reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-06 - Risk Modification Plan Regulation › Section 45-05-06-06 - Rate compliance examinations

Current through Supplement No. 393, July, 2024
To determine compliance with this chapter the commissioner
				  may order a rate compliance examination be made of any insurer to which this
				  chapter applies. Any examination must be conducted pursuant to North Dakota
				  Century Code chapter 26.1-03.
General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-25,
					 26.1-30-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-06 - Risk Modification Plan Regulation › Section 45-05-06-07 - Filing of rate modification plans

Current through Supplement No. 393, July, 2024
Within one hundred eighty days of October 1, 1989, each
				  insurer to which this chapter applies shall refile its rate modification plans
				  in accordance with the provisions of this chapter. At the end of the one
				  hundred eighty-day period all prior rate modification plans filed with the
				  department of insurance will be considered obsolete. Subsequent changes in any
				  insurer's rate modification plan will not be considered to be filed with the
				  commissioner unless the complete plan, as modified, is submitted.
General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-25,
					 26.1-30-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-06 - Risk Modification Plan Regulation › Section 45-05-06-08 - Separability

Current through Supplement No. 393, July, 2024
If any provision of this chapter or the application thereof
				  to any person or circumstance is for any reason held to be invalid, the
				  remainder of the chapter and the application of such provision shall not be
				  affected thereby.
General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-25,
					 26.1-30-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-06 - Risk Modification Plan Regulation › Section 45-05-06-09 - Dissemination

Current through Supplement No. 393, July, 2024
Each insurer or rating organization is instructed to
				  distribute a copy of this chapter to all personnel engaged in activities
				  requiring knowledge of this chapter, and to instruct them as to its scope and
				  operation.
General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-25,
					 26.1-30-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-07 - Advisory Organization Exemption - Highly Protected Risk Market › Section 45-05-07-01 - Definition - Highly protected risk market

Current through Supplement No. 393, July, 2024
"Highly protected risk market" consists of commercial
				  property coverage written specifically for large, complex, and multistate
				  commercial and industrial properties. Further, the "highly protected risk
				  market" is characterized by large size, high value, diversity and loss control;
				  and with policyholders who are sophisticated commercial insureds employing
				  professional risk managers and insurance appraisers on staff.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-25-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-07 - Advisory Organization Exemption - Highly Protected Risk Market › Section 45-05-07-02 - Exemption

Current through Supplement No. 393, July, 2024
The market commonly known as "highly protected risk market"
				  is exempt from the filing restrictions limiting filings to prospective loss
				  cost filings as found in North Dakota Century Code chapter 26.1-25 and an
				  advisory organization may file fully developed rates on behalf of specific
				  companies for this market.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-25-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-07 - Advisory Organization Exemption - Highly Protected Risk Market › Section 45-05-07-03 - Definition - North Dakota automobile insurance plan

Current through Supplement No. 393, July, 2024
The North Dakota automobile insurance plan is an association
				  of all insurance companies licensed to write automobile insurance in North
				  Dakota and is the residual market mechanism for automobile liability insurance
				  in North Dakota, through which applicants who are in good faith entitled to but
				  unable to procure such insurance through ordinary means may obtain such
				  insurance. This plan is managed and operated by the automobile insurance plan
				  services office.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-25-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-07 - Advisory Organization Exemption - Highly Protected Risk Market › Section 45-05-07-04 - Exemption

Current through Supplement No. 393, July, 2024
The automobile insurance plan services office is exempt from
				  the filing restrictions limiting filings to prospective loss cost filings as
				  found in North Dakota Century Code chapter 26.1-25 and as an advisory
				  organization may file fully developed rates on behalf of the North Dakota
				  automobile insurance plan.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-25-19
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-09 - Defense Expenses Within the Limit of Liability Provisions › Section 45-05-09-01 - Defense expenses within limit of liability provisions - Exceptions

Current through Supplement No. 393, July, 2024
1. No admitted insurer shall issue or renew a
				policy of liability insurance in this state that includes defense expenses
				within the limit of liability unless the policy's minimum limit per occurrence
				or the aggregate liability limit for all liability risks and coverages under
				the policy is at least:
a. One million
				dollars for primary coverages; and
b. One hundred thousand dollars for secondary
				coverages.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-09 - Defense Expenses Within the Limit of Liability Provisions › Section 45-05-09-02 - Policies within which defense expenses within limit of liability permitted

