reglab/statecodes huggingface dataset:
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0522 - ACCIDENT AND HEALTH ADVERTISING: PRE-EXISTING CONDITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
An advertisement which is subject to the requirements of
				  11 NCAC
				  12 .0521 shall, in negative terms, disclose
				  the extent to which any loss is not covered if the cause of such loss is
				  traceable to a condition existing prior to the effective date of the policy.
				  The use of the term "pre-existing condition" without an appropriate definition
				  or description shall not be used.
When a policy does not cover losses resulting from
				  pre-existing conditions, no advertisement of the policy shall 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, shall disclose that a medical examination is
				  required.
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 shall contain a question or statement which
				  reflects the pre-existing condition provision of the policy immediately
				  preceding the blank space for the applicant's signature. For example, such an
				  application form shall contain a question or statement 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 substantially the following statement:
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.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0523 - ADVERTISING: RENEWABILITY AND TERMINATION

Current through Register Vol. 39, No. 2, July 15, 2024
When an advertisement which is an invitation to contract
				  refers to either a dollar amount or a period of time for which any benefit is
				  payable, or the cost of the policy, or the loss for which such benefit is
				  payable, it shall disclose the provisions relating to renewability,
				  cancellability and termination and any modification of benefits, losses covered
				  or premiums because of age or for other reasons, in a manner which shall not
				  minimize or render obscure the qualifying conditions.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0524 - ACCIDENT AND HEALTH ADVERTISING: TESTIMONIALS

Current through Register Vol. 39, No. 2, July 15, 2024
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 statements, is subject to all the provisions of these
				  Rules.
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 shall be
				  disclosed in the advertisement. If a person is compensated for making a
				  testimonial, endorsement or appraisal, such fact shall 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 TV or radio performances. The
				  payment of substantial amounts, directly or indirectly, for "travel and
				  entertainment" for filming or recording of TV or radio advertisements remove
				  the filming or recording from the category of an unsolicited testimonial and
				  require disclosure of such compensation. This Rule does not apply to an
				  institutional advertisement which has as its sole purpose the promotion of the
				  insurer.
An advertisement shall not state or imply that an insurer or
				  a policy has been approved or endorsed by any individual or 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 shall be disclosed
				  in the advertisement.
When a testimonial refers to benefits received under a
				  policy, the specific claim data, including claim number, date of loss, and
				  other pertinent information shall 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.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0525 - ACCIDENT AND HEALTH ADVERTISING: USE OF STATISTICS

Current through Register Vol. 39, No. 2, July 15, 2024
An advertisement relating to the dollar amounts of claims
				  paid, the number of persons insured, or similar statistical information
				  relating to any insurer or policy shall not use irrelevant facts, and shall not
				  be used unless it accurately reflects all of the relevant facts. Such an
				  advertisement shall not imply that such statistics are derived from the policy
				  advertised unless such is the fact, and when applicable to other policies or
				  plans shall specifically so state.
An advertisement shall not represent or imply that claim
				  settlements by the insurer are "liberal" or "generous," or use words of similar
				  import, or that claim settlements are or will be beyond the actual terms of the
				  contract. An unusual amount paid for a unique claim for the policy advertised
				  is misleading and shall not be used.
The source of any statistics used in an advertisement shall
				  be identified in such advertisement.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0526 - ACCIDENT AND HEALTH ADVERTISING OF PLAN OR POLICIES

Current through Register Vol. 39, No. 2, July 15, 2024
When a choice of the amount of benefits is referred to, an
				  advertisement which is an invitation to contract shall disclose that the amount
				  of benefits provided depends upon the plan selected and that the premium will
				  vary with the amount of the benefits selected.
When an advertisement refers to various benefits which may be
				  contained in two or more policies, other than group master policies, the
				  advertisement shall disclose that such benefits are provided only through a
				  combination of such policies.
Authority
				  G.S.
				  58-2-40;
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Amended Eff. February 1, 1992;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0527 - REPEALED - ACCIDENT AND HEALTH ADVERTISING: COMPARISONS: STATEMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-9(1);
				  58-54.4;
Eff. February
				  1, 1976;
Readopted Eff. September 26, 1978;
Repealed
				  Eff. February 1, 1992.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0528 - ACCIDENT AND HEALTH ADVERTISING: LICENSING AND STATUS

