reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1007 - PROHIBITION OF POST-CLAIMS UNDERWRITING

Current through Register Vol. 39, No. 2, July 15, 2024
(a) All
				applications for policies except those that are guaranteed issue shall contain
				clear and unambiguous questions designed to ascertain the health condition of
				the applicant.
(b) If an
				application for a policy contains a questions that asks whether the applicant
				has had medication prescribed by a physician, it must also ask the applicant to
				list the medication that has been prescribed.
(c) If, at the time of the application, the
				medications listed in the application were known or should have been known by
				the insurer or by the insurer's agent or representative to be directly related
				to a medical condition for which coverage would otherwise be limited or denied,
				the policy shall not be rescinded nor shall coverage be denied or limited for
				that condition.
(d) Except for
				policies that are guaranteed issue:
(1) The
				following language shall be set out conspicuously and in close conjunction with
				the applicant's signature block on an application for a policy:
"Caution: If your answers on this application are incorrect
				  or untrue, [name of company] has the right to deny benefits or rescind your
				  policy".
(2) The following
				language, or language substantially similar to the following, shall be set out
				conspicuously on the policy at the time of delivery:
"Caution: The issuance of this long-term care insurance
				  [policy] [certificate] is based upon your responses to the questions on your
				  application. A copy of your [application] [enrollment form] [is enclosed] [was
				  retained by you when you applied]. If your answers are incorrect or untrue,
				  [name of company] has the right to deny benefits or rescind your policy. The
				  best time to clear up any questions is now, before a claim arises. If, for any
				  reason, any of your answers are incorrect, contact the company at this address:
				  [insert address]"
(3) Prior
				to issuance of a policy to an applicant age 80 years or older, the insurer
				shall obtain one of the following: A report of a physical examination; an
				assessment of functional capacity; an attending physician's statements; or
				copies of medical records.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1008 - MINIMUM STANDARDS FOR HOME HEALTH CARE BENEFITS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) A
				policy providing benefits for home health care services may not limit or
				exclude benefits by:
(1) requiring that the
				insured or claimant would need skilled care in a skilled nursing facility if
				home health care services were not provided;
(2) requiring that the insured or claimant
				first or simultaneously receive nursing or therapeutic services in a home or
				community setting before home health care services are covered;
(3) limiting eligible services to services
				provided by registered nurses or licensed practical nurses;
(4) requiring that a nurse or therapist
				provide services covered by the policy that can be provided by a home health
				aide or by another licensed or certified home care worker acting within the
				scope of his or her licensure or certification.
(5) requiring that the insured or claimant
				have an acute condition before home health care services are covered;
(6) limiting benefits to services provided by
				Medicare-certified agencies or providers; or
(7) excluding coverage for adult day care
				services.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1009 - REQUIREMENT TO OFFER INFLATION PROTECTION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) No
				insurer may offer a policy unless the insurer also offers to the applicant the
				option to purchase a policy that provides for benefit levels to increase with
				benefit maximums or reasonable durations that are meaningful to account for
				reasonably anticipated increases in the costs of long-term care services
				covered by the policy. Insurers must offer to each applicant, at the time of
				purchase, the option to purchase a policy with an inflation protection feature
				no less favorable than one of the following:
(1) Increases benefit levels annually, in a
				manner so that the increases are compounded annually at a minimum of 5
				percent;
(2) Guarantees the insured
				individual the right to periodically increase benefit levels without providing
				evidence of insurability or health status as long as the option for the
				previous period has not been declined. The amount of the additional benefit
				shall be no less than the difference between the existing policy benefit and
				the existing policy benefit compounded annually at a rate of at least five
				percent for the period beginning with the purchase of the existing policy
				benefit and extending until the year in which the offer is made.
(3) Covers a specified percentage of actual
				or reasonable charges and does not include a maximum specified indemnity amount
				or limit.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1011 - DISCRETIONARY POWERS OF COMMISSIONER