Current through Supplement No. 393, July, 2024
Defense expenses within the limit of liability provisions are
				  allowed only within the following types of policies or coverages within a
				  policy with the limits of liability as required in section
				  45-05-09-01:
1. Cyber liability:
2. Fiduciary liability;
3. Directors and officers
				liability;
4. Errors and omissions
				liability;
5. Employer practices
				liability;
6. Medical malpractice
				liability;
7. Pollution
				liability;
8. Liquor
				liability;
9. Nuclear
				liability;
10. Fidelity
				bond:
11. Umbrella and excess
				policies; and
12. Other policies
				permitted within the discretion of the insurance commissioner.
General Authority:
NDCC 28-32-02
Law Implemented:
NDCC
					 26.1-04-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-09 - Defense Expenses Within the Limit of Liability Provisions › Section 45-05-09-03 - Notice required

Current through Supplement No. 393, July, 2024
The fact that defense expenses are within the limit of
				  liability or defense costs are limited by an allowance must be disclosed on the
				  declaration page in at least twelve-point bold print.
General Authority:
NDCC 28-32-02
Law Implemented:
NDCC 26.1-04-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-09 - Defense Expenses Within the Limit of Liability Provisions › Section 45-05-09-04 - Acknowledgment

Current through Supplement No. 393, July, 2024
The applicant or insured must sign a disclosure form as part
				  of the application or renewal process wherein the applicant or insured
				  acknowledges that the subject policy has limits of liability which may be
				  reduced or completely eliminated by payments for legal defense costs or claims
				  expenses. Only one signed disclosure is required regardless of whether the
				  disclosure is attached to an application or a renewal.
General Authority:
NDCC 28-32-02
Law Implemented:
NDCC
					 26.1-04-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-05 - Property and Casualty Insurance › Chapter 45-05-09 - Defense Expenses Within the Limit of Liability Provisions › Section 45-05-09-05 - Defense-only policies excepted

Current through Supplement No. 393, July, 2024
Defense-only policies are excepted from the requirements of
				  chapter 45-05-09. A defense-only policy is a policy which is purchased solely
				  to provide a legal defense and is not meant to provide indemnification or to be
				  a source of payment for damages to a third party.
General Authority:
NDCC 28-32-02
Law Implemented:
NDCC
					 26.1-04-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-01 - Applicability and scope

Current through Supplement No. 393, July, 2024
1. Except as
				otherwise specifically provided in sections
				45-06-01.1-05,
				45-06-01.1-10,
				45-06-01.1-11,
				45-06-01.1-14, and
				45-06-01.1-19, this chapter
				applies to:
a. All medicare supplement
				policies delivered or issued for delivery in this state on or after the
				effective date of this rule; and
b. All certificates issued under group
				medicare supplement policies which certificates have been delivered or issued
				for delivery in this state.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-03 - Policy definitions and terms

Current through Supplement No. 393, July, 2024
No policy or certificate may be advertised, solicited, or
				  issued for delivery in this state as a medicare supplement policy or
				  certificate unless such policy or certificate contains definitions or terms
				  which conform to the requirements of this section.
1. "Accident", "accidental injury", or
				"accidental means" must be defined to employ "result" language and may not
				include words which establish an accidental means test or use words such as
				"external, violent, visible wounds" or similar words of description or
				characterization.
a. The definition may not
				be more restrictive than the following: "Injury or injuries for which benefits
				are provided means accidental bodily injury sustained by the insured person
				which is the direct result of an accident, independent of disease or bodily
				infirmity or any other cause, and occurs while insurance coverage is in force".
b. The definition may provide that
				injuries do not include injuries for which benefits are provided or available
				under any workers' compensation, employer's liability or similar law, or motor
				vehicle no-fault plan, unless prohibited by law.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-04 - Policy provisions