Current through Register Vol. 39, No. 2, July 15, 2024
An advertisement which is intended to be seen or heard beyond
				  the limits of the jurisdiction in which the insurer is licensed shall not imply
				  licensing beyond those limits.
An advertisement shall 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.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0529 - ACCIDENT AND HEALTH ADVERTISING: IDENTITY OF INSURER

Current through Register Vol. 39, No. 2, July 15, 2024
The name of the actual insurer shall be stated in all of its
				  advertisements and the form number of the policy advertised shall be stated in
				  an advertisement which is an invitation to contract. An advertisement shall 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, service mark,
				  slogan, symbol or other device which without disclosing the name of the actual
				  insurer would have the capacity and tendency to mislead or deceive as to the
				  true identity of the insurer.
No advertisement shall use any combination of words, symbols,
				  or physical materials which by their content, phraseology, shape, color or
				  other characteristics are so similar to combinations 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.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0530 - ACCIDENT AND HEALTH ADVERTISING: GROUP IMPLICATIONS

Current through Register Vol. 39, No. 2, July 15, 2024
An advertisement of a particular policy shall not state or
				  imply that prospective insureds become group or quasi-group members covered
				  under a group policy and as such enjoy special rates or underwriting
				  privileges, unless such is the fact.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0532 - ACCIDENT: HEALTH ADVERTISING: STATEMENT ABOUT AN INSURER

Current through Register Vol. 39, No. 2, July 15, 2024
An advertisement shall not contain statements which are
				  untrue in fact, or by implication misleading, with respect to the assets,
				  corporate structure, financial standing, age or relative position of the
				  insurer in the insurance business. An advertisement shall not contain a
				  recommendation by a commercial rating system unless it clearly indicates the
				  purpose of the recommendation and the limitations of the scope and extent of
				  the recommendation.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0533 - ACCIDENT AND HEALTH ADVERTISING: ADVERTISING FILE

Current through Register Vol. 39, No. 2, July 15, 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 other
				  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 shall be subject to regular and periodical inspection by
				  this department. All such advertisements shall 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.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0534 - ACCIDENT AND HEALTH ADVERTISING: CERTIFICATE OF COMPLIANCE

Current through Register Vol. 39, No. 2, July 15, 2024
Each insurer required to file an annual statement which is
				  now or which hereafter becomes subject to the provisions of these rules must
				  file with this department, with its annual statement, a certificate of
				  compliance executed by an authorized officer of the insurer wherein it is
				  stated that, to the best of his knowledge, information and belief, the
				  advertisements which were disseminated by the insurer during the preceding
				  statement year complied or were made to comply in all respects with the
				  provisions of these Rules and insurance laws of this state as implemented and
				  interpreted by these Rules.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0535 - ACCIDENT AND HEALTH ADVERTISING: ADVERTISING EXPENSE

Current through Register Vol. 39, No. 2, July 15, 2024
Total advertising expense incurred by the insurer or by an
				  affiliated corporation on behalf of the insurer for the purposes of
				  solicitation and conservation of accident and health insurance business shall
				  be included as line items in the expense exhibits of all statutory financial
				  statements filed by a licensed insurer with the Department.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0536 - ACCIDENT AND HEALTH ADVERTISING: PRIOR REVIEW OR APPROVAL

Current through Register Vol. 39, No. 2, July 15, 2024
The commissioner may, when in his discretion he deems it in
				  the public interest, require the filing of all or any part of the advertising
				  material of an insurer with this department for review prior to its use. All
				  advertising material subject to review prior to its use shall be filed with
				  this department 30 days prior to its intended use. In instances where charges
				  are pending against an insurer, the commissioner may, during the period such
				  charges are pending but not to exceed 30 days unless extended by consent order,
				  by order require all or any part of the advertising material be filed for
				  review prior to its use or for prior approval. The commissioner may within his
				  discretion refuse to approve all or any part of the advertising material so
				  filed. All advertising material subject to prior approval shall be filed with
				  this department 60 days prior to its intended use. When it has been determined
				  by the commissioner after notice and hearing that an insurer has violated any
				  of the insurance laws of this state or Rules of the commissioner, the
				  commissioner may in his discretion, by order require that all or any part of
				  the advertising material be filed with this department for review prior to its
				  use or for prior approval. The commissioner may within his discretion refuse to
				  approve all or any part of the advertising material so filed. In any case where
				  review prior to its use or prior approval is required, a shorter period of time
				  may be allowed by the commissioner.
Authority
				  G.S.
				  58-2-40(1);
				  58-63-15;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0537 - REPEALED - PRE-EXISTING CONDITIONS: INSURED'S AGE OVER 65