Current through Register Vol. 39, No. 2, July 15, 2024
The Commissioner may, upon written request and after an
				  administrative hearing, issue an order to modify or suspend a specific
				  provision or provisions of this Section with respect to a specific policy upon
				  a written finding that:
(1) the
				modification or suspension would be in the best interest of the insureds;
				and
(2) the purposes to be achieved
				could not be effectively or efficiently achieved without the modification or
				suspension; and
(3) the
				modification or suspension is necessary to the development of an innovative and
				reasonable approach for insuring long-term care; or
(4) the policy is to be issued to residents
				of a continuing care facility or some other residential community for the
				elderly and the modification or suspension is reasonably related to the special
				needs or nature of such a community; or
(5) the modification or suspension is
				necessary to permit long-term care insurance to be sold as part of, or in
				conjunction with, another insurance product.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. September 1, 1990;
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 .1012 - RESERVE STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) When long-term
				care benefits are provided through the acceleration of benefits under group or
				individual life insurance policies or riders to such policies, policy reserves
				for such benefits shall be determined in accordance with
				G.S.
				58-58-50. Claim reserves must also be
				established in the case when such policy or rider is in claim status.
(b) Reserves for policies and riders subject
				to this Rule shall be based on the multiple decrement model utilizing all
				relevant decrements except for voluntary termination rates. Single decrement
				approximations are acceptable if the calculation produces essentially similar
				reserves, if the reserve is clearly more conservative, or if the reserve is
				immaterial. The calculations may take into account the reduction in life
				insurance benefits due to the payment of long-term care benefits. However, in
				no event shall the reserves for the long-term care benefit and the life
				insurance benefit be less than the reserves for the life insurance benefit
				assuming no long-term care benefit.
(c) In the development and calculation of
				reserves for policies and riders subject to this Rule, due regard shall be
				given to the applicable policy provisions, marketing methods, administrative
				procedures, and all other considerations that have an effect on projected claim
				costs, including the following: definition of insured events; covered long-term
				care facilities; existence of home convalescence care coverage; definition of
				facilities; existence or absence of barriers to eligibility; premium waiver
				provision; renewability; ability to raise premiums; marketing method;
				underwriting procedures; claims adjustment procedures; waiting period; maximum
				benefit; availability of eligible facilities; margins in claim costs; optional
				nature of benefit; delay in eligibility for benefit; inflation protection
				provisions; and guaranteed insurability option.
(d) Any applicable valuation morbidity table
				shall be certified as appropriate as a statutory valuation table by a member of
				the American Academy of Actuaries.
(e) When long-term care benefits are provided
				other than as in Paragraphs (a) through (d) of this Rule, reserves shall be
				determined in accordance with
				11 NCAC
				11F .0200.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. September 1, 1990;
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 .1013 - LOSS RATIO