Current through Supplement No. 393, July, 2024
1. Except for
				permitted preexisting condition clauses as described in subdivision a of
				subsection 1 of section
				45-06-01.1-05, subdivision a of
				subsection 1 of section 45-06-01.1 -06, and subdivision a of subsection 1 of
				section 45-06-01.1-06.1, no policy or
				certificate may be advertised, solicited, or issued for delivery in this state
				as a medicare supplement policy if the policy or certificate contains
				limitations or exclusions on coverage that are more restrictive than those of
				medicare.
2. No medicare
				supplement policy or certificate may use waivers to exclude, limit, or reduce
				coverage or benefits for specifically named or described preexisting diseases
				or physical conditions.
3. No
				medicare supplement policy or certificate in force in the state may contain
				benefits which duplicate benefits provided by medicare.
4.
a.Subject to subdivisions d, e, and g of subsection 1
				of section
				45-06-01.1-05 and subdivisions d
				and e of subsection 1 of section
				45-06-01.1-06, a medicare
				supplement policy with benefits for outpatient prescription drugs in existence
				prior to January 1, 2006, shall be renewed for current policyholders who do not
				enroll in part D at the option of the policyholder.
b. A medicare supplement policy with benefits
				for outpatient prescription drugs shall not be issued after December 31, 2005.
c. After December 31, 2005, a
				medicare supplement policy with benefits for outpatient prescription drugs may
				not be renewed after the policyholder enrolls in medicare part D unless:
(1) The policy is modified to eliminate
				outpatient prescription coverage for expenses of outpatient prescription drugs
				incurred after the effective date of the individual's coverage under a medicare
				part D plan; and
(2) Premiums are
				adjusted to reflect the elimination of outpatient prescription drug coverage at
				the time of medicare part D enrollment, accounting for any claims paid, if
				applicable.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-07.1 - Standard Medicare supplement benefit plans for 2010 standardized Medicare supplement benefit plan policies or certificates issued for delivery with an effective date for coverage on or after June 1, 2010

Current through Supplement No. 393, July, 2024
The following standards are applicable to all Medicare
				  supplement policies or certificates delivered or issued for delivery in this
				  state with an effective date for coverage on or after June 1, 2010. No policy
				  or certificate may be advertised, solicited, delivered, or issued for delivery
				  in this state as a Medicare supplement policy or certificate unless it complies
				  with these benefit plan standards. Benefit plan standards applicable to
				  Medicare supplement policies and certificates with an effective date for
				  coverage before June 1, 2010, remain subject to the requirements of sections
				  45-06-01.1-06 and 45-06-01.1-07.
1.
a. An issuer shall make available to each
				prospective policyholder and certificate holder a policy form or certificate
				form containing only the basic benefits, as defined in subsection 2 of section
				45-06-01.1-06.1.
b. If an issuer
				makes available any of the additional benefits described in subsection 3 of
				section 45-06-01.1-06.1, or offers standardized benefit plans K or L as
				described in subdivisions h and i of subsection 5, then the issuer shall make
				available to each prospective policyholder and certificate holder, in addition
				to a policy form or certificate form with only the basic benefits as described
				in subdivision a, a policy form or certificate form containing either
				standardized benefit plan C as described in subdivision c of subsection 5 or
				standardized benefit plan F as described in subdivision e of subsection 5.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-08 - Medicare select policies and certificates

Current through Supplement No. 393, July, 2024
1.
a. This
				section applies to medicare select policies and certificates, as defined in
				this section.
b. No policy or
				certificate may be advertised as a medicare select policy or certificate unless
				it meets the requirements of this section.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-09 - Open enrollment

Current through Supplement No. 393, July, 2024
1. Any issuer may
				not deny or condition the issuance or effectiveness of any medicare supplement
				policy or certificate available for sale in this state, or discriminate in the
				pricing of such a policy or certificate because of the health status, claims
				experience, receipt of health care, or medical condition of an applicant in the
				case of an application for a policy or certificate that is submitted prior to
				or during the six-month period beginning with the first day of the first month
				in which an individual is both sixty-five years of age or older and is enrolled
				for benefits under medicare part B. Each medicare supplement policy and
				certificate currently available from an insurer must be made available to all
				applicants who qualify under this subsection without regard to age.
2.
a.If an
				applicant qualifies under subsection 1 and submits an application during the
				time period referenced in subsection 1 and, as of the date of application, has
				had a continuous period of creditable coverage of at least six months, the
				issuer may not exclude benefits based on a preexisting condition.
b. If the applicant qualifies under
				subsection 1 and submits an application during the time period referenced in
				subsection 1 and, as of the date of application, has had a continuous period of
				creditable coverage that is less than six months, the issuer shall reduce the
				period of any preexisting condition exclusion by the aggregate of the period of
				creditable coverage applicable to the applicant as of the enrollment date. The
				secretary shall specify the manner of the reduction under this subsection.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-09.1 - Guaranteed issue for eligible persons