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-251.1;
				  58-252;
Eff. February
				  1, 1976;
Readopted Eff. September 26, 1978;
Repealed
				  Eff. February 1, 1992.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0538 - ACCIDENT: HEALTH PROMOTIONAL MATERIAL: STICKERS REQUIRED

Current through Register Vol. 39, No. 2, July 15, 2024
For all accident and health insurance promotional material of
				  all kinds for presentation in person, by mail or otherwise by an insurer, or
				  its representative to the insurance buying public, including but not limited to
				  circulars, leaflets and booklets, the same procedure as outlined in
				  11 NCAC
				  12 .0543 and
				  12 .0544 shall be used and similar
				  wording such as that required by these rules and be placed in a prominent place
				  on all of such material.
Authority
				  G.S.
				  58-2-40;
				  58-63-15;
				  58-65-1;
				  58-65-40;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0539 - NOTICE FOR REVISION OF RATES FOR NON-PROFIT SERVICE CORP

Current through Register Vol. 39, No. 2, July 15, 2024
Notice of a public hearing on the revision of an existing
				  schedule of rates or establishment of a new schedule of rates for a non-profit
				  hospital, medical or dental service corporation shall be published once a week
				  for two consecutive weeks, with the last publication date not more than 10 days
				  before the date of the hearing, in the major morning newspapers in the Cities
				  of Wilmington, Raleigh, Greensboro, Charlotte and Asheville, North Carolina and
				  the cities wherein the principal office of the corporation is located, if other
				  than the aforementioned.
The notice shall be in the form designated as
				  11 NCAC
				  12 .0204.
Authority
				  G.S.
				  58-2-40;
				  58-65-45;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0540 - BLANKET AND FRANCHISE POLICIES

Current through Register Vol. 39, No. 2, July 15, 2024
A group disability policy as interpreted under
				  G.S.
				  58-14-5(4) does not include
				  blanket and franchise policies.
Authority
				  G.S.
				  58-2-40;
				  58-14-5(4);
Eff. February 1, 1976;
Readopted Eff. September 26,
				  1978;
Amended Eff. April 8, 2002;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0541 - NOTICE OF CLAIM: CREDIT INSURANCE

Current through Register Vol. 39, No. 2, July 15, 2024
The claimant shall have a minimum of 30 days to give written
				  notice of claim.
Authority
				  G.S.
				  58-2-40;
				  58-57-25;
Eff.
				  February 1, 1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0542 - ACCIDENT AND HEALTH APPLICATION: GUARANTEED ISSUE

Current through Register Vol. 39, No. 2, July 15, 2024
When an accident and health policy is sold on a guaranteed
				  issue basis, the application for such insurance used in the solicitation may
				  not contain health questions on the application.
Authority
				  G.S.
				  58-2-40;
Eff. February 1,
				  1976;
Readopted Eff. September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0543 - POLICIES CONTAINING A PRE-EXISTING CONDITION EXCLUSION

Current through Register Vol. 39, No. 2, July 15, 2024
All individual or franchise insurance policy forms and group
				  certificates containing an exclusion for pre-existing conditions, or other
				  language substantially similar to that set forth in form
				  11 NCAC
				  12 .0201, shall display a sticker or printed
				  notice on the face of the policy and the outline of coverage. Such sticker
				  shall be in red bold face type the size of which shall not be less than 14
				  point. The use of a rubber stamp will not satisfy this requirement.
Laser printed policies may be excused from this red print
				  requirement provided the notice is in bold face print. Companies must certify
				  that policy forms are produced by laser print in order to exercise this
				  excuse.
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-65-1;
				  58-65-40;
Eff.
				  September 26, 1978;
Amended Eff. April 1, 1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0544 - POLICIES RENEWABLE AT THE OPTION OF THE COMPANY

