LONG-TERM CARE INSURANCE
20:06:21:01.01 Nature of care -- How defined.
20:06:21:01.02 Service providers -- How defined.
20:06:21:01.03 Long-term care insurance.
20:06:21:01.04 Similar policy forms.
20:06:21:01.05 Treatment of accelerated benefits in life insurance.
20:06:21:01.06 Claim and clean claim -- Defined.
20:06:21:02 Minimum standards for long-term care insurance policies.
20:06:21:02.01 Annuity policies with long-term care benefits subject to waiting period.
20:06:21:03 Renewability of group policies -- Required disclosures.
20:06:21:04 Permissible exclusions from coverage.
20:06:21:05 Loss ratios.
20:06:21:05.01 Relation of benefits to premium for accelerated death benefit on life insurance.
20:06:21:06 Cost-of-living adjustments -- Basis.
20:06:21:06.01 Cost-of-living adjustments -- Minimum standards.
20:06:21:06.02 Group cost-of-living adjustments -- Exceptions.
20:06:21:06.03 Cost-of-living adjustments -- Continuation of benefit increases.
20:06:21:06.04 Cost-of-living adjustments -- Automatic increases -- Conspicuous offer of constant premium.
20:06:21:06.05 Cost-of-living adjustments -- Rejection by policyholder.
20:06:21:07 Applicability of rules to long-term care insurance riders.
20:06:21:08 "Medically necessary" defined.
20:06:21:09 Basis for conversion of coverage from group defined.
20:06:21:10 Converted policy from group defined.
20:06:21:11 Converted policy from group -- Time allowed for written application.
20:06:21:12 Converted policy from group -- Calculation of policy premium.
20:06:21:13 Continuation or conversion is mandatory -- Exceptions.
20:06:21:14 Converted policy from group to individual -- Reduction of benefits -- Exception.
20:06:21:15 Converted policy from group -- Benefits payable.
20:06:21:16 Converted policy from group -- Eligibility for coverage of relatives.
20:06:21:17 Converted policy from group -- Managed care plan defined.
20:06:21:18 Discontinuance and replacement of a group policy.
20:06:21:19 Premium increase prohibitions.
20:06:21:20 Lapse or termination notice required.
20:06:21:21 Lapse or termination for payment through payroll or pension deduction plan.
20:06:21:22 Lapse or termination for nonpayment of premium.
20:06:21:23 Disclosure of renewability.
20:06:21:24 Disclosure of payment of benefits based on certain standards.
20:06:21:25 Disclosure of limitations on preexisting conditions.
20:06:21:26 Disclosure of other limitations or conditions on eligibility for benefits.
20:06:21:26.01 Notice to claimants -- Temporary leave.
20:06:21:27 Outline of coverage.
20:06:21:28 Outline of coverage -- Standard format.
20:06:21:28.01 Applications -- Questions about replacement.
20:06:21:29 Replacement notices.
20:06:21:30 Filing requirements for advertising -- Exemption.
20:06:21:31 Standards for marketing -- Requirements.
20:06:21:32 Standards for marketing -- Prohibited practices.
20:06:21:33 Standards for marketing -- Associations.
20:06:21:34 Extension of benefits.
20:06:21:35 Basis for continuation or conversion from group coverage required.
20:06:21:36 Basis for continuation of coverage from group defined.
20:06:21:38 Disclosure of riders and endorsements.
20:06:21:39 Disclosure of tax consequences.
20:06:21:40 Applications -- Health and medication questions.
20:06:21:41 Applications -- Notice about incorrect answers.
20:06:21:42 Policies -- Notice about incorrect answers on applications.
20:06:21:43 Elderly applicants -- Required information.
20:06:21:44 Applications -- Delivery.
20:06:21:45 Records of rescissions -- Maintaining and filing records.
20:06:21:46 Minimum standards for home health and community care benefits.
20:06:21:47 Policy summary for individual life insurance policy containing long-term care benefits.
20:06:21:48 Monthly report to policyholder.
20:06:21:49 Incontestability period.
20:06:21:50 Assisted living center or facility defined.
20:06:21:51 Assisted living centers -- Minimum benefit standards.