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This Rule shall
				apply to all long-term care insurance policies except those subject to
				11 NCAC
				12 .1014 and
				12 .1028. Further,
				11 NCAC
				12 .0555(b)(3) shall not
				apply to policies or certificates covered under
				11 NCAC
				12 .1014 and
				12 .1028.
(b) Benefits under long-term care insurance
				policies shall be deemed to be reasonable in relation to premiums, provided
				that the expected loss ratio is at least 60 percent for individual policies and
				75 percent for group policies, and is calculated in a manner that provides for
				reserving of the long-term care insurance risk. In evaluating the expected loss
				ratio, consideration shall be given to all relevant factors, including:
(1) statistical credibility of incurred
				claims experience and earned premiums;
(2) the period for which rates are computed
				to provide coverage;
(3)
				experienced and projected trends;
(4) concentration of experience within early
				policy duration;
(5) expected claim
				fluctuation;
(6) experience
				refunds, adjustments, or dividends;
(7) renewability features;
(8) expense factors;
(9) interest;
(10) experimental nature of the
				coverage;
(11) policy
				reserves;
(12) mix of business by
				risk classification; and
(13)
				product features such as long elimination periods, high deductibles, and high
				maximum limits.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1014 - FILING REQUIREMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Before an
				insurer offers a group policy to a resident of North Carolina pursuant to
				G.S.
				58-55-25, it shall file with the Commissioner
				evidence that the group policy has been approved by a state having statutory or
				regulatory long-term care insurance requirements substantially similar to those
				of North Carolina.
(b) This Rule
				applies to any long-term care policy issued in this state on or after February
				1,2003. An insurer shall provide the information listed in this paragraph to
				the commissioner 45 days prior to making a long-term care insurance form
				available for sale.
(1) A copy of the
				disclosure documents required in
				11 NCAC
				12 .1027, and
(2) An actuarial certification consisting of
				at least the following:
(A) A statement that
				the initial premium rate schedule is sufficient to cover anticipated costs
				under moderately adverse experience and that the premium rate schedule is
				reasonably expected to be sustainable over the life of the form with no future
				premium increases anticipated;
(B)
				A statement that the policy design and coverage provided have been reviewed and
				taken into consideration;
(C) A
				statement that the underwriting and claims adjudication processes have been
				reviewed and taken into consideration;
(D) A complete description of the basis for
				contract reserves that are anticipated to be held under the form to include:
(i) Sufficient detail or sample calculations
				provided so as to have a complete depiction of the reserve amounts to be
				held;
(ii) A statement that the
				assumptions used for reserves contain reasonable margins for adverse
				experience;
(iii) A statement that
				the net valuation premium for renewal years does not increase (except for
				attained-age rating where permitted); and
(iv) A statement that the difference between
				the gross premium and the net valuation premium for renewal years is sufficient
				to cover expected renewal expenses; or if such a statement cannot be made, a
				complete description of the situations where this does not occur. An aggregate
				distribution of anticipated issues may be used as long as the underlying gross
				premiums maintain a reasonably consistent relationship. If the gross premiums
				for certain age groups appear to be inconsistent with this requirement, the
				commissioner may request a demonstration based on a standard age distribution;
				and
(E) A statement that
				the premium rate schedule is not less than the premium rate schedule for
				existing similar policy forms also available from the insurer except for
				reasonable differences attributable to benefits; or a comparison of the premium
				schedules for similar policy forms that are currently available from the
				insurer with an explanation of the differences.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1016 - PERMITTED COMPENSATION ARRANGEMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) As
				used in this Rule:
(1) "Compensation" means
				consideration or remuneration of any kind relating to the sale or renewal of a
				policy, including but not limited to commissions, bonuses, gifts, prizes, or
				awards.
(2) "Policy" includes a
				certificate.
(3) "Representative"
				includes an agent, general agent, manager, broker, or other producer.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1017 - REQUIREMENTS FOR ADVERTISING

Current through Register Vol. 39, No. 2, July 15, 2024
Every insurer, health care service plan or other entity
				  providing long-term care insurance or benefits in this State shall provide a
				  copy of any long-term care insurance advertisement intended for use, whether
				  through written, radio or television medium, to the Commissioner for approval.
				  In addition, all advertisements shall be retained by the insurer, health care
				  service plan or other entity for at least three years from the date the
				  advertisement was first used.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
				  58-55-30(j);
Eff. 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 .1018 - STANDARDS FOR MARKETING

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Every insurer,
				health care service plan or other entity marketing long-term care insurance
				coverage in this state, directly or through its producers, shall:
(1) Establish marketing procedures and agent
				training requirements to assure that:
(A) Any
				marketing activities, including any comparison of policies, by its agents or
				other producers will be fair and accurate; and
(B) Excessive insurance is not sold or
				issued.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1019 - REPLACEMENT POLICIES

Current through Register Vol. 39, No. 2, July 15, 2024
If a policy replaces another policy, the replacing insurer
				  shall waive any time periods applicable to pre-existing conditions and
				  probationary periods in the new policy for similar benefits to the extent that
				  similar exclusions have been satisfied under the original
				  policy.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. December 1, 1992;
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 .1020 - SHOPPER'S GUIDE

Current through Register Vol. 39, No. 2, July 15, 2024
Every insurer providing long-term care insurance in this
				  State shall, before sale, deliver a shopper's guide to every applicant. The
				  guide shall be in the format developed by the NAIC.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. December 1, 1992;
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 .1021 - REPORTING