Current through Register Vol. 39, No. 2, July 15, 2024
All individual or franchise insurance policy forms and group
				  certificates that are renewable at the option of the company or other language
				  substantially similar to that set forth in form
				  11 NCAC
				  12 .0201 shall display a sticker or printed
				  notice on the face of the policy and the outline of coverage. Such sticker or
				  notice shall be in red bold face type the size of which shall not be less than
				  14 point. The use of a rubber stamp will not satisfy this requirement.
Laser printed policies may be excused from this red print
				  requirement provided the notice is in bold face print. Companies must certify
				  that policy forms are produced by laser print in order to exercise this
				  excuse.
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-65-1;
				  58-65-40;
Eff.
				  September 26, 1978;
Amended Eff. April 1, 1989;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0545 - REPEALED - OFFSET OF INCREASED SOCIAL SECURITY: GROUP DISABILITY

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-65-1;
				  58-65-40;
Eff.
				  September 26, 1978;
Repealed Eff. July 1,
				  2012.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0546 - DIAGNOSIS OF CANCER

Current through Register Vol. 39, No. 2, July 15, 2024
No insurer shall exclude a clinical diagnosis of cancer if,
				  in the opinion of the attending physician, a positive diagnosis can not
				  otherwise be made without jeopardizing the life of the claimant. The insurer
				  may require that there be definitive treatment for cancer. The insurer may
				  require confirmation of the diagnosis, at the insurer's expense, by a physician
				  not associated with the attending physician.
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-51-95;
				  58-65-40;
Eff.
				  September 26, 1978;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0547 - REPEALED - WAITING PERIOD

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  57-1;
				  57-4;
				  58-249;
				  58-252;
Eff. September
				  26, 1978;
Repealed Eff. April 1,
				  1989.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0548 - INSURANCE FOR MEDICARE ELIGIBLE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Direct
				response insurers providing accident and health insurance to persons eligible
				for Medicare by reason of age shall:
(1)
				guarantee to the policyholder an unconditional 30 day right to return the
				policy for a full refund of premium; and
(2) alert prospective policyholders, in
				advertisements or direct mail solicitations, of their right to obtain a copy of
				the NAIC-HHS Guide to Health Insurance for People with Medicare prior to
				sale.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0549 - CONVERSION POLICIES: HOSPITAL ROOM RATES

Current through Register Vol. 39, No. 2, July 15, 2024
The dollar amount for the maximum hospital room and board
				  daily expense benefit for Plan A of conversion policies required by
				  G.S.
				  58-53-90 shall be one hundred seventy dollars
				  ($170.00).
Authority
				  G.S.
				  58-2-40;
				  58-53-90;
				  58-53-115;
Eff.
				  February 1, 1982;
Amended Eff. February 1, 1992;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0550 - ORTHODONTIC COVERAGE LIMITATIONS

