T41CH46
Title 41 > T41CH46
Sections (11)
41-4601
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4601. Purpose. The purpose of this chapter is to promote the public interest, to promote the availability of long-term care insurance policies, to protect applicants for long-term care insurance, as defined, from unfair or deceptive sales or enrollment practices, to establish standards for long-term care insurance, to facilitate public understanding and comparison of long-term care insurance policies, and to facilitate flexibility and innovation in the development of long-term care insurance coverage. History: [41-4601, added 1999, ch. 98, sec. 2, p. 304.]
41-4602
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4602. Scope. The requirements of this chapter shall apply to policies delivered or issued for delivery in this state on or after the effective date of this chapter. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws insofar as they do not conflict with this chapter, except that laws and regulations designed and intended to apply to medicare supplement insurance policies shall not be applied to long-term care insurance. History: [41-4602, added 1999, ch. 98, sec. 2, p. 304.]
41-4603
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4603. Definitions. Unless the context requires otherwise, the definitions in this section apply throughout this chapter. (1) Applicant means: (a) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (b) In the case of a group long-term care insurance policy, the proposed certificate holder. (2) Certificate means, for the purposes of this chapter, any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state. (3) Director means the director of the department of insurance of this state. (4) Group long-term care insurance means a long-term care insurance policy which is delivered or issued for delivery in this state and issued to: (a) One (1) or more employers or labor organizations, or to a trust or to the trustees of a fund established by one (1) or more employers or labor organizations, or a combination thereof, for employees or former employees or a combination thereof, or for members or former members or a combination thereof, of the labor organizations; or (b) Any professional, trade or occupational association for its members or former or retired members, or combination thereof, if such association: (i) Is composed of individuals all of whom are or were actively engaged in the same profession, trade or occupation; and (ii) Has been maintained in good faith for purposes other than obtaining insurance; or (c) An association or a trust or the trustee(s) of a fund established, created or maintained for the benefit of members of one (1) or more associations. Prior to advertising, marketing or offering such policy within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the director that the association or associations have at the outset a minimum of one hundred (100) persons and have been organized and maintained in good faith for purposes other than that of obtaining insurance; have been in active existence for at least one (1) year; and have a constitution and bylaws which provide that: (i) The association or associations hold regular meetings not less than annually to further purposes of the members; (ii) Except for credit unions, the association or associations collect dues or solicit contributions from members; and (iii) The members have voting privileges and representation on the governing board and committees. Sixty (60) days after such filing the association or associations will be deemed to satisfy such organizational requirements, unless the director makes a finding that the association or associations do not satisfy those organizational requirements. (d) A group other than as described in paragraphs (a), (b) and (c) of this subsection, subject to a finding by the director that: (i) The issuance of the group policy is not contrary to the best interest of the public; (ii) T
41-4604
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4604. Extraterritorial jurisdiction — Group long-term care insurance. No group long-term care insurance coverage may be offered to a resident of this state under a group policy issued in another state to a group described in section 41-4603 (4)(d), Idaho Code, unless this state or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met. History: [41-4604, added 1999, ch. 98, sec. 2, p. 306.]
41-4605
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4605. Disclosure and performance standards for long-term care insurance. (1) The director may adopt rules that include standards for full and fair disclosure setting forth the manner, content and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions and definitions of terms. (2) No long-term care insurance policy may: (a) Be cancelled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or (b) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or (c) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care. (3) Preexisting condition: (a) No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in section 41-4603 (4)(a), Idaho Code, shall use a definition of preexisting condition which is more restrictive than the following: preexisting condition means a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within six (6) months preceding the effective date of coverage of an insured person. (b) No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in section 41-4603 (4)(a), Idaho Code, may exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six (6) months following the effective date of coverage of an insured person. (c) The director may extend the limitation periods set forth in paragraphs (a) and (b) of this subsection as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public. (d) The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer’s established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until
41-4606
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4606. Incontestability period. (1) For a policy or certificate that has been in force for less than six (6) months an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage. (2) For a policy or certificate that has been in force for at least six (6) months but less than two (2) years an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought. (3) After a policy or certificate has been in force for two (2) years it is not contestable upon the grounds of misrepresentation alone; such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health. (4) (a) No long-term care insurance policy or certificate may be field issued based on medical or health status. (b) For purposes of this section, field issued means a policy or certificate issued by an agent or a third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer. (5) If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded. (6) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by section 41-1905 , Idaho Code, as it pertains to incontestability. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care. History: [41-4606, added 1999, ch. 98, sec. 2, p. 309.]
41-4607
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4607. Nonforfeiture benefits. (1) Except as provided in subsection (2) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. In the event the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates. (2) When a group long-term care insurance policy is issued, the offer required in subsection (1) of this section shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance as defined in section 41-4603 (4)(d), Idaho Code, other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificate holder. (3) The director shall promulgate rules specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding a contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection (1) of this section. History: [41-4607, added 1999, ch. 98, sec. 2, p. 310.]
41-4608
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4608. Authority to promulgate rules. The director shall issue reasonable rules to promote premium adequacy and to protect the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, agent compensation, agent testing, penalties and reporting practices for long-term care insurance. History: [41-4608, added 1999, ch. 98, sec. 2, p. 311.]
41-4609
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4609. Administrative procedures. Rules adopted for the implementation and administration of this chapter shall be in accordance with the provisions of chapter 52, title 67 , Idaho Code. History: [41-4609, added 1999, ch. 98, sec. 2, p. 311.]
41-4610
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4610. Severability. If any provision of this chapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the chapter and the application of such provision to other persons or circumstances shall not be affected thereby. History: [41-4610, added 1999, ch. 98, sec. 2, p. 311.]
41-4611
TITLE 41 INSURANCE CHAPTER 46 LONG-TERM CARE INSURANCE ACT 41-4611. Penalties. In addition to any other penalties provided by the laws of this state, any insurer and any agent found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to three (3) times the amount of any commissions paid for each policy involved in the violation or up to ten thousand dollars ($10,000), whichever is greater. History: [41-4611, added 1999, ch. 98, sec. 2, p. 311.]