Current through Register Vol. 39, No. 2, July 15, 2024
Each insurer shall on a statewide basis:
(1) Maintain records for each agent of that
				agent's amount of replacement sales as a percent of the agent's total annual
				sales.
(2) Maintain records of the
				amount of lapses of long-term care insurance policies sold by agents as a
				percent of the agent's total annual sales.
(3) Report annually by June 30th the 10
				percent of its agents with the greatest percentages of lapses and
				replacements.
(4) Report annually
				by June 30th the number of lapsed policies as a percent of its total annual
				sales and as a percent of its total number of policies in force as of the end
				of the preceding calendar year.
(5)
				Report annually by June 30th the number of replacement policies sold as a
				percent of its total annual sales and as a percent of its total number of
				policies in force as of the end of the preceding calendar year.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
				  58-2-195(a);
Eff. December 1, 1992;
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 .1023 - INCONTESTABILITY PERIOD

Current through Register Vol. 39, No. 2, July 15, 2024
(a) For a policy
				that has been in force for less than six months, an insurer may rescind the
				policy or deny an otherwise valid long-term care insurance claim upon a showing
				of misrepresentation by the insured that is material to the acceptance for
				coverage.
(b) For a policy that has
				been in force for at least six months but less than two years, an insurer may
				rescind the policy or deny an otherwise valid long-term care insurance claim
				upon a showing of misrepresentation by the insured that is both material to the
				acceptance for coverage and that pertains to the condition for which benefits
				are sought.
(c) After a policy has
				been in force for two years, the policy is not contestable upon the grounds of
				misrepresentation alone; that policy may be contested only upon a showing that
				the insured knowingly and intentionally misrepresented relevant facts relating
				to the insured's health.
(d) No
				policy may be field issued based on medical or health status. For purposes of
				this Paragraph, "field issued" means a policy or certificate issued by an agent
				or a third-party administrator pursuant to the underwriting authority granted
				to the agent or third party administrator by an insurer.
(e) If an insurer has paid benefits under a
				policy, the benefit payments may not be recovered by the insurer if the policy
				is rescinded.
Authority
				  G.S.
				  58-2-40(1);
				  58-55-30(a);
Eff. December 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 .1000 - LONG TERM CARE INSURANCE › Section 12 .1024 - PROHIBITED POLICY PRACTICE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) No
				insurer may increase the rate or premium charged to an insured for a policy
				because of:
(1) the increasing age of the
				insured at ages beyond 65; or
(2)
				the amount of time the insured has been covered under a policy.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1025 - SUITABILITY

