CREDIT LIFE & CREDIT ACCIDENT/HEALTH INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
For the purpose of calculating refunds on Credit Life and
				  Credit Accident and Health insurance no charge for credit insurance may be made
				  for the first 15 days of a loan month and a full may be charged for 16 days or
				  more of a loan month; or a refund may be made on a pro rate basis for each day
				  within the loan month.
Authority
				  G.S.
				  58-2-40;
				  58-57-50;
Eff. May 1,
				  1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0704 - MISSTATEMENT OF AGE: CREDIT LIFE AND HEALTH INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
The provision on misstatement of age is subject to the
				  incontestible period of the policy.
Authority
				  G.S.
				  58-2-40;
				  58-57-25;
Eff. April
				  1, 1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0705 - REPEALED - REFUND OF UNEARNED PREMIUM AT DEATH: CREDIT LIFE/CREDIT ACCIDENT/HEALTH INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-57-50;
Eff. May 1,
				  1989;
Amended Eff. April 8, 2002;
Repealed Eff.
				  September 1, 2009.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0706 - SUICIDE: CREDIT LIFE INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
In the event of the suicide of the insured debtor or the
				  joint insured debtor, if any, sane or insane, within one year after the
				  effective date of this certificate, the insurer shall have no liability with
				  respect to such death except for a refund of the premium paid, provided, that
				  in the event of joint life coverage a refund of premiums shall be forty percent
				  of the premium paid.
Authority
				  G.S.
				  58-2-40;
				  58-57-40;
Eff. April
				  1, 1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0707 - NOTICE OF CLAIM: CREDIT LIFE/CREDIT ACCIDENT/HEALTH INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
The claimant under a Credit Life or Credit Accident and
				  Health certificate or policy shall have a minimum of 30 days to give written
				  notice of claim.
Authority
				  G.S.
				  58-2-40;
				  58-57-25;
Eff. May 1,
				  1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0708 - AMOUNT/CREDIT LIFE INSURANCE/TRANSACTIONS OF GREATER THAN 120 MONTHS DURATION

Current through Register Vol. 39, No. 2, July 15, 2024
For transactions of greater than 120 months in duration, the
				  initial amount of credit life insurance shall not exceed the amount of
				  contractural indebtedness.
Authority
				  G.S.
				  58-2-40;
				  58-57-15;
Eff. May 1,
				  1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0709 - UNIFORM DECREASING COVERAGE: CREDIT LIFE

Current through Register Vol. 39, No. 2, July 15, 2024
No policy written, on transactions of 60 months or greater in
				  duration, shall incorporate a schedule of benefits which does not follow an
				  amortization schedule.
Authority
				  G.S.
				  58-2-40;
				  58-57-15;
Eff. April
				  1, 1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0710 - ACTUARIALLY EQUIVALENT: CREDIT LIFE

Current through Register Vol. 39, No. 2, July 15, 2024
With respect to
				  G.S.
				  58-57-40 entitled "Credit Life Insurance Rate
				  Standards", for credit life insurance on a basis other than the foregoing,
				  premiums charged shall be actuarially equivalent, is interpreted by the
				  department to mean that the actuarially equivalent rates must maintain a sixty
				  percent loss ration and must exhibit a composite rate equal to the appropriate
				  prima facie rate. The loss ratio shall be calculated by dividing the present
				  value of future benefits by the present value of future premiums. In
				  calculating the present value both interest and mortality rate used should
				  reflect anticipated company experience.
Authority
				  G.S.
				  58-2-40;
				  58-57-40;
Eff. April
				  1, 1989;
Amended Eff. April 8, 2002;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0711 - MOTOR VEHICLE LEASES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A motor vehicle
				lease is eligible for Credit Life and Credit Accident and Health insurance if:
(1) the lessee's has assumed a contractural
				obligation to make payments as compensation for use of the leased
				vehicle,
(2) the total of all
				payments which the lesses is contractually obligated to make for such use
				either exceeds or is substantially equal to the value of the property when
				leased, and
(3) the term of the
				lease does not exceed 15 years.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0712 - TRUNCATED COVERAGE NOTICE

