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 45-06-05-10 - Standard format outline of coverage

Current through Supplement No. 393, July, 2024
This section implements, interprets, and makes specific the
				  provisions of subsection 2 of North Dakota Century Code section 26.1-45-09 in
				  prescribing a standard format and the content of an outline of coverage.
1. The outline of coverage must be a
				freestanding document, using no smaller than ten point type.
2. The outline of coverage must contain no
				material of an advertising nature.
3. Text which is capitalized or underscored
				in the standard format outline of coverage may be emphasized by other means
				which provide prominence equivalent to such capitalization or underscoring.
4. Use of the text and sequence of
				text of the standard format outline of coverage is mandatory, unless otherwise
				specifically indicated.
5. Format
				for outline of coverage:
[COMPANY NAME]
[ADDRESS - CITY AND STATE]
[TELEPHONE NUMBER]
LONG-TERM CARE INSURANCE
OUTLINE OF COVERAGE
[Policy number or group master policy and certificate
				  number]
[Except for policies or certificates which are guaranteed
				  issue, the following caution statement, or language substantially similar, must
				  appear as follows in the outline of coverage.]
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, the
				  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]
1. This policy is [an
				individual policy of insurance] ([a group policy] which was issued in the
				[indicate jurisdiction in which group policy was issued]).
2. PURPOSE OF OUTLINE OF COVERAGE. This
				outline of coverage provides a very brief description of the important features
				of the policy. You should compare this outline of coverage to outlines of
				coverage for other policies available to you. This is not an insurance
				contract, but only a summary of coverage. Only the individual or group policy
				contains governing contractual provisions. This means that the policy or group
				policy sets forth in detail the rights and obligations of both you and the
				insurance company. Therefore, if you purchase this coverage, or any other
				coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE) CAREFULLY!
3. TERMS UNDER WHICH THE POLICY OR
				CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED.
a. [Provide a brief description of the right
				to return - "free look" provision of the policy.]
b. [Include a statement that the policy
				either does or does not contain provisions providing for a refund or partial
				refund of premium upon the death of an insured or surrender of the policy or
				certificate. If the policy contains such provisions, include a description of
				them.]