Current through Supplement No. 393, July, 2024
1.
Guaranteed issue.
a. Eligible
				persons are those individuals described in subsection 2 who seek to enroll
				under the policy during the period specified in subsection 3, and who submit
				evidence of the date of termination, disenrollment, or medicare part D
				enrollment with the application for a medicare supplement policy.
b. With respect to eligible persons, an
				issuer may not deny or condition the issuance or effectiveness of a medicare
				supplement policy described in subsection 5 that is offered and is available
				for issuance to new enrollees by the issuer, may not discriminate in the
				pricing of such a medicare supplement policy because of health status, claims
				experience, receipt of health care, or medical condition, and may not impose an
				exclusion of benefits based on a preexisting condition under such a medicare
				supplement policy.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-10 - Standards for claims payment

Current through Supplement No. 393, July, 2024
1. An issuer
				must comply with section 1882(c)(3) of the Social Security Act [as enacted by
				section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 ( Pub.
				L. 100-203; 101 Stat. 1330; 42 U.S.C. 1395 ss(c)(3) )] by:
a. Accepting a notice from a medicare carrier
				on dually assigned claims submitted by participating physicians and suppliers
				as a claim for benefits in place of any other claim form otherwise required and
				making a payment determination on the basis of the information contained in
				that notice;
b. Notifying the
				participating physician or supplier and the beneficiary of the payment
				determination;
c. Paying the
				participating physician or supplier directly;
d. Furnishing, at the time of enrollment,
				each enrollee with a card listing the policy name, number, and a central
				mailing address to which notices from a medicare carrier may be sent;
e. Paying user fees for claim
				notices that are transmitted electronically or otherwise; and
f. Providing to the secretary of health and
				human services, at least annually, a central mailing address to which all
				claims may be sent by medicare carriers.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-11 - Loss ratio standards and refund or credit of premium

Current through Supplement No. 393, July, 2024
1.
Loss ratio standards.
a.
(1) A
				medicare supplement policy form or certificate form may not be delivered or
				issued for delivery unless the policy form or certificate form can be expected,
				as estimated for the entire period for which rates are computed to provide
				coverage, to return to policyholders and certificate holders in the form of
				aggregate benefits (not including anticipated refunds or credits) provided
				under the policy form or certificate form:
(a) At least seventy-five percent of the
				aggregate amount of premiums earned in the case of group policies; or
(b) At least sixty-five percent of
				the aggregate amount of premiums earned in the case of individual policies;
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-12 - Filing and approval of policies and certificates and premium rates

Current through Supplement No. 393, July, 2024
1. An issuer may not deliver or issue for
				delivery a policy or certificate to a resident of this state unless the policy
				form or certificate form has been filed with and approved by the commissioner
				in accordance with filing requirements and procedures prescribed by the
				commissioner.
2. An issuer shall
				file any riders or amendments to policy or certificate forms to delete
				outpatient prescription drug benefits as required by the Medicare Prescription
				Drug Improvement and Modernization Act of 2003 only with the commissioner in
				the state in which the policy or certificate was issued.
3. An issuer may not use or change premium
				rates for a medicare supplement policy or certificate unless the rates, rating
				schedule, and supporting documentation have been filed with and approved by the
				commissioner in accordance with the filing requirements and procedures
				prescribed by the commissioner.
4.
a.Except as provided in subdivision b of
				this subsection, an issuer may not file for approval more than one form of a
				policy or certificate of each type for each standard medicare supplement
				benefit plan.
b. An issuer may
				offer, with the approval of the commissioner, up to four additional policy
				forms or certificate forms of the same type for the same standard medicare
				supplement benefit plan, one for each of the following cases:
(1) The inclusion of new or innovative
				benefits.
(2) The addition of
				either direct response or agent marketing methods.
(3) The addition of either guaranteed issue
				or underwritten coverage.
(4) The
				offering of coverage to individuals eligible for medicare by reason of
				disability.
c. For the
				purposes of this section, a "type" means an individual policy, a group policy,
				an individual medicare select policy, or a group medicare select policy.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-13 - Permitted compensation arrangements

