Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-7 - Required Disclosure Provisions

Current through July 13, 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.
(b) 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.
(c) 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 shall include a definition of such
				terms and an explanation of such terms in its accompanying outline of
				coverage.
(d) Limitations. If a
				long-term care insurance policy or certificate contains any limitations with
				respect to preexisting conditions, such limitations shall appear as a separate
				paragraph of the policy or certificate and shall be labeled as "Preexisting
				Condition Limitations."
(e) Other
				limitations or conditions on eligibility for benefits. A long-term care
				insurance policy or certificate containing any limitations or conditions for
				eligibility 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."
(f) 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 advisor. The disclosure
				statement shall be prominently displayed on the first page of the policy rider
				and any other related documents. This subsection shall not apply to qualified
				long-term care insurance contracts.
(g) Benefit Triggers. Activities of daily
				living and cognitive impairment shall be used to measure an insured's need for
				long-term care and shall be described in the policy or certificate in a
				separate paragraph and shall be labeled "Eligibility for the Payment of
				Benefits." Any additional benefit triggers shall also be explained in this
				section. If these triggers differ for different benefits, explanation of the
				trigger shall accompany each benefit description. If an attending physician or
				other specified person must certify a certain level of functional dependency in
				order to be eligible for benefits, this, too, shall be specified.
(h) A qualified long-term care insurance
				contract shall include a disclosure statement in the policy and in the outline
				of coverage as contained in section 19(e) that the policy is intended to be a
				qualified long-term care insurance contract under Section 7702 B(b) of the
				Internal Revenue Code of 1986, as amended.
(i) A nonqualified long-term care insurance
				contract shall include a disclosure statement in the policy and in the outline
				of coverage as contained in section 19(e) that the policy is not intended to be
				a qualified long-term care insurance contract.