Current through Register Vol. 39, No. 2, July 15, 2024
No insurer providing benefits for orthodontic services and
				  supplies shall condition receipt of those benefits upon a determination of the
				  class of malocclusion or any measurement of the position of the teeth or jaws,
				  but shall rely upon the opinion of an orthodontist who has examined the
				  patient.
Authority
				  G.S.
				  58-2-40;
				  58-3-120;
				  58-3-150;
				  58-51-1;
				  58-51-95;
				  58-63-15;
				  58-65-40;
				  58-67-50;
Eff. April
				  1, 1982;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0551 - CANCER INSURANCE REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Cancer policy requirements. Cancer policies approved in this
				  State shall comply with the following:
(1) The policy shall have a pre-existing
				conditions sticker that complies with
				11 NCAC
				12 .0543 and reads as follows: NO RECOVERY
				FOR PRE-EXISTING DIAGNOSED CANCER - READ CAREFULLY No benefits will be provided
				during the first 12 months of the policy for cancer diagnosed before the 30th
				day after the effective date shown in the policy schedule.
(2) In the definition of cancer, clinical
				diagnosis of cancer shall be accepted as evidence that cancer exists in an
				insured when a pathological diagnosis cannot be made, provided the medical
				evidence substantially documents the diagnosis of cancer and the insured
				received definitive treatment for cancer. If the requisite pathological
				clinical diagnosis can only be made postmortem, liability shall be assumed
				retroactively beginning with the date of the terminal admission to the hospital
				for not less than 45 days before the date of death.
(3) A cancer policy shall not have a waiting
				period any longer than 30 days after the effective date.
(4) Benefits shall be provided for unrelated
				cancers diagnosed after the effective date of the policy.
(5) Under the benefits provisions of the
				policy, provided the contract offers these benefits, the minimum standards are
				as follows:
(a) Benefits for blood and plasma
				shall cover actual charges incurred, including fees for administering the
				blood.
(b) The term "In-patient"
				shall precede the words "drugs" and "medicines" if the policy is an in-hospital
				indemnity contract or does not provide out-patient benefits.
(c) Ambulance benefits shall include
				transportation from one medical facility to another.
(d) First diagnosed or first occurrence
				cancer benefits shall be no less favorable than other generally offered cancer
				benefits and shall be offered in addition to core benefits.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0552 - REPEALED - TEMPOROMANDIBULAR JOINT DYSFUNCTION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-51-95;
				  58-65-85;
Eff. July 1,
				  1986;
Repealed Eff. February 1,
				  1996.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0553 - EXCESS INSURANCE: NON-DUPLICATION OF COVERAGE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) An
				accident and health policy with a nonduplication of coverage benefit may be
				permitted, if it contains the following sticker on the face in red:
EXCESS INSURANCE
This policy is not intended to be issued where other medical
				  insurance exists. If other medical insurance does exist at the time of the
				  claim, then the amounts of benefit payable by such other medical insurance will
				  become the deductible amount of this policy if such benefits exceed the
				  deductible amount shown in the Schedule of Benefits.
Such sticker shall be in red bold face type the size of which
				  shall not be less than 12 points. The use of a rubber stamp will not satisfy
				  this requirement. The use of laser print shall exempt the use of red
				  print.
(b) A
				non-duplication of coverage benefit in blanket insurance shall be permitted
				when premiums are non-contributory and 100 percent of the participants are
				covered.
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-65-1;
				  58-65-40;
Eff. July 1,
				  1986;
Amended Eff. February 1, 1992;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0554 - REPEALED - STOP-LOSS COVERAGE - REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-9;
				  58-249;
				  58-254.7;
Eff. April
				  1, 1989;
Repealed Eff. February 1,
				  1992.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0555 - LONG-TERM CARE POLICY REQUIREMENTS

Current through Register Vol. 39, No. 2, July 15, 2024
(a)
				Definitions:
(1) Long-Term Care Insurance is
				defined as any contract of insurance offering institutional or noninstitutional
				support in order to restore deteriorating health and to maintain functional
				independence. Such services for an acute or chronic physical or mental
				impairment, or short term illness or injury, include but are not limited to
				assistance with daily living, medical or rehabilitative care, and home health
				care.
(2) In regard to Skilled,
				Intermediate, Custodial, or Home Health Care, when the insured receives
				definitive treatment for these services regardless of the type of facility or
				setting the insured is confined in, benefits are payable for the service
				receive based on the benefits of the contract for that service.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0556 - HOME HEALTH CARE POLICY REQUIREMENT

Current through Register Vol. 39, No. 2, July 15, 2024
All Home Health Care Policies shall have the notice printed
				  in contrasting type or color on the face of the policy as follows: "This Is Not
				  A Long-Term Care Policy - This Policy Provides Home Health Care Benefits Only -
				  Read Carefully". Home health care policies must comply with
				  G.S.
				  58-51-60 and the following items:
(1) Prior hospitalization or skilled nursing
				home confinement shall not be required to satisfy eligibility for
				benefits.
(2) Benefits shall be
				provided without a physician certification that the insured or claimant would
				need medical care in a skilled nursing facility or hospital setting.
(3) Home health benefits shall not be limited
				to acute conditions.
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
				  58-51-95;
Eff. April
				  1, 1989;
Amended Eff. February 1, 1992;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0557 - POLICIES CONTAINING A TERMINATION OR CANCELLATION PROVISION

