reglab/statecodes huggingface dataset:
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-04 - Advertising Rules › Section 45-06-04-07 - Preexisting conditions

Current through Supplement No. 393, July, 2024
1. An advertisement
				which is subject to the requirements of section
				45-06-04-06 must, in negative
				terms, disclose the extent to which any loss is traceable to a condition
				existing prior to the effective date of the policy. The use of the term
				"preexisting condition" without an appropriate definition or description may
				not be used.
2. When a policy does
				not cover losses resulting from preexisting conditions, no advertisement of the
				policy may state or imply that the applicant's physical condition or medical
				history will not affect the issuance of the policy or payment of a claim
				thereunder. This rule prohibits the use of the phrase "no medical examination
				required" and phrases of similar import, but does not prohibit explaining
				"automatic issue". If an insurer requires a medical examination for a specified
				policy, the advertisement if it is an invitation to contract must disclose that
				a medical examination is required.
3. When an advertisement contains an
				application form to be completed by the applicant and returned by mail for a
				direct response insurance product, such application form must contain a
				question requiring a response by the applicant or a statement in prominent
				type, all in capital letters, which reflects the preexisting condition
				provisions of the policy immediately preceding the blank space for the
				applicant's signature. For example, such an application form must contain a
				question substantially as follows:
"Do you understand that this policy will not pay benefits
				  during the first - year(s) after the issue date for a disease or physical
				  condition which you now have or have had in the past?"--------Yes
Or a statement in prominent type, all capitalized,
				  substantially as follows:
"I UNDERSTAND THAT THE POLICY APPLIED FOR WILL NOT PAY
				  BENEFITS FOR ANY LOSS INCURRED DURING THE FIRST-------YEAR(S) AFTER THE ISSUE
				  DATE ON ACCOUNT OF DISEASE OR PHYSICAL CONDITION WHICH I NOW HAVE OR HAVE HAD
				  IN THE PAST"
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 45-06-04-08 - Testimonials or endorsements by third parties

Current through Supplement No. 393, July, 2024
1. Testimonials used in advertisements must
				be genuine, represent the current opinion of the author, be applicable to the
				policy advertised, and be accurately reproduced. The insurer, in using a
				testimonial, makes as its own all of the statements contained therein, and the
				advertisement, including such statement is subject to all the provisions of
				these rules.
2. If the person
				making a testimonial, an endorsement, or an appraisal has a financial interest
				in the insurer or a related entity as a stockholder, director, officer,
				employee, or otherwise, such fact must be disclosed in the advertisement. If a
				person is compensated for making a testimonial, endorsement, or appraisal, such
				fact must be disclosed in the advertisement by language substantially as
				follows: "Paid endorsement". This rule does not require disclosure of union
				"scale" wages required by union rules if the payment is actually for such
				"scale" for television or radio performance. The payment of substantial
				amounts, directly or indirectly, for "travel and entertainment" for filming or
				recording of television or radio advertisements removes the filming or
				recording from the category of an unsolicited testimonial and requires
				disclosure of such compensation. This subsection does not apply to an
				institutional advertisement which has as its sole purpose the promotion of the
				insurer.
3. An advertisement may
				not state or imply that any insurer or a policy has been approved or endorsed
				by an individual, group of individuals, society, association, or other
				organizations, unless such is the fact, and unless any proprietary relationship
				between an organization and the insurer is disclosed. If the entity making the
				endorsement or testimonial has been formed by the insurer or is owned or
				controlled by the insurer or the person or persons who own or control the
				insurer, such fact must be disclosed in the advertisement.
4. When a testimonial refers to benefits
				received under a policy, the specific claim data, including claim number, date
				of loss, and other pertinent information must be retained by the insurer for
				inspection for a period of four years or until the filing of the next regular
				report on examination of the insurer, whichever is the longer period of
				time.
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 45-06-04-09 - Jurisdictional licensing and status of insurer