Current through Register Vol. 39, No. 2, July 15, 2024
The following notice must appear in bold print on the face of
				  the individual policy or certificate of truncated credit insurance:
NOTICE: The death benefit in this policy may not completely
				  pay off your loan. If the term of your loan is longer than the term of this
				  insurance, the death benefit is only payable if death occurs during the term of
				  the insurance. Total disability benefits will not be paid for any period of
				  total disability continuing after the termination date shown in the
				  schedule.
Authority
				  G.S.
				  58-2-40;
				  58-57-20;
				  58-57-70;
Eff. January
				  1, 1994;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0713 - REVOLVING OR OPEN-END CREDIT INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
The following notice must appear in bold print on the face of
				  an individual policy or certificate of credit insurance written under
				  G.S.
				  58-57-105 to address the effective date and
				  termination date of coverage:
NOTICE: Coverage will begin when your account has an open
				  balance and will continue, subject to other provisions in this policy, as long
				  as your account has an open balance. No premium will be charged when your
				  account does not have an open balance. Premium charges will automatically
				  resume when your account has another open balance, subject to the termination
				  provisions in this policy.
Authority
				  G.S.
				  58-2-40;
				  58-57-70;
				  58-57-105;
Eff.
				  January 1, 1994;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0700 - CREDIT INSURANCE AND CREDIT LIFE:ACCIDENT AND HEALTH INSURANCE › Section 12 .0714 - REFUND OF UNEARNED PREMIUM FOR CREDIT INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
If credit life insurance coverage is sold together with any
				  other credit insurance coverage, such as accident and health, and death occurs,
				  then as of the date of death the credit life insurance premium is deemed to be
				  fully earned, but the other credit insurance coverage(s) shall provide for a
				  refund of unearned premium. Such refund shall be made in accordance with the
				  provisions of
				  G.S.
				  58-57-50.
Authority
				  G.S.
				  58-2-40;
				  58-57-50;
Eff. July 1,
				  2010;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0801-0814

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as a Temporary
				  Repeal Eff. June 13, 1990, for a period of 180 days to expire on
December 10, 1990;
Filed as a Temporary Rule Eff. August 31, 1989
				  for a period of 180 days to expire on
February 26,
				  1990;
Authority
				  G.S.
				  58-9;
				  58-710;
				  58-711;
				  58-712;
				  58-713;
				  58-714;
				  58-715;
				  58-717;
Eff. February
				  1, 1990;
Repealed Eff. December 1,
				  1990.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0815-.0816

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-54-5;
				  58-54-10;
				  58-54-15;
				  58-54-25;
				  58-54-50;
Temporary
				  Adoption Eff. June 13, 1990, for a period of 180 days to expire on December 10,
				  1990;
Eff. December 1, 1990;
Temporary Amendment Eff.
				  October 16, 1991 for a period of 180 days to expire on April 13,
				  1992;
Amended Eff. March 1, 1992;
Temporary Amendment
				  Eff. February 1, 2002;
Amended Eff. April 1, 2003;
Repealed Eff. December 31, 2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0817 - EXPIRED - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as a Temporary
				  Adoption Eff. June 13, 1990, for a period of 180 days to expire on
December 10, 1990;
ARRC Objection Lodged July 19, 1990;
Authority G.S. 58-2-40;
				  58-54-1;
Expired on
				  December 10, 1990.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0818-.0822

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-54-5;
				  58-54-10;
				  58-54-15;
				  58-54-50;
Temporary
				  Adoption Eff. June13, 1990 for a period of 180 days to expire on December 10,
				  1990;
Eff. December 1, 1990;
Temporary Amendment Eff.
				  October 16, 1991 for a period of 180 days to expire on April 13,
				  1992;
Amended Eff. August 3, 1992; March 1, 1992;
Temporary Amended Eff. February 1, 2002;
Amended Eff. April 1,
				  2003;
Repealed Eff. December 31,
				  2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0823 - REPEALED - FILING REQUIREMENTS FOR OUT-OF-STATE GROUP POLICIES

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as a Temporary
				  Repeal Eff. October 16, 1991 for a period of 180 days to expire on
April 13, 1992;
Filed as a Temporary Adoption Eff. June 13, 1990,
				  for a period of 180 days to expire on
December 10,
				  1990;
Authority
				  G.S.
				  58-2-40;
				  58-54-20;
Eff.
				  December 1, 1990;
Repealed Eff. March 1,
				  1992.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0824-.0830

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40,
				  58-54-25;
				  58-54-35;
Temporary
				  Adoption Eff. June 13, 1990 for a period of 180 days to expire on December 10,
				  1990;
Eff. December 1, 1990;
Temporary Amendment Eff.
				  October 16, 1991 for a period of 180 days to expire on April 13,
				  1992;
Amended Eff. February 1, 1996; August 3, 1992; March 1,
				  1992;
Repealed Eff. December 31,
				  2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0831-0833