20:06:21:52 Reporting requirements for insurers.
20:06:21:53 Appropriateness of recommended purchase or replacement.
20:06:21:53.01 Suitability standards.
20:06:21:53.02 Suitability -- Long-term care insurance personal worksheet.
20:06:21:53.03 Suitability -- Response letter.
20:06:21:53.04 Suitability -- Policies not included.
20:06:21:53.05 Suitability -- Overinsurance.
20:06:21:54 Requirement to deliver shopper's guide.
20:06:21:55 Standards for benefit triggers.
20:06:21:56 Additional standards for benefit triggers for qualified long-term care insurance contracts.
20:06:21:57 Nonforfeiture benefits.
20:06:21:58 Nonforfeiture benefit requirement.
20:06:21:59 Electronic enrollment for group policies.
20:06:21:60 Required disclosure of rating practices to consumers -- Rate stabilization.
20:06:21:61 Initial filing requirements.
20:06:21:62 Reserve standards.
20:06:21:63 Premium rate schedule increases -- Notice of pending increase.
20:06:21:64 Premium rate schedule increase requirements.
20:06:21:65 Premium rate schedule increases -- Review by the director
20:06:21:66 Premium rate schedule increases -- Adverse lapsation.
20:06:21:67 Premium rate schedule increases -- Policies to which does not apply.
20:06:21:68 Premium rate schedule increases -- Group insurance policies.
20:06:21:69 Premium rate schedule increases -- Adoption of rules.
20:06:21:70 Premium rate schedule increases -- Exceptional increases.
20:06:21:71 Permitted compensation arrangements.
20:06:21:72 Disclosure to applicant for a claim denial.
20:06:21:73 Providers in a different state.
20:06:21:74 Agent training required to market long-term care plans.
20:06:21:75 Insurers required to verify agent training and maintain records.
20:06:21:76 Long-term care partnership policies -- Inflation protection requirements.
20:06:21:77 Long-term care partnership policies -- Required policy disclosures.
20:06:21:78 Long-term care partnership policies -- Filing requirements.
20:06:21:79 Long-term care -- Minimum benefit requirements.
20:06:21:80 Long-term care partnership policies -- Policy amendments.
20:06:21:81 Long-term care policies -- Policy amendments.
20:06:21:82 Availability of new services or providers.
20:06:21:83 Policies issued considered exchanges.
20:06:21:84 Policies offered through employers, labor unions, and associations.
20:06:21:85 Applicability of new provider or service requirements.
20:06:21:86 Right to reduce coverage and lower premiums.
20:06:21:87 Authorized representative.
20:06:21:88 Notice to insured.
20:06:21:89 Internal appeal.
20:06:21:90 Internal appeal notice requirements.
20:06:21:91 Independent review of benefit trigger determination.
20:06:21:92 Independent review process.
20:06:21:93 Additional appeal information.
20:06:21:94 Independent review notification.
20:06:21:95 Independent review organization selection.
20:06:21:96 Review of information.
20:06:21:97 Additional information to independent review.
20:06:21:98 Process if determination overturned.
20:06:21:99 Review decision requirements.
20:06:21:100 Acceptance of state certification.
20:06:21:101 Certification of long-term care insurance independent review organizations.
20:06:21:102 Maintenance of records and reporting obligations by independent review organizations.
20:06:21:103 Additional rights.
20:06:21:105 Payment of clean claim.
20:06:21:106 Claim timeframes.
20:06:21:107 Unpaid claims.
Appendix A Outline of Coverage.
Appendix B Replacement of Individual Accident and Sickness or Long-Term Care Coverage.
Appendix C Replacement of Accident and Sickness or Long-Term Care Coverage.
Appendix D Rescission Reporting Form.
Appendix E Personal Worksheet.
Appendix F Disclosure Form.
Appendix G Response Letter.
Appendix H Sample Claims Denial Format.
Appendix I Potential Rate Increase Disclosure Form.
Appendix J Replacement and Lapse Reporting Form.
Appendix K Partnership Disclosure Form.
Appendix L Partnership Certification Form.
Appendix M Guidelines for Long-Term Care Independent Review Entities.