Current through Supplement No. 393, July, 2024
1.
				An issuer or other entity must provide level commissions or other compensation
				to an agent or other representative for the sale of a medicare supplement
				policy or certificate for the year of issuance and no fewer than five renewal
				years.
2. No issuer or other
				entity may provide compensation to its agents or other producers and no agent
				or producer may receive compensation greater than the renewal compensation
				payable by the replacing issuer on renewal policies or certificates if an
				existing policy or certificate is replaced.
3. For purposes of this section,
				"compensation" includes pecuniary or nonpecuniary remuneration of any kind
				relating to the sale or renewal of the policy or certificate including, but not
				limited to, bonuses, gifts, prizes, awards, and finders fees.
4. This section does not apply to an issuer
				or other entity that provides a one-time commission or other compensation
				provided the amount paid to an agent or other representative for the sale of a
				medicare supplement insurance policy or certificate does not exceed twenty-five
				dollars. This payment is in lieu of level commissions.
General Authority: NDCC 26.1-36.1-02(1 )(2)
Law Implemented: NDCC
					 26.1-36.1-03
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-16 - Filing requirements for advertising

Current through Supplement No. 393, July, 2024
An issuer must provide a copy of any medicare supplement
				  advertisement intended for use in this state whether through written, radio, or
				  television medium to the insurance commissioner of this state for review or
				  approval by the commissioner to the extent it may be required under state law.
General Authority: NDCC 26.1-36.1-03
Law Implemented: NDCC
					 26.1-36.1-07
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-17 - Standards for marketing

Current through Supplement No. 393, July, 2024
1. An
				issuer, directly or through its producers, must:
a. Establish marketing procedures to assure
				that any comparison of policies by its agents or other producers will be fair
				and accurate.
b. Establish
				marketing procedures to assure excessive insurance is not sold or issued.
c. Display prominently by type,
				stamp, or other appropriate means on the first page of the policy the
				following:
"Notice to buyer: This policy may not cover all of your
				  medical expenses."
d.
				Inquire and otherwise make every reasonable effort to identify whether a
				prospective applicant or enrollee for medicare supplement insurance already has
				accident and sickness insurance and the types and amounts of any such
				insurance.
e. Establish auditable
				procedures for verifying compliance with this subsection.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-18 - Appropriateness of recommended purchase and excessive insurance

Current through Supplement No. 393, July, 2024
1. In recommending the purchase or
				replacement of any medicare supplement policy or certificate an agent shall
				make reasonable efforts to determine the appropriateness of a recommended
				purchase or replacement.
2. Any
				sale of a medicare supplement policy or certificate that will provide an
				individual more than one medicare supplement policy or certificate is
				prohibited.
3. An issuer shall not
				issue a medicare supplement policy or certificate to an individual enrolled in
				medicare part C unless the effective date of the coverage is after the
				termination date of the individual's part C coverage.
General Authority: NDCC 26.1-36.1-02(1 )(2), 26.1-36.1-03
Law Implemented: NDCC
					 26.1-36.1-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-19 - Reporting of multiple policies

Current through Supplement No. 393, July, 2024
1. On
				or before March first of each year, an issuer must report the following
				information for every individual resident of this state for which the issuer
				has in force more than one medicare supplement policy or certificate:
a. Policy and certificate number.
b. Date of issuance.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-20 - Prohibition against preexisting conditions, waiting periods, elimination periods, and probationary periods in replacement policies or certificates

Current through Supplement No. 393, July, 2024
1. If a medicare supplement policy or
				certificate replaces another medicare supplement policy or certificate, the
				replacing issuer must waive any time periods applicable to preexisting
				conditions, waiting periods, elimination periods, and probationary periods in
				the new medicare supplement policy or certificate for similar benefits to the
				extent such time was spent under the original policy.
2. If a medicare supplement policy or
				certificate replaces another medicare supplement policy or certificate which
				has been in effect for at least six months, the replacing policy may not
				provide any time period applicable to preexisting conditions, waiting periods,
				elimination periods, and probationary periods for benefits similar to those
				contained in the original policy or certificate.
General Authority: NDCC 26.1-36.1-02(1 )(2), 26.1-36.1-03
Law Implemented: NDCC
					 26.1-36.1-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-20.1 - Prohibition against use of genetic information and requests for genetic testing

