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
20:06:21:01.06 Claim and clean claim -- Defined.
20:06:21:02 Minimum standards for long-term care
20:06:21:02.01 Annuity policies with long-term care benefits
subject to waiting period.
20:06:21:03 Renewability of group policies --
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
20:06:21:06.02 Group cost-of-living adjustments --
20:06:21:06.03 Cost-of-living adjustments -- Continuation of
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
20:06:21:07 Applicability of rules to long-term care
20:06:21:08 "Medically necessary" defined.
20:06:21:09 Basis for conversion of coverage from
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
20:06:21:14 Converted policy from group to
individual -- Reduction of benefits -- Exception.
20:06:21:15 Converted policy from group -- Benefits
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
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
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
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 --
20:06:21:31 Standards for marketing -- Requirements.
20:06:21:32 Standards for marketing -- Prohibited
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
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
20:06:21:41 Applications -- Notice about incorrect
20:06:21:42 Policies -- Notice about incorrect
answers on applications.
20:06:21:43 Elderly applicants -- Required
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
20:06:21:51 Assisted living centers -- Minimum
20:06:21:52 Reporting requirements for insurers.
20:06:21:53 Appropriateness of recommended purchase
20:06:21:53.01 Suitability standards.
20:06:21:53.02 Suitability -- Long-term care insurance
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
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
20:06:21:65 Premium rate schedule increases --
Review by the director
20:06:21:66 Premium rate schedule increases --
20:06:21:67 Premium rate schedule increases --
Policies to which does not apply.
20:06:21:68 Premium rate schedule increases -- Group
20:06:21:69 Premium rate schedule increases --
Adoption of rules.
20:06:21:70 Premium rate schedule increases --
20:06:21:71 Permitted compensation arrangements.
20:06:21:72 Disclosure to applicant for a claim
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 --
20:06:21:79 Long-term care -- Minimum benefit
20:06:21:80 Long-term care partnership policies --
20:06:21:81 Long-term care policies -- Policy
20:06:21:82 Availability of new services or
20:06:21:83 Policies issued considered exchanges.
offered through employers, labor unions, and associations.
20:06:21:85 Applicability of new provider or service
20:06:21:86 Right to reduce coverage and lower
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
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
20:06:21:96 Review of information.
20:06:21:97 Additional information to independent
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.