Current through Supplement No. 393, July, 2024
1. An advertisement which reasonably is
				expected to be seen or heard beyond the limits of the jurisdiction in which the
				insurer is licensed may not imply licensing beyond those limits.
2. An advertisement may not create the
				impression directly or indirectly that the insurer, its financial condition or
				status, or the payment of its claims, or the merits, desirability, or
				advisability of its policy forms or kinds or plans of insurance are approved,
				endorsed, or accredited by any division or agency of this state or the United
				States government.
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 45-06-04-10 - Identity of insurer and agent or agency

Current through Supplement No. 393, July, 2024
1. The full legal name of the actual insurer
				and insurance agent or agency must be shown in each advertisement. An
				advertisement may not use a trade name, any insurance group designation, name
				of the parent company of the insurer, name of a particular division of the
				insurer or agency, service mark, slogan, symbol, or other device in a manner
				which would have the capacity and tendency to mislead or deceive as to the true
				identity of the insurer or insurance agent or agency.
2. No advertisement may use any combination
				of words, symbols, or physical materials which by their content, phraseology,
				shape, color, or other characteristics are so similar to combination of words,
				symbols, or physical materials, used by agencies of the federal government or
				of this state, or otherwise appear to be of such a nature that it tends to
				confuse or mislead prospective insureds into believing that the solicitation is
				in some manner connected with an agency of the municipal, state, or federal
				government.
3. Each advertisement
				must clearly disclose that it is a promotion for an insurance product, company,
				agent, or agency.
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 45-06-04-11 - Advertising file to be maintained

Current through Supplement No. 393, July, 2024
Each insurer shall maintain at its home or principal office
				  a complete file containing every printed, published, or prepared advertisement
				  of its individual policies and typical printed, published, or prepared
				  advertisements of its blanket, franchise, and group policies hereafter
				  disseminated in this or any other state whether or not licensed in such state,
				  with a notation attached to each such advertisement which shall indicate the
				  manner and extent of distribution and the form number of any policy advertised.
				  Such file is subject to regular and periodical inspection by the insurance
				  commissioner. All such advertisements must be maintained in said file for a
				  period of either four years or until the filing of the next regular report on
				  examination of the insurer, whichever is the longer period of
				  time.
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 45-06-04-12 - Violation defined as unfair trade practice

Current through Supplement No. 393, July, 2024
A violation of this chapter by an insurance company or agent
				  is an unfair method of competition and an unfair or deceptive act or practice
				  in the conduct of the business of insurance, pursuant to North Dakota Century
				  Code section 26.1-04-03.
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 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-01 - Applicability and scope

Current through Supplement No. 393, July, 2024
Except as otherwise specifically provided, this section
				  applies to all long-term care insurance policies delivered or issued for
				  delivery in this state between July 1, 1988, and February 29, 2004, by
				  insurers, fraternal benefit societies, nonprofit health, hospital and medical
				  service corporations, prepaid health maintenance organizations, and all similar
				  organizations. Policies delivered or issued for delivery in this state on or
				  after March 1, 2004, are governed by chapter 45-06-05.1.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-02 - Definitions

Current through Supplement No. 393, July, 2024
For the purpose of this regulation, the terms "long-term
				  care insurance", "group long-term care insurance", "commissioner", "applicant",
				  "policy", and "certificate" have the meanings set forth in North Dakota Century
				  Code section 26.1-45-01.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-03 - Policy definitions

