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 - Required disclosure provisions

Current through Supplement No. 393, July, 2024
1.
Renewability.
Individual long-term care insurance policies must
				contain a renewability provision. Such provision must be appropriately
				captioned, must appear on the first page of the policy, and must clearly state
				the duration, where limited, of renewability and the duration of the term of
				coverage for which the policy is issued and for which it may be renewed.
2.
Riders and endorsements.
Except for riders or endorsements by which the insurer effectuates a
				request made in writing by the insured under an individual long-term care
				insurance policy, all riders or endorsements added to an individual long-term
				care insurance policy after date of issue or at reinstatement or renewal which
				reduce or eliminate benefits or coverage in the policy must require signed
				acceptance by the individual insured. After the date of policy issue, any rider
				or endorsement which increases benefits or coverage with a concomitant increase
				in premium during the policy term must be agreed to in writing signed by the
				insured, except if the increased benefits or coverage are required by law.
				Where a separate additional premium is charged for benefits provided in
				connection with riders or endorsements, such premium charge must be set forth
				in the policy, rider, or endorsement.
3.
Payment of benefits.
A
				long-term care insurance policy which provides for the payment of benefits
				based on standards described as "usual and customary", "reasonable and
				customary", or words of similar import must include a definition of such terms
				and an explanation of such terms in its accompanying outline of coverage.
4.
Limitations.
If a
				long-term care insurance policy or certificate contains any limitations with
				respect to preexisting conditions, such limitations must appear as a separate
				paragraph of the policy or certificate and be labeled as "preexisting condition
				limitations".
5.
Other
				limitations or conditions on eligibility for benefits.
Effective July 1,
				1990, a long-term care insurance policy or certificate containing any
				limitations or conditions for eligibility other than those prohibited in
				subsection 2 of North Dakota Century Code section 26.1-45-07 must set forth a
				description of such limitations or conditions, including any required number of
				days of confinement, in a separate paragraph of the policy or certificate and
				must label such paragraph "limitations or conditions on eligibility for
				benefits".
6.
Disclosure of
				tax consequences.
With regard to life insurance policies that provide an
				accelerated benefit for long-term care, a disclosure statement is required at
				the time of application for the policy or rider and at the time the accelerated
				benefit payment request is submitted that receipt of these accelerated benefits
				may be taxable, and that assistance should be sought from a personal tax
				adviser. The disclosure statement must be prominently displayed on the first
				page of the policy or rider and any other related documents.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
					 26.1-45