Current through Register Vol. 39, No. 2, July 15, 2024
Filed as a Temporary
				  Repeal Eff. October 16, 1991 for a period of 180 days to expire on
April 13, 1992;
Filed as a Temporary Adoption Eff. June 13, 1990,
				  for a period of 180 days to expire on
December 10,
				  1990;
Authority
				  G.S.
				  58-2-40;
				  58-54-10;
				  58-54-15;
				  58-54-25;
				  58-54-35;
Eff.
				  December 1, 1990;
Repealed Eff. March 1,
				  1992.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0834 - REPEALED - PERMITTED COMPENSATION ARRANGEMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-54-15;
Temporary
				  Rule Eff. August 17, 1990, for a period of 180 days to expire on
February 13, 1991;
Eff. February 1, 1991;
Temporary
				  Amendment Eff. October 16, 1991 for a period of 180 days to expire
on April 13, 1992;
Amended Eff. March 1, 1992;
Repealed
				  Eff. December 31, 2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0835-.0838

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-54-10;
				  58-54-15;
				  58-54-20;
				  58-54-50;
Temporary
				  Adoption Eff. October 16, 1991 for a period of 180 days to expire on April 13,
				  1992;
Eff. March 1, 1992;
Amended Eff. February 1,
				  1996;
Temporary Amendment Eff. February 1, 2002;
Amended Eff. April 1, 2003;
Repealed Eff. December 31,
				  2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0839 - REPEALED - MEDICARE SELECT POLICIES AND CERTIFICATES

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-54-10;
				  58-54-15;
				  58-54-25;
Eff.
				  February 1, 1996;
Repealed Eff. December 31,
				  2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0840-.0842

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-54-10;
				  58-54-15;
				  58-54-25;
				  58-54-50;
Temporary
				  Adoption Eff. August 1, 1998;
Eff. April 1, 1999;
Temporary Amendment Eff. February 1, 2002;
Amended Eff. April 1,
				  2003;
Repealed Eff. December 31,
				  2005.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0800 - MEDICARE SUPPLEMENT INSURANCE › Section 12 .0843 - NAIC MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS MODEL ACT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The North Carolina Department of
				Insurance incorporates by reference, including subsequent amendments and
				editions, the National Association of Insurance Commissioners Medicare
				Supplement Insurance Minimum Standards Model Act, Model No. 651. Copies of this
				Act may be obtained from: The National Association of Insurance Commissioners,
				2301 McGee Street, Kansas City, MO 64108-1662; the North Carolina Department of
				Insurance, Life & Health Division, 1201 Mail Service Center, Raleigh, NC
				27699-1201; and from the Department of Insurance web page:
http://www.ncdoi.com/
.
(b) Section 7 of Model No. 651 shall apply to
				policies or certificates issued for delivery in North Carolina before January
				1, 1992.
(c) Section 8 of Model No.
				651 shall apply to policies or certificates issued for delivery in North
				Carolina on or after January 1, 1992.
(d) For purposes of this rule, Section
				8A(7)(c) of Model No. 651 shall read as follows:
Each Medicare supplement policy shall provide that benefits
				  and premiums under the policy shall be suspended (for any period that may be
				  provided by federal regulation) at the request of the policyholder if the
				  policyholder is entitled to benefits under Section 226(b) of the Social
				  Security Act and is covered under a group health plan (as defined in Section
				  1862(b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the
				  policyholder or certificate holder loses coverage under the group health plan,
				  the policy shall be automatically reinstituted (effective as of the date of
				  loss of coverage) if the policyholder provides notice of loss of coverage
				  within 90 days after the date of the loss and pays the premium attributable to
				  the period effective as of the date of termination of enrollment in the group
				  health plan.
(e) The
				applicable effective dates for Section 14B(3) of Model No. 651 are October 16,
				1991, December 1, 1995, and May 31, 1997.
(f) Insurers shall use the Appendices of
				Model No. 651 for reporting and disclosure formats.
(g) This Rule applies to policies issued,
				renewed, or reinstated on or after January 1, 2006.
Authority
				  G.S.
				  58-2-40;
				  58-54-10;
				  58-54-15;
				  58-54-25;
				  58-54-50;
Eff. August
				  1, 2005;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0900 - UTILIZATION REVIEW › Section 12 .0901 - REPEALED - ORGANIZATIONAL STRUCTURE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40(1);
				  58-50-60;
Eff. June 1,
				  1996;
Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s.
				  4.4.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0900 - UTILIZATION REVIEW › Section 12 .0902-0903