Current through Supplement No. 393, July, 2024
No long-term care insurance policy delivered or issued for
				  delivery in this state may use the terms set forth in this section, unless the
				  terms are defined in the policy and the definitions satisfy the following
				  requirements:
1. "Acute condition"
				means that the individual is medically unstable. Such an individual requires
				frequent monitoring by medical professionals, such as physicians and registered
				nurses, in order to maintain the individual's health status.
2. "Adult day care" means a program for six
				or more individuals of social and health-related services provided during the
				day in a community group setting for the purpose of supporting frail, impaired
				elderly, or other disabled adults who can benefit from care in a group setting
				outside the home.
3. "Home health
				care services" means medical and nonmedical services provided to ill, disabled,
				or infirm persons in their residences. Such services may include homemaker
				services, assistance with activities of daily living, and respite care
				services.
4. "Medicare" must be
				defined as "The Health Insurance for the Aged Act, Title XVIII of the Social
				Security Amendments of 1965, as then constituted or later amended", or "Title
				I, Part I of Public Law 89-97, as enacted by the Eighty-ninth Congress of the
				United States of America and popularly known as the Health Insurance for the
				Aged Act, as then constituted and any later amendments or substitutes thereof",
				or words of similar import.
5.
				"Mental or nervous disorder" may not be defined to include more than neurosis,
				psychoneurosis, psychopathy, psychosis, or mental or emotional disease or
				disorder.
6. "Personal care" means
				the provisions of hands-on services to assist an individual with activities of
				daily living (such as bathing, eating, dressing, transferring, continence, and
				toileting).
7. "Skilled nursing
				care", "intermediate care", "personal care", "home care", and other services
				must be defined in relation to the level of skill required, the nature of the
				care, and the setting in which care must be delivered.
8. All providers of services, including
				"skilled nursing facility", "extended care facility", "intermediate care
				facility", "convalescent nursing home", "personal care facility", and "home
				care agency" must be defined in relation to the services and facilities
				required to be available and the licensure or degree status of those providing
				or supervising the services. The definition may require that the provider be
				appropriately licensed or certified.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-04 - Policy practices and provisions

Current through Supplement No. 393, July, 2024
1.
Renewability
. The terms "guaranteed renewable" and "noncancelable"
				may not be used in any individual long-term care insurance policy without
				further explanatory language in accordance with the disclosure requirements of
				section 45-06-04-05.
a. No such policy issued to an individual may
				contain renewal provisions less favorable to the insured than "guaranteed
				renewable" or "noncancelable".
b.
				The term "guaranteed renewable" may be used only when the insured has the right
				to continue the long-term care insurance in force by the timely payment of
				premiums and when the insurer has no unilateral right to make any change in any
				provision of the policy or rider while the insurance is in force, and cannot
				decline to renew, except that rates may be revised by the insurer on a class
				basis.
c. The term "noncancelable"
				may be used only when the insured has the right to continue the long-term care
				insurance in force by the timely payment of premiums during which period the
				insurer has no right to unilaterally make any change in any provision of the
				insurance or in the premium rate.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-05.1 - Prohibition against post-claims underwriting

Current through Supplement No. 393, July, 2024
1. All applications for long-term care
				insurance policies or certificates, except those which are guaranteed issue,
				must contain clear and unambiguous questions designed to ascertain the health
				condition of the applicant.
2.
a. If an application for long-term care
				insurance contains a question which 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.
b. If the medications listed in such
				application were known by the insurer, or should have been known at the time of
				application, to be directly related to a medical condition for which coverage
				would otherwise be denied, then the policy or certificate may not be rescinded
				for that condition.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-05.2 - Minimum standards for home health and community care benefits in long-term care insurance policies

Current through Supplement No. 393, July, 2024
1. A
				long-term care insurance policy or certificate may not, if it provides benefits
				for home health care or community care services, limit or exclude benefits:
a. By requiring that the insured or claimant
				would need care in a skilled nursing facility if home health care services were
				not provided;
b. By requiring that
				the insured or claimant first or simultaneously receive nursing or therapeutic
				services, or both in a home, community, or institutional setting before home
				health care services are covered;
c. By limiting eligible services to services
				provided by registered nurses or licensed practical nurses;
d. By requiring that a nurse or therapist
				provide services covered by the policy that can be provided by a home health
				aide, or other licensed or certified home care worker acting within the scope
				of his or her licensure or certification;
e. By requiring that the insured or claimant
				have an acute condition before home health care services are covered;
f. By limiting benefits to
				services provided by medicare-certified agencies or providers;
g. By excluding coverage for personal care
				services provided by a home health aide;
h. By requiring that the provision of home
				health care services be at a level of certification or licensure greater than
				that required by the eligible service; or
i. By excluding coverage for adult day care
				services.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-05.3 - Requirement to offer inflation protection