Current through Supplement No. 393, July, 2024
This section applies to all policies with policy years
				  beginning on or after May 21, 2009.
1. An issuer of a medicare supplement policy
				or certificate shall not:
a. Deny or
				condition the issuance or effectiveness of the policy or certificate, including
				the imposition of any exclusion of benefits under the policy based on a
				preexisting condition, on the basis of the genetic information with respect to
				such individual; and
b.
				Discriminate in the pricing of the policy or certificate, including the
				adjustment of premium rates, of an individual on the basis of the genetic
				information with respect to such individual.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-21 - Separability

Current through Supplement No. 393, July, 2024
If any provision of this chapter or the application thereof
				  to any person or circumstance is for any reason held to be invalid, the
				  remainder of the chapter and the application of such provision to other persons
				  or circumstances may not be affected thereby.
General Authority: NDCC 26.1-36.1-03
Law Implemented: NDCC
					 26.1-36.1
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-01.1 - MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › Section 45-06-01.1-22

Current through Supplement No. 393, July, 2024
General Authority: NDCC 26.1-36.1-02(1 )(2), 26.1-36.1-03
Law Implemented: NDCC
					 26.1-36.1.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02 - Intercarrier Health Insurance Pool › Section 45-06-02-01 - Definitions

Current through Supplement No. 393, July, 2024
Unless otherwise defined, or made inappropriate by context,
				  all words used in this chapter shall have the meanings given them under North
				  Dakota Century Code chapter 26.1-08.
General Authority: NDCC 26.1-08-03
Law Implemented: NDCC 26.1-08-01, 26.1-08-02, 26.1-08-03,
					 26.1-08-04, 26.1-08-06, 26.1-08-07, 26.1-08-08, 26.1-08-09, 26.1-08-10,
					 26.1-08-11, 26.1-08-12
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02 - Intercarrier Health Insurance Pool › Section 45-06-02-02 - Assessment of insurers for losses and expenses of the comprehensive health association and comprehensive health insurance plan

Current through Supplement No. 393, July, 2024
1. Insurers which are members of the
				association will be assessed annually for their proportionate share of
				administrative expenses of the association and the amount by which operating,
				administrative, and claims expenses of the association plan exceed the
				association plan premium in each fiscal year of the association.
2. The association shall notify each insurer
				member of the association of the insurer's total annual premium volume for
				accident and sickness insurance policies received from or on behalf of state
				residents for the calendar year immediately preceding the assessment, as shown
				on page 46, column 3, line 25 of that insurer's annual statement if an accident
				and health insurance company, or the figures shown on page 14, column 3, lines
				13, 15.1, 15.2, 15.3, 15.4, 15.5, and 15.6 if a property and casualty company,
				for the appropriate year required to be filed with the commissioner. That
				figure will be used in determining an insurer's proportionate share of
				association expenses and association plan losses under subsection 4 of North
				Dakota Century Code section 26.1-08-09, unless within thirty days after
				receiving notification the insurer objects in writing to the association and
				the commissioner. The objection shall set forth the following information:
a. The reasons why the figure shown on page
				46, column 3, line 25 of its annual statement if an accident and health
				insurance company, or the figures shown on page 14, column 3, lines 13, 15.1,
				15.2, 15.3, 15.4, 15.5, and 15.6 of its annual statement if a property and
				casualty company, should not be used in determining that insurer's
				proportionate share of association losses; and
b. A certification by that insurer's chief
				actuarial officer of the correct total annual premium volume for accident and
				sickness policies received from or on behalf of state residents.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02 - Intercarrier Health Insurance Pool › Section 45-06-02-03 - Penalty

Current through Supplement No. 393, July, 2024
If an insurer fails to pay an assessment, in the time
				  prescribed, subject to the hearing requirements of North Dakota Century Code
				  chapter 28-32, its membership in the association will cease, and it shall not
				  be permitted to write accident and sickness insurance policies as defined in
				  North Dakota Century Code chapter 26.1-08 in this state.
General Authority: NDCC 26.1-08-03
Law Implemented: NDCC
					 26.1-08-03(4)
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02 - Intercarrier Health Insurance Pool › Section 45-06-02-04 - Coordination of benefits with other accident and sickness insurance policies

