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 45-06-05.1-27 - 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 shall be a
				freestanding document, using no smaller than ten-point type.
2. The outline of coverage shall contain no
				material of an advertising nature.
3. Text that is capitalized or underscored in
				the standard format outline of coverage may be emphasized by other means that
				provide prominence equivalent to the 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. FEDERAL TAX CONSEQUENCES.
This [POLICY] [CERTIFICATE] is intended to be a federally
				  tax-qualified, long-term care insurance contract under Section 7702B(b) of the
				  Internal Revenue Code of 1986, as amended.
OR
Federal Tax Implications of this [POLICY] [CERTIFICATE].
				  This [POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified,
				  long-term care insurance contract under Section 7702B(b) of the Internal
				  Revenue Code of 1986, as amended. Benefits received under the [POLICY]
				  [CERTIFICATE] may be taxable as income.
4. Terms Under Which the Policy OR
				Certificate May Be Continued in Force or Discontinued.
a. [For long-term care health insurance
				policies or certificates describe one of the following permissible policy
				renewability provisions:
(1) Policies and
				certificates that are guaranteed renewable shall contain the following
				statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS GUARANTEED RENEWABLE.
				This means you have the right, subject to the terms of your policy
				[certificate], to continue this policy as long as you pay your premiums on
				time. [Company Name] cannot change any of the terms of your policy on its own,
				except that, in the future, IT MAY INCREASE THE PREMIUM YOU PAY.
(2) [Policies and certificates that are
				noncancelable shall contain the following statement:] RENEWABILITY: THIS POLICY
				[CERTIFICATE] IS NONCANCELABLE. This means that you have the right, subject to
				the terms of your policy, to continue this policy as long as you pay your
				premiums on time. [Company Name] cannot change any of the terms of your policy
				on its own and cannot change the premium you currently pay. However, if your
				policy contains an inflation protection feature where you choose to increase
				your benefits, [Company Name] may increase your premium at that time for those
				additional benefits.