Current through Supplement No. 393, July, 2024
1. No insurer may offer a long-term care
				insurance policy unless the insurer also offers to the policyholder in addition
				to any other inflation protection the option to purchase a policy that provides
				for benefit levels to increase with benefit maximums or reasonable durations
				which 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 policyholder, at the time of purchase, the option to purchase a policy
				with an inflation protection feature no less favorable than one of the
				following:
a. Increases benefit levels
				annually, in a manner so that the increases are compounded annually at a rate
				not less than five percent;
b.
				Guarantees the insured individual the right to periodically increase benefit
				levels without providing evidence of insurability or health status so long as
				the option for the previous period has not been declined. The amount of the
				additional benefit must be no less than the difference between the existing
				policy benefit and that benefit compounded annually at a rate of at least five
				percent for the period beginning with the purchase of the existing benefit and
				extending until the year in which the offer is made; or
c. Covers a specified percentage of actual or
				reasonable charges and does not include a maximum specified indemnity amount or
				limit.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-06 - Requirements for application forms and replacement coverage

Current through Supplement No. 393, July, 2024
1. Application forms must include the
				following questions designed to elicit information as to whether, as of the
				date of the application, the applicant has another long-term care insurance
				policy or certificate in force or whether a long-term care policy or
				certificate is intended to replace any other accident and sickness or long-term
				care policy or certificate presently in force. A supplementary application or
				other form to be signed by the applicant and agent, except when the coverage is
				sold without an agent, containing such questions may be used. With regard to a
				replacement policy issued to groups defined by subsection 3 of North Dakota
				Century Code section 26.1-45-01, the following questions may be modified only
				to the extent necessary to elicit information about health or long-term care
				insurance policies other than the group policy being replaced; provided,
				however, that the certificate holder has been notified of the replacement.
a. Do you have another long-term care
				insurance policy or certificate in force (including health care service
				contract or health maintenance organization contract)?
b. Did you have another long-term care
				insurance policy or certificate in force during the last twelve months?
(1) If so, with which company?
(2) If that policy lapsed, when did it lapse?
c. Are you covered by
				medicaid?
d. Do you intend to
				replace any of your medical or health insurance coverage with this policy
				[certificate]?
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-06.1 - Reporting requirements

Current through Supplement No. 393, July, 2024
1. Every
				insurer shall maintain records for each agent of that agent's amount of
				replacement sales as a percent of the agent's total annual sales and the amount
				of lapses of long-term care insurance policies sold by the agent as a percent
				of the agent's total annual sales.
2. Each insurer shall report annually by June
				thirtieth the ten percent of its agents with the greatest percentages of lapses
				and replacements as measured by subsection 1.
3. Reported replacement and lapse rates do
				not alone constitute a violation of insurance laws or necessarily imply
				wrongdoing. The reports are for the purpose of reviewing more closely agent
				activities regarding the sale of long-term care insurance.
4. Every insurer shall report annually by
				June thirtieth 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.
				Every insurer shall report annually by June thirtieth 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 preceding calendar year.
6. For purposes of this section, "policy"
				means only long-term care insurance and "report" means on a statewide basis.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-07 - Discretionary powers of commissioner

Current through Supplement No. 393, July, 2024
The commissioner may, upon written request and after an
				  administrative hearing, issue an order to modify or suspend a specific
				  provision or provision of this chapter with respect to a specific long-term
				  care insurance policy or certificate 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
a. The modification or suspension is
				necessary to the development of an innovative and reasonable approach for
				insuring long-term care;
b. The
				policy or certificate is to be issued to residents of a life care or continuing
				care retirement community 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
c. 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.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-08 - Loss ratio

Current through Supplement No. 393, July, 2024
Benefits under long-term care insurance policies must be
				  deemed reasonable in relation to premiums provided the expected loss ratio is
				  at least sixty percent, calculated in a manner which provides for adequate
				  reserving of the long-term care insurance risk. In evaluating the expected loss
				  ratio, due consideration must 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. All appropriate
				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.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-08.1 - Reserve standards