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40(1);
				  58-50-60;
Eff.
				  February 1, 1991;
Repealed Eff. January 1, 1998 pursuant to S.L.
				  1997-5 s. 4.4.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0900 - UTILIZATION REVIEW › Section 12 .0904 - REPEALED - REQUIREMENTS FOR UTILIZATION REVIEW

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40(1);
				  58-50-60;
Eff. March
				  1, 1991;
Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s.
				  4.4.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0900 - UTILIZATION REVIEW › Section 12 .0905-0917

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40(1);
				  58-50-60;
Eff.
				  February 1, 1991;
Repealed Eff. January 1, 1998 pursuant to S.L.
				  1997-5 s. 4.4.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0900 - UTILIZATION REVIEW › Section 12 .0918-0919

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40(1);
				  58-50-60;
Eff. June 1,
				  1996;
Repealed Eff. January 1, 1998 pursuant to S.L. 1997-5 s.
				  4.4.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1001 - REPEALED - APPLICABILITY AND SCOPE

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. September 1, 1990;
Repealed Eff. April 1,
				  1995.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1002 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) As used in this
				Section, "insurer" means an entity licensed under G.S. 58 that writes long-term
				care insurance.
(b) As used in this
				Section, "exceptional increase" means only those increases filed by an insurer
				as exceptional for which the Commissioner determines the need for the premium
				rate increase is justified: due to changes in laws or rules applicable to
				long-term care coverage in this state; or due to increased and unexpected
				utilization that affects the majority of insurers of similar products. Except
				as provided in
				11 NCAC
				12 .1028, exceptional increases are subject
				to the same requirements as other premium rate schedule increases. The
				Commissioner may request a review by an independent actuary or a professional
				actuarial body of the basis for a request that an increase be considered an
				exceptional increase. The Commissioner, in determining that the necessary basis
				for an exceptional increase exists, shall also determine any potential offsets
				to higher claim costs.
(c) As used
				in 11
				NCAC 12 .1028(k),
				"incidental" means that the value of the long-term care benefits provided is
				less than ten percent of the total value of the benefits provided over the life
				of the policy. These values shall be measured as of the date of
				issue.
(d) As used in this Section,
				"qualified actuary" means a member in good standing of the American Academy of
				Actuaries.
(e) As used in this
				Section, "similar policy forms" means all of the long-term care insurance
				policies and certificates issued by an insurer in the same long-term care
				benefit classification as the policy form being considered. Certificates of
				groups that meet the definition in
				G.S.
				58-55-20(3)a. are not
				considered similar to certificates or policies otherwise issued as long-term
				care insurance, but are similar to other comparable certificates with the same
				long-term care benefit classifications. For purposes of determining similar
				policy forms, long-term care benefit classifications are defined as follows:
				institutional long-term care benefits only, non-institutional long-term care
				benefits only, or comprehensive long-term care benefits.
(f) The definitions contained in
				G.S.
				58-1-5 and in
				G.S.
				58-55-20 are incorporated in this Section by
				reference.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. September 1, 1990;
Amended Eff. February 1, 1996; December 1,
				  1993; December 1, 1992;
Amended Eff. August 1, 2002;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1003 - POLICY DEFINITIONS; APPEALS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Unless
				otherwise required by federal law or regulation, no policy issued or issued for
				delivery in this State shall use the terms set forth below, unless the terms
				are defined in the policy and the definitions satisfy the following
				requirements:
(1) "Activities of daily
				living" means at least bathing, continence, dressing, eating, toileting, and
				transferring.
(2) "Acute condition"
				means that the individual is medically unstable and requires frequent
				monitoring by a medical doctor or registered nurse.
(3) "Bathing" means washing oneself by sponge
				bath, or in a tub or shower, including the task of getting into and out of the
				tub or shower.
(4) "Cognitive
				impairment" means a deficiency in a person's short or long-term memory;
				orientation as to person, place, and time; deductive or abstract reasoning; or
				judgment as it relates to safety awareness.
(5) "Continence" means the ability to
				maintain control of bowel and bladder function; or, when unable to maintain
				control of bowel or bladder function, the ability to perform associated
				personal hygiene (including caring for catheter or colostomy bag).
(6) "Dressing" means putting on and taking
				off all items of clothing and any necessary braces, fasteners, or artificial
				limbs.
(7) "Eating" means feeding
				oneself by getting food into the body from a receptacle (such as a plate, cup,
				or table); or by feeding tube or intravenously.
(8) "Hands-on-assistance" means physical
