model regulation

(5) (A) For purposes of clause (iii)(III), the model regulations and the requirements of the model Act specified in this paragraph are: (i) In the case of the model regulation, the following requirements: (I) Section 6A (relating to guaranteed renewal or noncancellability), other than paragraph (5) thereof, and the requirements of section 6B of the model Act relating to such section 6A. (II) Section 6B (relating to prohibitions on limitations and exclusions) other than paragraph (7) thereof. (III) Section 6C (relating to extension of benefits). (IV) Section 6D (relating to continuation or conversion of coverage). (V) Section 6E (relating to discontinuance and replacement of policies). (VI) Section 7 (relating to unintentional lapse). (VII) Section 8 (relating to disclosure), other than sections 8F , 8G , 8H , and 8I thereof. (VIII) Section 9 (relating to required disclosure of rating practices to consumer). (IX) Section 11 (relating to prohibitions against post-claims underwriting). (X) Section 12 (relating to minimum standards). (XI) Section 14 (relating to application forms and replacement coverage). (XII) Section 15 (relating to reporting requirements). (XIII) Section 22 (relating to filing requirements for marketing). (XIV) Section 23 (relating to standards for marketing), including inaccurate completion of medical histories, other than paragraphs (1), (6), and (9) of section 23C. (XV) Section 24 (relating to suitability). (XVI) Section 25 (relating to prohibition against preexisting conditions and probationary periods in replacement policies or certificates). (XVII) The provisions of section 26 relating to contingent nonforfeiture benefits, if the policyholder declines the offer of a nonforfeiture provision described in paragraph (4). (XVIII) Section 29 (relating to standard format outline of coverage). (XIX) Section 30 (relating to requirement to deliver shopper’s guide). (ii) In the case of the model Act, the following: (I) Section 6C (relating to preexisting conditions). (II) Section 6D (relating to prior hospitalization). (III) The provisions of section 8 relating to contingent nonforfeiture benefits. (IV) Section 6F (relating to right to return). (V) Section 6G (relating to outline of coverage). (VI) Section 6H (relating to requirements for certificates under group plans). (VII) Section 6J (relating to policy summary). (VIII) Section 6K (relating to monthly reports on accelerated death benefits). (IX) Section 7 (relating to incontestability period). (B) For purposes of this paragraph and paragraph (1)(C)— (i) the terms “model regulation” and “model Act” mean the long-term care insurance model regulation, and the long-term care insurance model Act, respectively, promulgated by the National Association of Insurance Commissioners (as adopted as of October 2000); (ii) any provision of the model regulation or model Act listed under subparagraph (A) shall be treated as including any other provision of such regulation or Act necessary to implement the provision; and (iii) with respect to a long-term care insurance policy issued in a State, the policy shall be deemed to meet applicable requirements of the model regulation or the model Act if the State plan amendment under paragraph (1)(C)(iii) provides that the State insurance commissioner for the State certifies (in a manner satisfactory to the Secretary) that the policy meets such requirements. (C) Not later than 12 months after the National Association of Insurance Commissioners issues a revision, update, or other modification of a model regulation or model Act provision specified in subparagraph (A), or of any provision of such regulation or Act that is substantively related to a provision specified in such subparagraph, the Secretary shall review the changes made to the provision, determine whether incorporating such changes into the corresponding provision specified in such subparagraph would improve qualified State long-term care insurance partnerships, and if so, shall incorporate the changes into such provision.


42 USC § 1396p(b)(5)

Scoping language

in this paragraph
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