Current through Register Vol. 39, No. 2, July 15, 2024
(a) Any policy or certificate of insurance
				that may be terminated for reasons other than non-payment of premium or the
				insured's stated age must be affixed with a notice referring the insured to the
				renewal provision. Such notice must appear in 12 point bold red print and read
				as follows: Important Cancellation Information - Please Read The Provision
				Entitled, ".................", Found On Page "...".
(b) Laser printed policies are not subject to
				the red print requirement in Paragraph (a) of this Rule if the notice is in
				bold face print and if the insurer certifies that its policy forms are produced
				by laser print.
Authority
				  G.S.
				  58-2-40;
				  58-51-1;
Eff. April 1,
				  1989;
Amended Eff. February 1, 1992;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0558 - REPEALED - PREMIUM REVISION

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-9;
				  58-249;
				  58-254.7;
Eff. April
				  1, 1989;
Repealed Eff. February 1,
				  1992.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0559 - PRECERTIFICATION

Current through Register Vol. 39, No. 2, July 15, 2024
Policies requiring precertification must contain a disclosure
				  of penalties for benefits and services that are not
				  precertified.
Authority
				  G.S.
				  58-2-40;
				  58-50-60;
Eff.
				  February 1, 1992;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0560 - REPEALED - UNIFORM CLAIM FORMS

Current through Register Vol. 39, No. 2, July 15, 2024
Authority
				  G.S.
				  58-2-40;
				  58-3-171;
Filed as a
				  Temporary Adoption Eff. January 1, 1994 for a period of 180 days or until the
				  permanent rule becomes effective, whichever is sooner;
Eff. April
				  1, 1994;
Repealed Eff. July 1,
				  2012.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0561 - DEDUCTIBLES AND COPAYMENTS BASED ON REAL COST

Current through Register Vol. 39, No. 2, July 15, 2024
(a) As
				used in this Rule:
(1) "Health benefit plan"
				means any accident and health insurance policy or certificate; a nonprofit
				hospital or medical service corporation contract; a health maintenance
				organization subscriber contract; a plan provided by a multiple employer
				welfare arrangement; or a plan provided by another benefit
				arrangement.
(2) "Health care
				provider" includes any person who, under Chapter 90 of the General Statutes is
				licensed, registered, or certified to engage in the practice of or performs
				duties associated with any of the following: medicine, surgery, dentistry,
				pharmacy, optometry, midwifery, osteopathy, podiatry, chiropractic, radiology,
				nursing, physiotherapy, pathology, anesthesiology, anesthesia, laboratory
				analysis, rendering assistance to a physician, dental hygiene, psychiatry,
				psychology; or a hospital as defined by
				G.S.
				131E-76(3); or a nursing
				home as defined by
				G.S.
				131E-101(6).
(3) "Health insurer" means any health
				insurance company subject to Articles 1 through 63 of Chapter 58, including a
				multiple employer welfare arrangement; any preferred provider plan; and any
				corporation subject to Articles 65 and 67 of Chapter 58; that provides a health
				benefit plan.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0562 - UNEARNED PREMIUM

Current through Register Vol. 39, No. 2, July 15, 2024
As used in this Rule, "unearned premium" means that portion
				  of the premium representing the unexpired portion of the policy term. All
				  insurers of individual health or accident and health insurance shall in the
				  event of cancellation or the death of the insured return any portion of
				  unearned premium.
Authority
				  G.S.
				  58-2-40(1);
Eff.
				  February 1, 1996;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0500 - ACCIDENT AND HEALTH: GENERAL NATURE › Section 12 .0563 - WEIGHTED AVERAGE: MENTAL ILLNESS BENEFITS COVERAGE

Current through Register Vol. 39, No. 2, July 15, 2024
(a) The definitions contained in
				G.S.
				58-3-220(h) are incorporated
				into this rule by reference.
(b) To
				exercise the option under
				G.S.
				58-3-220(f), at the time of
				submission for approval of a group health benefit plan policy form,
				certificate, or rider containing mental illness benefits, the insurer shall
				include in the submission a certification of compliance with this rule signed
				by a qualified actuary, as defined in
				11 NCAC
				16 .0401(17). The
				certification of compliance shall include a statement that:
(1) No more than 70 percent of the entire
				plan's actuarial value is contained in the selected physical illness and injury
				benefits that are subject to any limit.
(2) The weighted average calculation was
				performed and calculated as prescribed in paragraph (c) of this rule.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0601 - PURPOSE AND SCOPE