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Each insurer,
				except an insurer issuing life insurance that accelerates benefits for
				long-term care, shall:
(1) Train its agents
				in the use of its suitability standards.
(2) Maintain a copy of its suitability
				standards and make them available for inspection upon request by the
				Division.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1026 - NONFORFEITURE BENEFIT REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This
				Rule does not apply to life insurance policies or riders containing accelerated
				long-term care benefits.
(b) To
				comply with the requirement to offer a nonforfeiture benefit pursuant to the
				provisions of
				G.S.
				58-55-31:
(1) A policy or certificate offered with
				nonforfeiture benefits shall have coverage elements, eligibility, benefit
				triggers and benefit length that are the same as coverage to be issued without
				nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
				be the benefit described in Paragraph (g) of this Rule; and
(2) The offer shall be in writing if the
				nonforfeiture benefit is not otherwise described in the outline of coverage or
				other materials given to the prospective policyholder.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1027 - REQUIRED DISCLOSURE OF RATING PRACTICES TO CONSUMERS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This
				Rule shall apply as follows:
(1) To any
				long-term care policy or certificate issued in this state on or after February
				1, 2003, except as provided in Paragraph (a)(2) of this Rule.
(2) For certificates issued on or after
				August 1, 2002 under a group long-term care insurance policy as defined in
				G.S.
				58-55-20(3), which policy
				was in force at the time this Rule became effective, the provisions of this
				Rule shall apply on the policy anniversary following July 1, 2003.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1028 - PREMIUM RATE SCHEDULE INCREASES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) This
				Rule shall apply as follows:
(1) Except as
				provided in Paragraph (a)(2) of this Rule, this Rule applies to any long-term
				care policy or certificate issued in this state on or after February 1, 2003;
				and
(2) For certificates issued on
				or after August 1, 2002, under a group long-term care insurance policy as
				defined in
				G.S.
				58-55-20(3), which policy
				was in force at the time this Rule became effective, the provisions of this
				Rule shall apply on the policy anniversary following August 1, 2003.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1029 - SCOPE AND APPLICATION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Except as
				otherwise specifically provided, this Section applies to all long-term care
				insurance policies and life insurance policies that accelerate benefits for
				long-term care delivered or issued for delivery in this state on or after the
				effective date by insurers; fraternal benefit societies; nonprofit health,
				hospital and medical service corporations, prepaid health plans; health
				maintenance organizations and all similar organizations.
(b) This Section applies to policies having
				indemnity benefits that are triggered by activities of daily living and sold as
				disability income insurance if:
(1) The
				benefits of the disability income policy are dependent upon or vary in amount
				based on the receipt of long-term care services; or
(2) The disability income policy is
				advertised, marketed or offered as insurance for long-term care services;
				or
(3) Benefits under the policy
				may commence after the policyholder has reached Social Security's normal
				retirement age unless benefits are designed to replace lost income or pay for
				specific expenses other than long-term care services.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1000 - LONG TERM CARE INSURANCE › Section 12 .1030 - LONG-TERM CARE PARTNERSHIP STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) As
				used in this Rule:
(1) "Consumer Price Index"
				means the measure of the average change over time in the prices paid by urban
				consumers for a market basket of consumer goods and services as determined by
				the Bureau of Labor Statistics of the U. S. Department of Labor.
(2) "Qualified Policy" has the same meaning
				as in G.S. 58-55-55(6)
				and includes a certificate issued under a group policy as specified in
				G.S.
				58-55-60.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1101 - APPLICATION