Current through Supplement No. 393, July, 2024
The contracts issued by the comprehensive health association
				  of North Dakota for accident and sickness insurance coverage must in all cases
				  be considered secondary to any other accident and sickness insurance policy the
				  insured may have. Benefits to be paid by the comprehensive health association
				  of North Dakota for a covered person on any individual claim may not exceed the
				  difference in the amount between allowable covered expenses for that claim and
				  any amounts covered by other accident and sickness insurance policies carried
				  by the insured. For the purpose of this section, policy includes insurance
				  certificates and other evidence of coverage.
General Authority: NDCC 26.1-04-08
Law Implemented: NDCC
					 26.1-04-03
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02.1 - Comprehensive Health Association of North Dakota › Section 45-06-02.1-01 - Definitions

Current through Supplement No. 393, July, 2024
1. "Applicant" means an individual seeking enrollment under
				  the association.
2. "Board" means the board of directors of the association as
				  set forth under North Dakota Century Code section 26.1-08-03.
3. "Enrollee" means an eligible person who is covered under
				  an association plan.
4. "Grievance" means a written complaint submitted in
				  accordance with the formal grievance procedure by or on behalf of the enrollee
				  or applicant regarding any aspect of the association relative to the enrollee
				  or applicant.
General Authority: NDCC 26.1-08-02
Law Implemented: NDCC
					 26.1-08-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02.1 - Comprehensive Health Association of North Dakota › Section 45-06-02.1-02 - Grievance procedures

Current through Supplement No. 393, July, 2024
1. The board of
				directors of the association shall establish and maintain a grievance procedure
				which has been approved by the commissioner to provide procedures for the
				resolution of grievances initiated by enrollees or applicants. The board shall
				maintain records regarding grievances received.
2. The commissioner may examine the grievance
				procedures and records.
3. Any
				enrollee or applicant receiving an adverse determination through the grievance
				procedure may request a hearing pursuant to North Dakota Century Code chapter
				28-32.
General Authority: NDCC 26.1-08-02
Law Implemented: NDCC
					 26.1-08-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-02.1 - Comprehensive Health Association of North Dakota › Section 45-06-02.1-03 - Enrollment by certain children

Current through Supplement No. 393, July, 2024
A child will be deemed an "eligible person" pursuant to
				  subdivision b of subsection 4 of North Dakota Century Code section 26.1-08-01,
				  despite the lack of eighteen months of qualifying previous coverage, if:
1. The child was covered under any
				qualifying previous coverage within thirty days of birth, adoption, or
				placement for adoption; and
2. The
				child has not had a break in qualifying previous coverage which exceeds
				sixty-three days.
General Authority: NDCC 26.1-08-02
Law Implemented: NDCC
					 26.1-08-02
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-03.1 - Standardized Health Claim Form Model Regulation › Section 45-06-03.1-02 - Applicability and scope

Current through Supplement No. 393, July, 2024
1. Except as
				otherwise specifically provided, the requirements of this chapter apply to
				issuers, health care practitioners, and institutional care practitioners.
2. Nothing in this chapter
				prevents an issuer from requesting additional information that is not contained
				on the forms required under this chapter to determine eligibility of the claim
				for payment if required under the terms of the policy or certificate issued to
				the claimant.
General Authority: NDCC 26.1-36-37.1, 26.1-36-38
Law Implemented: NDCC
					 26.1-36-37.1
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-03.1 - Standardized Health Claim Form Model Regulation › Section 45-06-03.1-03 - General provisions

Current through Supplement No. 393, July, 2024
1. Health care
				practitioners and institutional care practitioners shall file claims in a
				manner consistent with the requirements of this chapter. Claims filed in paper
				form must be printed on eight and one-half by eleven-inch [21.59 by
				27.94-centimeter] paper.
2.
				Issuers shall accept forms submitted in compliance with this chapter for the
				processing of claims.
3. Health
				care practitioners, institutional care practitioners, and issuers shall:
a. Use and accept the most current editions
				of the HCFA form 1450, HCFA form 1500, prescription universal claim form, or
				J512 form and most current instructions for these forms in the billing of
				patients or their representatives filing claims with issuers.
b. Modify their billing and claim
				reimbursement practices to encompass the coding changes for all billing and
				claim filing by the effective date of the changes set forth by the developers
				of the forms, codes, and procedures required under this chapter.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-04 - Advertising Rules › Section 45-06-04-01 - Purpose