Current through Register Vol. 39, No. 2, July 15, 2024
The purpose of the rules in this Section are:
(1) To regulate the activities of insurers
				and producers with respect to the replacement of existing life insurance and
				annuities.
(2) To protect the
				interests of life insurance and annuity purchasers by establishing minimum
				standards of conduct to be observed in replacement or financed purchase
				transactions that will:
(a) assure that
				purchasers receive information with which a decision can be made in their own
				best interest;
(b) reduce the
				opportunity for misrepresentation and incomplete disclosures; and
(c) establish penalties for failure to comply
				with requirements of the rules in this section.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0602 - DEFINITION OF REPLACEMENT

Current through Register Vol. 39, No. 2, July 15, 2024
When used in the rules in this Section, "replacement" means a
				  transaction in which a new policy or contract is to be purchased, and it is
				  known or should be known to the proposing producer, or to the proposing insurer
				  if there is no producer, that by reason of the transaction, an existing policy
				  or contract has been or is to be:
(1)
				lapsed, forfeited, surrendered, or partially surrendered, assigned to the
				replacing insurer or otherwise terminated;
(2) converted to reduced paid-up insurance,
				continued as extended term insurance, or otherwise reduced in value by the use
				of nonforfeiture benefits or other policy values;
(3) amended so as to effect either a
				reduction in benefits or in the term for which coverage would otherwise remain
				in force or for which benefits would be paid;
(4) reissued with any reduction in cash
				value; or
(5) used in a financed
				purchase.
Authority
				  G.S.
				  58-2-40;
				  58-3-115;
				  58-58-1;
				  58-58-40;
Eff. October
				  1, 1985;
Amended Eff. August 1, 2004;
Pursuant to
				  G.S.
				  150B-21.3A, rule is necessary without
				  substantive public interest Eff. May 1, 2018.
North Carolina Administrative Code › Title 11 - INSURANCE › Chapter 12 - LIFE AND HEALTH DIVISION › Section .0600 - REPLACEMENT REGULATIONS › Section 12 .0603 - OTHER DEFINITIONS

Current through Register Vol. 39, No. 2, July 15, 2024
When used in the rules in this Section:
(1) "Direct-response solicitation" means a
				solicitation through a sponsoring or endorsing entity, or individually, solely
				through mails, telephone, the Internet or other mass communication
				media.
(2) "Existing insurer" means
				the insurance company whose policy or contract is or will be changed or
				affected in a manner described within the definition of "replacement" in
				11 NCAC
				12 .0602.
(3) "Existing policy or contract" means an
				individual life insurance policy (policy) or annuity contract (contract) in
				force, including a policy under a binding or conditional receipt or a policy or
				contract that is within an unconditional refund period.
(4) "Financed purchase" means the purchase of
				a new policy involving the actual or intended use of funds obtained by the
				withdrawal or surrender of, or by borrowing from values of an existing policy
				to pay all or part of any premium due on the new policy. For purposes of a
				regulatory review of an individual transaction only, if a withdrawal, surrender
				or borrowing involving the policy values of an existing policy is used to pay
				premiums on a new policy owned by the same policyholder and issued by the same
				company within four months before or 13 months after the effective date of the
				new policy, it shall be deemed prima facie evidence of the policyholder's
				intent to finance the purchase of the new policy with existing policy values.
				This prima facie standard is not intended to increase or decrease the
				monitoring obligations contained in
				11 NCAC
				12 .0607(1)(e).
(5) "Illustration" means a presentation or
				depiction that includes non-guaranteed elements of a policy of life insurance
				over a period of years as defined in
				11 NCAC
				04 .0501(b)(8).
(6) "Policy summary" means:
(a) For policies or contracts other than
				universal life policies, a written statement regarding a policy or contract
				which contains, to the extent applicable, the following information:
(i) current death benefit;
(ii) annual contract premium;
(iii) current cash surrender value;
(iv) current dividend;
(v) application of current dividend;
				and
(vi) amount of outstanding
				loan.