Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 5 - Minimum Standards; Contract Guidelines › Part 5 - LONG-TERM CARE INSURANCE › Section 365:10-5-44 - Required disclosure provisions

Current through Vol. 41, No. 20,
				  July 1, 2024
(a)
Renewability.
Individual long-term care insurance policies shall
				  contain a renewability provision. Such provision shall be appropriately
				  captioned, shall appear on the first page of the policy, and shall 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.
				  This provision shall not apply to policies which do not contain a renewability
				  provision, and under which the right to non-renew is reserved solely to the
				  policyholder.
(b)
Premium
				  rate change.
A long-term care insurance policy or certificate, other
				  than one where the insurer does not have the right to change the premium, shall
				  include a statement that premium rates may change. Such provision shall be
				  appropriately captioned, and shall appear on the first page of the
				  policy.
(c)
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 shall 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 shall be set forth in the policy, rider or endorsement.
(d)
Payment of benefits.
A
				  long-term 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 shall include definitions of such terms and an
				  explanation of such terms in its accompanying outline of coverage.
(e)
Limitations.
If a long-term
				  care insurance policy or certificate contains any limitations with respect to
				  pre-existing conditions, such limitations shall appear as a separate paragraph
				  of the policy or certificate and shall be labeled as "Pre-existing Condition
				  Limitations."
(f)
Other
				  limitations or conditions on eligibility for benefits.
A long-term care
				  insurance policy or certificate containing any limitations or conditions for
				  eligibility other than those listed in paragraphs (1) and (2) of this
				  subsection shall 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 shall label such paragraph "Limitations or
				  Conditions on Eligibility for Benefits."
(1) A
				  long-term care insurance policy containing post-confinement, post-acute care or
				  recuperative benefits shall clearly label in a separate paragraph of the policy
				  or certificate entitled "Limitations or Conditions on Eligibility for Benefits"
				  such limitations or conditions, including any required number of days of
				  confinement.
(2) A long-term care
				  insurance policy or rider which conditions eligibility of non-institutional
				  benefits on the prior receipt of institutional care shall not require a prior
				  institutional stay of more than thirty (30) days.