Current through Supplement No. 393, July, 2024
The purpose of this chapter is to assure truthful and
				  adequate disclosure of all material and relevant information in the advertising
				  of disability and accident and sickness insurance (including nursing home,
				  long-term care, and medicare supplement insurance). This purpose is intended to
				  be accomplished by the establishment of, and adherence to, certain minimum
				  standards and guidelines of conduct in the advertising of such insurance in a
				  manner which prevents unfair competition among insurers and is conducive to the
				  accurate presentation and description to the insurance buying public of a
				  policy or agreement of such insurance offered through various advertising
				  media. Subsections 1 and 2 of North Dakota Century Code section 26.1-04-03
				  prohibit false, deceptive or misleading advertising in the conduct of the
				  business of insurance. Because those statutes establish only general standards,
				  this rule establishes specific standards for advertisements relating to
				  individual group, blanket, and franchise disability, and accident and sickness
				  insurance.
General Authority: NDCC 26.1-04-08, 28-32-02
Law Implemented: NDCC 26.1-04-03(1), 26.1-04-03(2),
					 26.1-04-07
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-04 - Advertising Rules › Section 45-06-04-02 - Applicability

Current through Supplement No. 393, July, 2024
1. This chapter applies to every
				"advertisement", as that term is defined in this chapter unless otherwise
				specified in this chapter, intended for presentation, distribution, or
				dissemination in this state when such presentation, distribution, or
				dissemination is made either directly or indirectly by or on behalf of an
				insurer, agent, or broker as those terms are defined in the insurance code of
				this state and this chapter.
2.
				Every insurer, agent, or broker shall establish and at all times maintain a
				system of control over the content, form, and method of dissemination of all
				advertisements of its policies. All such advertisements, regardless of by whom
				written, created, designed, or presented, are the joint and several
				responsibility of the insurer, agent, broker, or agency for whom such
				advertisements are prepared.
General Authority: NDCC 26.1-04-08, 28-32-02
Law Implemented: NDCC 26.1-04-03(1), 26.1-04-03(2),
					 26.1-04-07
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-04 - Advertising Rules › Section 45-06-04-04 - Form and content of advertisements

Current through Supplement No. 393, July, 2024
1. The format and content of an advertisement
				to which this chapter applies must be sufficiently complete and clear to avoid
				deception or the capacity or tendency to mislead or deceive. Whether an
				advertisement has a capacity or tendency to mislead or deceive must be
				determined by the insurance commissioner from the overall impression that the
				advertisement may be reasonably expected to create upon a person of average
				education or intelligence, within the segment of the public to which it is
				directed.
2. Advertisements must
				be truthful and not misleading in fact or in implication. Words or phrases, the
				meaning of which is clear only by implication or by familiarity with insurance
				terminology, may not be used.
General Authority: NDCC 26.1-04-08, 28-32-02
Law Implemented: NDCC 26.1-04-03(1), 26.1-04-03(2),
					 26.1-04-07
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-04 - Advertising Rules › Section 45-06-04-06 - Exceptions, reductions, and limitations to be disclosed

Current through Supplement No. 393, July, 2024
1. When an advertisement which is an
				invitation to contract refers to either a dollar amount, or a period of time
				for which any benefit is payable, or the cost of the policy, or specific policy
				benefit, or the loss for which such benefit is payable, it must also disclose
				those exceptions, reductions, and limitations affecting the basic provisions of
				the policy without which the advertisement would have the capacity or tendency
				to mislead or deceive.
2. When a
				policy contains a waiting, elimination, probationary, or similar time period
				between the effective date of the policy and the effective date of coverage
				under the policy or a time period between the date a loss occurs and the date
				benefits begin to accrue for such loss, an advertisement which is subject to
				the requirements of subsection 1 must disclose the existence of such
				periods.
3. An advertisement may
				not use the words "only"; "just"; "merely"; "minimum"; or similar words or
				phrases to deceptively describe or unfairly minimize the applicability of any
				exceptions and reductions contained in the policy advertised.
General Authority: NDCC 26.1-04-08, 28-32-02
Law Implemented: NDCC 26.1-04-03(1), 26.1-04-03(2),
					 26.1-04-07