Current through Register Vol. 39, No. 2, July 15, 2024
This Section applies to:
(1) All consolidations, whether the old
				coverage is provided under an individual or a group policy; and
(2) All mortgage insurance offered, issued,
				or delivered in this State, through the mail or otherwise, in connection with
				consolidations.
Authority
				  G.S.
				  58-2-40;
				  58-2-210;
Eff.
				  February 1, 1992;
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 .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1102 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
In this Section, unless the context clearly indicates
				  otherwise:
(1) "Consolidation" means
				any transaction in which a financial institution or servicer makes its premium
				collection services available to its mortgage debtors in connection with a
				particular insurer's ("new insurer") offer of mortgage insurance, which offer
				is made to debtors who, immediately prior to the offer, had mortgage insurance
				with another insurer ("old insurer") and were paying premiums for that
				insurance with their monthly mortgage payments.
(2) "Financial institution" or "servicer"
				means any entity or organization that services mortgage loans by collecting and
				accounting for monthly mortgage payments.
(3) "Loan transfer" means a transaction in
				which the servicing of a block of mortgage loans is transferred from one
				servicer to another. This includes, but is not limited to, a transfer of
				servicing to a new servicing location that occurs within a financial
				institution following, and as a result of, a merger or acquisition.
(4) "Loan transfer consolidation" means a
				consolidation involving debtors whose mortgage loans have been transferred from
				one servicer to another.
(5)
				"Mortgage" or "mortgage loan" means an indebtedness that is secured by real
				estate and that is not subject to Article 57 of General Statute Chapter
				58.
(6) "Mortgage insurance" means
				group or individual life, individual accidental death, or individual disability
				insurance, or any combination thereof, designed to pay all or part of a
				mortgage loan in the event of the insured's death or disability. Group mortgage
				life insurance can only be written with contracts issued in North Carolina.
				Trust arrangements are not allowed for use for group mortgage life
				insurance.
(7) "New coverage" or
				"new plan" means the mortgage insurance coverage or mortgage insurance plan for
				which the financial institution collects premiums beginning on the effective
				date of a consolidation.
(8) "Old
				coverage" or "old plan" means the mortgage insurance coverage or mortgage
				insurance plan the financial institution collected premiums for immediately
				prior to the consolidation.
Authority
				  G.S.
				  58-2-40;
				  58-2-210;
Eff.
				  February 1, 1992;
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 .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1103 - GENERAL REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
No insurer shall participate in any consolidation unless it
				  complies with the following requirements:
(1) The offer of new coverage must be made on
				a timely basis:
(a) In a loan transfer
				consolidation, the offer of new coverage to the prospective insured must be
				made as soon as reasonably possible. If the offer of new coverage is not made
				at least 30 days before the proposed effective date of the new coverage, the
				insurer shall notify the debtor, in writing, that he has the right to an
				unconditional refund of all premiums paid since the transfer date provided he
				exercises the right, in writing, within 30 days after the date of the
				notification.
(b) In all other
				consolidations, the offer of new coverage shall be made to the prospective
				insured at least 30 days before the proposed effective date of the new
				coverage.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1104 - SPECIFIC REQUIREMENTS FOR CERTAIN OFFERS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The offer
				of new coverage may be based on the same premium the prospective insured was
				paying for his old coverage, and a signed application need not be obtained, if
				the new insurer complies with all applicable requirements of this Section and
				General Statute Chapter 58, and the following conditions are met:
(1) The old coverage is accidental death
				insurance, disability insurance, or group mortgage life insurance.
(2) The amount of insurance provided by the
				new plan must be the same or greater than provided by the old plan.
(3) All of the benefits provided by the old
				plan, including but not limited to accidental death riders and
				waiver-of-premium benefits, must be provided by the new plan.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1105 - DISCLOSURE REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
In conjunction with any offer of new coverage made in any
				  consolidation, the new insurer shall disclose in writing to each debtor the
				  following:
(1) That the insured may
				have the right to continue or convert his old coverage by paying premium
				directly to the old insurer;
(2)
				That the new coverage is not conditioned upon either the termination or
				replacement of the old coverage;
(3) The name and address of the old and new
				insurer;
(4) The effective date of
				the new coverage;
(5) The
				beneficiary of the new coverage;
(6) Amount of coverage for both the new and
				old plans. If the amount of coverage for the old plan is not known, a statement
				that the amount may be scheduled and it may be less than or greater than the
				amount of the loan and the insured should check his old policy schedule for an
				exact amount of coverage;
(7)
				Material differences, if any, between the new plan and the old plan;
(8) A statement as to whether the old plan
				was an individual or group plan and a statement as to whether the new plan is
				an individual or a group policy.
(9) Cautionary language shall be affixed in
				sticker form in bold type upon the face or insert page of any
				policy/certificate issued pursuant to
				11 NCAC
				12 .1104 and
				12 .1106 with language
				substantially as follows:
IMPORTANT NOTICE
This certificate/policy is issued to you in connection with a
				  mortgage insurance consolidation. It is the intention of the insurer to provide
				  you coverage that is equal to or better than the coverage you had before. To
				  the extent the benefits provided or the provisions of your prior
				  certificate/policy are more liberal than those under this certificate/policy,
				  the provisions of your prior certificate will control. This certificate/policy
				  shall be incontestable from its date of issue.
Authority
				  G.S.
				  58-2-40;
				  58-2-210;
Eff.
				  February 1, 1992;
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 .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1106 - DISABILITY INSURANCE PLANS