Current through Supplement No. 393, July, 2024
1. When long-term
				care benefits are provided through the acceleration of benefits under group or
				individual life policies or riders to such policies, policy reserves for such
				benefits must be determined in accordance with North Dakota Century Code
				chapter 26.1-35. Claim reserves must also be established in the case when such
				policy or rider is in claim status.
Reserves for policies and riders subject to this subsection
				  should 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, the
				  reserves for the long-term care benefit and the life insurance benefit may not
				  be less than the reserves for the life insurance benefit assuming no long-term
				  care benefit.
In the development and calculation of reserves for policies
				  and riders subject to this subsection, due regard must be given to the
				  applicable policy provisions, marketing methods, administrative procedures, and
				  all other considerations that have an impact on projected claim costs,
				  including the following:
a.
				Definition of insured events;
b.
				Covered long-term care facilities;
c. Existence of home convalescence care
				coverage;
d. Definition of
				facilities;
e. Existence or
				absence of barriers to eligibility;
f. Premium waiver provision;
g. Renewability;
h. Ability to raise premiums;
i. Marketing method;
j. Underwriting procedures;
k. Claims adjustment procedures;
l. Waiting period;
m. Maximum benefit;
n. Availability of eligible facilities;
o. Margins in claim costs;
p. Optional nature of benefit;
q. Delay in eligibility for
				benefit;
r. Inflation protection
				provisions; and
s. Guaranteed
				insurability option.
Any applicable valuation morbidity table must be certified
				  as appropriate as a statutory valuation table by a member of the American
				  academy of actuaries.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-09 - Filing requirement

Current through Supplement No. 393, July, 2024
Prior to an insurer or similar organization offering group
				  long-term care insurance to a resident of this state pursuant to North Dakota
				  Century Code section 26.1-45-03, it shall file with the commissioner evidence
				  that the group policy or certificate thereunder has been approved by a state
				  having statutory or regulatory long-term care insurance requirements
				  substantially similar to those adopted in this state.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-09.1 - Filing requirements for advertising

Current through Supplement No. 393, July, 2024
1. An 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
				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. In addition, all
				advertisements must 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.
2. The commissioner may
				exempt from these requirements any advertising form or material when, in the
				commissioner's opinion, this requirement may not be reasonably applied.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-09.2 - Standards for marketing

Current through Supplement No. 393, July, 2024
1. Every
				insurer, health care service plan, or other entity marketing long-term care
				insurance coverage in this state, directly or through its producers, shall:
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 outline of coverage
				and policy the following: "Notice to buyer: This policy may not cover all of
				the costs associated with long-term care incurred by the buyer during the
				period of coverage. The buyer is advised to review carefully all policy
				limitations."
d. Inquire and
				otherwise make every reasonable effort to identify whether a prospective
				applicant or enrollee for long-term care insurance already has accident and
				sickness or long-term care insurance and the types and amounts of any such
				insurance.
e. Every insurer or
				entity marketing long-term care insurance shall establish auditable procedures
				for verifying compliance with this subsection.
f. If the state in which the policy or
				certificate is to be delivered or issued for delivery has a senior insurance
				counseling program approved by the commissioner, the insurer shall, at
				solicitation, provide written notice to the prospective policyholder and
				certificate holder that such a program is available and the name, address, and
				telephone number of the program.
g. For long-term care health insurance
				policies and certificates, use the terms "noncancelable" or "level premium"
				only when the policy or certificate conforms to subdivision c of subsection 1
				of section
				45-06-05-04.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-09.3 - Appropriateness of recommended purchase

Current through Supplement No. 393, July, 2024
In recommending the purchase or replacement of any long-term
				  care insurance policy or certificate, an agent shall make reasonable efforts to
				  determine the appropriateness of a recommended purchase or replacement.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Section 45-06-05-11 - Requirement to deliver shopper's guide

Current through Supplement No. 393, July, 2024
1.
				A long-term care insurance shopper's guide in the format developed by the
				national association of insurance commissioners, or a guide developed or
				approved by the commissioner, must be provided to all prospective applicants of
				a long-term care insurance policy or certificate.
a. In the case of agent solicitations, an
				agent must deliver the shopper's guide prior to the presentation of an
				application or enrollment form.
b.
				In the case of direct response solicitations, the shopper's guide must be
				presented in conjunction with any application or enrollment form.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05 - Long-Term Care Insurance Model Regulation › Appendix A

