3 AAC 28.555 - Required disclosure provisions

(a) Individual long-term care insurance policies must contain a renewability provision that

(1) is appropriately captioned, appears on the first page of the policy, and clearly states that the coverage is guaranteed renewable or noncancellable; this provision may not apply to policies that do not contain a renewability provision, and under which the right to nonrenew is reserved solely to the policyholder; and

(2) includes a statement that premium rates may change for a long-term care insurance policy or certificate, other than one where the insurer does not have the right to change the premium.

(b) 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 the date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured. After the date of policy issue, a rider or endorsement that 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, the premium charge shall be set out in the policy, rider, or endorsement.

(c) A long-term care insurance policy that provides for the payment of benefits based on standards described as "usual and customary, " "reasonable and customary," or words of similar import must include a definition of these terms and an explanation of the terms in its accompanying outline of coverage.

(d) If a long-term care insurance policy or certificate contains limitations with respect to preexisting conditions, the limitations must appear as a separate paragraph of the policy or certificate and must be labeled as "Preexisting Condition Limitations."

(e) A long-term care insurance policy or certificate containing limitations or conditions for eligibility other than those prohibited in AS 21.53.040(a)(3) must set out a description of the limitations or conditions, including required number of days of confinement, in a separate paragraph of the policy or certificate and must label the paragraph "Limitations or Conditions on Eligibility for Benefits."

(f) 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 or rider and other related documents. This subsection does not apply to qualified long-term care insurance contracts.

(g) 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." Additional benefit triggers shall also be explained in this section. If these additional benefit 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 to be eligible for benefits, this requirement shall be specified.

(h) A qualified long-term care insurance contract must include a disclosure statement in the policy and in the outline of coverage under 3 AAC 28.588(5) that the policy is intended to be a qualified long-term care insurance contract under 26 U.S.C. 7702B(b) (Internal Revenue Code).

(i) A nonqualified long-term care insurance contract must include a disclosure statement in the policy and in the outline of coverage under 3 AAC 28.588(5) that the policy is not intended to be a qualified long-term care insurance contract.

Notes

3 AAC 28.555

Eff. 3/27/2022, Register 241, April 2022

Authority:AS 21.06.090

AS 21.53.020

AS 21.53.030

AS 21.53.040

AS 21.53.050

AS 21.53.090