				assistance (minimal, moderate, or maximal) without which the individual would
				not be able to perform the activity of daily living.
(9) "Medicare" means the "Health Insurance
				for the Aged Act", Title XVIII of the Social Security Amendments of 1965, as
				amended.
(10) "Mental of nervous
				disorder" shall not be defined to include mroe than neurosis, psychoneurosis,
				psychopathy, psychosis, or mental or emotional disease or disorder.
(11) "Personal care" means the provision of
				hands-on services to assist an individual with activities of daily
				living.
(12) "Toileting" means
				getting to and from the toilet, getting on and off the toilet, and performing
				associated personal hygiene.
(13)
				"Transferring" means moving into our out of a bed, chair, or
				wheelchair.
(14) "Skilled nursing
				care," "intermediate care," "personal care," home care," and other services
				shall be defined in relation to the level of skill required, the nature of the
				care, and the setting in which care must be delivered.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1004 - POLICY PRACTICES AND PROVISIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The
				terms "guaranteed renewable" or "noncancellable" may not be used in any
				individual policy without further explanatory language in accordance with the
				disclosure requirements of
				11 NCAC
				12 .1006. No such policy issued to an
				individual shall contain renewal provisions other than "guaranteed renewable"
				or "noncancellable".
(b) The term
				"guaranteed renewable" may be used only when the insured has the right to
				continue the policy in force by timely payments of premiums; during which
				period the insurer has no unilateral right to make any change in any provision
				of the policy while the policy is in force and can not refuse to renew:
				Provided that rates may be revised by the insurer on a class basis.
(c) The term "level premium" may be used only
				when the insurer does not have the right to change the premium.
(d) The word "noncancellable" may be used
				only when the insured has the right to continue the policy in force by timely
				payments of premiums and during which period the insurer has no right to
				unilaterally make any change in any provision of the policy or in the premium
				rate.
(e) No policy may limit or
				exclude coverage by type of illness, treatment, medical condition, or accident,
				except as follows:
(1) preexisting conditions
				as specified in
				G.S.
				58-55-30;
(2) mental or nervous disorders, except for
				Alzheimer's Disease;
(3) alcoholism
				and drug addiction;
(4) illness,
				treatment, or medical condition arising out of:
(A) war or act of war (whether declared or
				undeclared);
(B) participation in a
				felony, riot, or insurrection;
(C)
				service in the armed forces or units auxiliary thereto;
(D) suicide, attempted suicide, or
				intentionally self-inflicted injury; or
(E) aviation activity as a nonfare-paying
				passenger;
(5) treatment
				provided in a government facility (unless otherwise required by law); services
				for which benefits are available under Medicare (unless otherwise required by
				law), under any other governmental program (except Medicaid), or under any
				state or federal workers' compensation, employer's liability, or occupational
				disease law; services provided by the insured's parents, spouse, children or
				siblings; and services for which no charge is normally made in the absence of
				insurance;
(6) exclusions and
				limitations for payment for services provided outside the United States;
				and
(7) legitimate variations in
				benefit levels to reflect differences in provider rates.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1005 - CONTINUATION OR CONVERSION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Group
				long-term care insurance newly issued or renewed in North Carolina on or after
				September 1, 1990, shall provide covered individuals with a basis for
				continuation or conversion of coverage.
(b) As used in this Rule, "a basis for
				continuation of coverage" means a policy provision that maintains coverage
				under the existing group policy when such coverage would otherwise terminate
				and that is subject only to the continued timely payments of premiums when due.
				A group policy that lawfully restricts provisions of benefits and services to,
				or contains incentives to use, certain providers or facilities, may provide
				continuation benefits that are substantially equivalent to the benefits of the
				existing group policy. The Commissioner shall make a determination as to the
				substantial equivalency of benefits; and in doing so shall take into
				consideration the differences between managed care and non-managed care plans,
				including provider system arrangements, service availability, benefit levels,
				and administrative complexity.
(c)
				As used in this Rule, "a basis for conversion of coverage" means a policy
				provision that an individual:
(1) whose
				coverage under the group policy would otherwise terminate or has been
				terminated for any reason, including discontinuance of the group policy in its
				entirety or with respect to an insured class; and
(2) who has been continuously insured under
				the group policy, and any group policy that it replaced, for at least six
				months immediately prior to termination, shall be entitled to the issuance of a
				converted policy by the insurer under whose group policy he is covered, without
				evidence of insurability.