Current through Supplement No. 393, July, 2024
RECISSION REPORTING FORM FOR
LONG-TERM CARE POLICIES
FOR THE STATE OF
				  __________________________
FOR THE REPORTING YEAR 20[ ]
Company Name:_____________________________
Address:___________________________________
____________________________________
Telephone Number:___________________________
Due: March 1, annually
Instructions:
The purpose of this form is to report all rescissions of
				  long-term care insurance policies or certificates. Those recissions voluntarily
				  effectuated by an insured are not required to be included in this report.
				  Please furnish one form per rescission.
Policy Form Number
Policy and Certificate
						  #
Name of Insured
Date of Policy Issuance
Date/s
						  Claim/s Submitted
Date of Rescission
_____________________________________________________
Date of Rescission: ______________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
__________________________
Signature
__________________________
Name and Title (please type)
__________________________
Date
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-01 - Applicability and scope

Current through Supplement No. 393, July, 2024
Except as otherwise specifically provided, this chapter
				  applies to all long-term care insurance policies, including qualified long-term
				  care contracts and life insurance policies that accelerate benefits for
				  long-term care delivered or issued for delivery in this state on or after March
				  1, 2004, fraternal benefit societies, nonprofit health, hospital and medical
				  service corporations, prepaid health plans, health maintenance organizations,
				  and all similar organizations. Certain provisions of this chapter apply only to
				  qualified long-term care insurance contracts as noted. Policies delivered or
				  issued for delivery in this state before March 1, 2004, are governed by chapter
				  45-06-05.
Additionally, this chapter is intended to apply to policies
				  having indemnity benefits 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;
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.
General Authority:
NDCC 28-32-02
Law Implemented:
NDCC 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-02 - Definitions

Current through Supplement No. 393, July, 2024
For the purpose of this chapter, the terms "long-term care
				  insurance", "qualified long-term care insurance", "group long-term care
				  insurance", "commissioner", "applicant", "policy", and "certificate" shall have
				  the meanings set forth in North Dakota Century Code section 26.1-45-01. In
				  addition, the following definitions apply:
1.
a."Exceptional increase" means only those increases filed by
				  an insurer as exceptional for which the commissioner determines the need for
				  the premium rate increase is justified:
(1) Due to changes in laws or regulations applicable to
				  long-term care coverage in this state; or
(2) Due to increased and unexpected utilization that affects
				  the majority of insurers of similar products.
b. Except as provided in section
				  45-06-05.1-18, exceptional
				  increases are subject to the same requirements as other premium rate schedule
				  increases.
c. The commissioner may request a review by an independent
				  actuary or a professional actuarial body of the basis for a request that an
				  increase be considered an exceptional increase.
d. The commissioner, in determining that the necessary basis
				  for an exceptional increase exists, shall also determine any potential offsets
				  to higher claims costs.
2. "Incidental", as used in subsection 10 of section
				  45-06-05.1-18, means that the
				  value of the long-term care benefits provided is less than ten percent of the
				  total value of the benefits provided over the life of the policy. These values
				  shall be measured as of the date of issue.
3. "Qualified actuary" means a member in good standing of the
				  American academy of actuaries.
4. "Similar policy forms" means all of the long-term care
				  insurance policies and certificates issued by an insurer in the same long-term
				  care benefit classification as the policy form being considered. Certificates
				  of groups that meet the definition in subdivision a of subsection 3 of North
				  Dakota Century Code section 26.1-45-01 are not considered similar to
				  certificates or policies otherwise issued as long-term care insurance, but are
				  similar to other comparable certificates with the same long-term care benefit
				  classifications. For purposes of determining similar policy forms, long-term
				  care benefit classifications are defined as follows: institutional long-term
				  care benefits only, noninstitutional long-term care benefits only, or
				  comprehensive long-term care benefits.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-04 - Policy practices and provisions