Current through Register Vol. 39, No. 2, July 15, 2024
If the financial institution sponsors a mortgage life
				  insurance plan and a disability insurance plan that are underwritten by the
				  same insurer, and if the new insurer consolidates the mortgage life plan
				  pursuant to
				  11 NCAC
				  12 .1104 by offering the same coverage at the
				  old premium, the new insurer must also consolidate the disability insurance
				  plan by offering the same coverage at the old premium.
Authority
				  G.S.
				  58-2-40;
				  58-2-210;
Eff.
				  February 1, 1992;
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 .1100 - MORTGAGE INSURANCE CONSOLIDATIONS › Section 12 .1107 - DISCLOSURE OF CONSOLIDATION TO THE DEPARTMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Except
				for loan transfer consolidations, the new insurer shall notify the Department
				of the intent to execute a mortgage insurance consolidation involving North
				Carolina financial institutions at least 30 days before the proposed effective
				date of the new coverage.
(b) If
				the consolidation is pursuant to a loan transfer, the Department shall be
				notified as soon as reasonably possible, but no later than 30 days after the
				date that the insurance company is notified by the financial institution that
				the loan transfer has occurred. Notifications required under this Rule shall be
				in writing and sent to:
North Carolina Department of Insurance
Life and Health Division
Post Office Box 26387
Raleigh, NC 27611
(c) Notifications required under this Rule
				shall contain the following information:
(1)
				Identification of financial institution(s) involved;
(2) Reason for transfer, i.e., loan transfer
				or other type of consolidation;
(3)
				Proposed effective date of the consolidation;
(4) Identification of the insurance companies
				whose coverages are being consolidated;
(5) A listing of the new insurer's form
				numbers to be used; and
(6) The
				approximate number of North Carolina insureds whose mortgages will be
				consolidated.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1200 - ACCELERATED BENEFITS › Section 12 .1201 - PURPOSE AND APPLICATION

Current through Register Vol. 39, No. 2, July 15, 2024
The purpose of this Section is to regulate accelerated
				  benefit provisions of individual and group life insurance policies and
				  annuities and to provide required standards of disclosure. This Section applies
				  to all accelerated benefits provisions of individual and group life insurance
				  policies and annuities, except those subject to Article 55 of General Statute
				  Chapter 58, that are issued or delivered in this State on or after the
				  effective date of this Section.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
Eff. March 1,
				  1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1202 - DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) "Accelerated
				benefits" covered under this Section are benefits are payable under a life
				insurance or annuity contract:
(1) To a
				policyowner or certificateholder, during the lifetime of the insured, in
				anticipation of death or upon the occurrence of specified life-threatening or
				catastrophic conditions as defined by the policy or rider; and
(2) That reduce the death benefit otherwise
				payable under the life insurance or annuity contract; and
(3) That are payable upon the occurrence of a
				single qualifying event that results in the payment of a benefit amount fixed
				at the time of acceleration.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1200 - ACCELERATED BENEFITS › Section 12 .1203 - TYPE OF PRODUCT

Current through Register Vol. 39, No. 2, July 15, 2024
Accelerated benefit riders and life insurance policies and
				  annuities with accelerated benefit provisions are primarily deemed to be
				  mortality risks rather than morbidity risks.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
Eff. March 1,
				  1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1204 - ASSIGNEE/BENEFICIARY

Current through Register Vol. 39, No. 2, July 15, 2024
Before the payment of any accelerated benefit, the insurer
				  shall obtain from any assignee or irrevocable beneficiary a signed
				  acknowledgement of concurrence for payment. If the insurer paying the
				  accelerated benefit is the assignee under the policy, no such acknowledgement
				  is required.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
Eff. March 1,
				  1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1205 - CRITERIA FOR PAYMENT

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Lump Sum
				Settlement Option Required. Contract payment options shall include the option
				to take the benefit as a lump sum. The benefit shall not be made available as
				an annuity that is contingent upon the life of the insured.
(b) Restrictions on Use of Proceeds. No
				restrictions by the insurer are permitted on the use of the proceeds by the
				insured.
(c) Accidental Death
				Benefit Provisions. If any death benefit remains after payment of an
				accelerated benefit, any accidental death benefit provision in the policy or
				rider shall not be affected by the payment of the accelerated
				benefit.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
Eff. March 1,
				  1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1206 - DISCLOSURES