Current through Supplement No. 393, July, 2024
1.
Renewability.
The terms "guaranteed renewable" and "noncancelable"
				shall not be used in any individual long-term care insurance policy without
				further explanatory language in accordance with the disclosure requirements of
				section 45-06-05.1-06.
a. A policy issued to
				an individual shall not contain renewal provisions other than "guaranteed
				renewable" or "noncancelable".
b.
				The term "guaranteed renewable" may be used only when the insured has the right
				to continue the long-term care insurance in force by the timely payment of
				premiums and when the insurer has no unilateral right to make any change in any
				provision of the policy or rider while the insurance is in force, and cannot
				decline to renew, except that rates may be revised by the insurer on a class
				basis.
c. The term "noncancelable"
				may be used only when the insured has the right to continue the long-term care
				insurance in force by the timely payment of premiums during which period the
				insurer has no right to unilaterally make any change in any provision of the
				insurance or in the premium rate.
d. The term "level premium" may only be used
				when the insurer does not have the right to change the premium.
e. In addition to the other requirements of
				this subsection, a qualified long-term care insurance contract shall be
				guaranteed renewable, within the meaning of section 7702B(b)(1)(C) of the
				Internal Revenue Code of 1986, as amended.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-06 - Required disclosure provisions

Current through Supplement No. 393, July, 2024
1.
Renewability.
Individual long-term care insurance policies shall
				contain a renewability provision.
a. The
				provision shall be appropriately captioned, shall appear on the first page of
				the policy, and shall clearly state that the coverage is guaranteed renewable
				or noncancelable. This provision shall not apply to policies that do not
				contain a renewability provision and under which the right to nonrenew is
				reserved solely to the policyholder.
b. A long-term care insurance policy or
				certificate, other than one in which the insurer does not have the right to
				change the premium, shall include a statement that premium rates may change.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-07 - Required disclosure of rating practices to consumers

Current through Supplement No. 393, July, 2024
1. This section shall apply as follows:
a. Except as provided in subdivision b, this
				section applies to any long-term care policy or certificate issued in this
				state on or after September 1, 2004.
b. For certificates issued on or after the
				effective date of this amended regulation under a group long-term care
				insurance policy as defined in subdivision a of subsection 3 of North Dakota
				Century Code section 26.1-45-01, which policy was in force at the time this
				amended regulation became effective, the provisions of this section shall apply
				on the policy anniversary following March 1, 2005.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-08 - Initial filing requirements

Current through Supplement No. 393, July, 2024
1. This
				section applies to any long-term care policy issued in this state on or after
				September 1, 2004.
2. An insurer
				shall provide the information listed in this subsection to the commissioner
				sixty days prior to making a long-term care insurance form available for sale.
a. A copy of the disclosure documents
				required in section 45-06-05.1-07; and
b. An actuarial certification consisting of
				at least the following:
(1) 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;
(2)
				A statement that the policy design and coverage provided have been reviewed and
				taken into consideration;
(3) A
				statement that the underwriting and claims adjudication processes have been
				reviewed and taken into consideration;
(4) A complete description of the basis for
				contract reserves that are anticipated to be held under the form, to include:
(a) Sufficient detail or sample calculations
				provided so as to have a complete depiction of the reserve amounts to be
				held;
(b) A statement that the
				assumptions used for reserves contain reasonable margins for adverse
				experience;
(c) A statement that
				the net valuation premium for renewal years does not increase, except for
				attained-age rating where permitted; and
(d) 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 in which this does not occur:
[1] An aggregate distribution of anticipated
				issues may be used as long as the underlying gross premiums maintain a
				reasonably consistent relationship; and
[2] If the gross premiums for certain age
				groups appear to be inconsistent with this requirement, the commissioner may
				request a demonstration under subsection 3 based on a standard age
				distribution; and
(5)
(a) 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
(b) A comparison of the premium schedules for
				similar policy forms that are currently available from the insurer with an
				explanation of the differences.
North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-09 - Prohibition against post-claims underwriting

Current through Supplement No. 393, July, 2024
1. All applications for long-term care
				insurance policies or certificates except those that are guaranteed issue shall
				contain clear and unambiguous questions designed to ascertain the health
				condition of the applicant.
2.
a. If an application for long-term care
				insurance contains a question 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.
b. If the medications listed in the
				application were known by the insurer, or should have been known at the time of
				application, to be directly related to a medical condition for which coverage
				would otherwise be denied, then the policy or certificate shall not be
				rescinded for that condition.