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Descriptive
				Title. The term "accelerated benefit" shall be included in the descriptive
				title printed on the first page of the policy or rider. Products regulated
				under this Section shall not be described or marketed as long-term care
				insurance or as providing long-term care benefits.
(b) Tax Consequences. A disclosure statement
				is required at the time of application for the policy or rider and at the time
				the accelerated benefit payment request is submitted, which statement shall
				advise that receipt of accelerated benefits may be taxable and that assistance
				should be sought from a personal tax advisor. The statement shall be
				prominently displayed on the first page of the policy or rider and on any other
				related documents.
(c)
				Solicitation:
(1) A written disclosure
				including, but not limited to, a brief description of the accelerated benefit
				and definitions of the conditions or occurrences triggering payment of the
				benefits shall be given to the applicant. The description shall include an
				explanation of any effect of the payment of a benefit on the policy's cash
				value, accumulation account, death benefit, premium, policy loans and policy
				liens:
(A) In the case of agent solicited
				insurance, the agent shall provide the disclosure form to the applicant prior
				to or concurrently with the application. Acknowledgement of the disclosure
				shall be signed by the applicant and writing agent.
(B) In the case of a solicitation by direct
				response methods, the insurer shall incorporate the disclosure in the
				application or attach a disclosure form thereto.
(C) In the case of group insurance policies,
				the disclosure form shall be contained as part of the certificate of coverage
				or any related document furnished by the insurer for the certificate
				holder.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .1200 - ACCELERATED BENEFITS › Section 12 .1207 - EFFECTIVE DATE OF THE ACCELERATED BENEFITS

Current through Register Vol. 39, No. 2, July 15, 2024
An accelerated benefit provision shall be effective for
				  qualifying events that occur on or after the effective date of the policy or
				  rider. The accelerated benefit provision shall be effective for illness no more
				  than 30 days after the effective date of the policy or rider.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
Eff. March 1,
				  1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1208 - WAIVER OF PREMIUMS

Current through Register Vol. 39, No. 2, July 15, 2024
The insurer may offer a waiver of premium for the accelerated
				  benefit provision in the absence of a regular waiver of premium provision being
				  in effect. At the time the benefit is claimed, the insurer shall explain any
				  continuing premium requirement to keep the policy in force.
Authority
				  G.S.
				  58-2-40;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
Eff. March 1,
				  1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1209 - DISCRIMINATION

Current through Register Vol. 39, No. 2, July 15, 2024
In addition to the requirements of
				  G.S.
				  58-58-35 and
				  G.S.
				  58-63-15(7)a, insurers shall
				  not apply any additional conditions on the payment of the accelerated benefits
				  other than those conditions specified in the policy or rider.
Authority
				  G.S.
				  58-2-40;
				  58-3-120;
				  58-3-150;
				  58-7-15(1);
				  58-58-1;
				  58-58-35;
				  58-63-15(7);
Eff. March 1, 1992;
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 .1200 - ACCELERATED BENEFITS › Section 12 .1210 - ACTUARIAL STANDARDS

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Financing
				Options:
(1) The insurer may require a
				premium charge or cost of insurance charge for the accelerated benefit. These
				charges shall be based on sound actuarial principles. In the case of group
				insurance, the additional cost may also be reflected in experience
				rating.
(2) The insurer may pay a
				present value of the face amount. The calculation shall be based on any
				applicable actuarial discount appropriate to the policy design. The interest
				rate or interest rate methodology used in the calculation shall be based on
				sound actuarial principles and disclosed in the contract or actuarial
				memorandum. The maximum interest rate used shall be no more than the greater
				of:
(A) The current yield on 90 day treasury
				bills; or
(B) The current maximum
				statutory adjustable policy loan interest rate.
(3) The insurer may accrue an interest charge
				on the amount of the accelerated benefits. The interest rate or interest rate
				methodology used in the calculation shall be based on sound actuarial
				principles and disclosed in the contract or actuarial memorandum. The maximum
				interest rate used shall be no more than the greater of:
(A) The current yield on 90 day treasury
				bills; or
(B) The current maximum
				statutory adjustable policy loan interest rate.
The interest rate on the portion of the lien that is equal in
				  amount to the cash value of the contract at the time of the benefit
				  acceleration shall be no more than the policy loan interest rate stated in the
				  contract.