NC Register Volume 24 Issue 19 - Office of Administrative Hearings

APPROVED RULES
History Note: Authority G.S. 58-2-40; 58-58-50(d); 58-58-
50(k);
Eff. January 1, 1998;
Temporary Amended Eff. January 1, 2000;
Amended Eff. March 1, 2010; July 1, 2000.
11 NCAC 11F .0801 MODEL REGULATION
PERMITTING THE RECOGNITION OF PREFERRED
MORTALITY TABLES FOR USE IN DETERMINING
MINIMUM RESERVE LIABILITIES
(a) The North Carolina Department of Insurance incorporates by
reference, including subsequent amendments and editions, the
National Association of Insurance Commissioners Model No.
815, Model Regulation Permitting the Recognition of Preferred
Mortality Tables for Use in Determining Minimum Reserve
Liabilities. Copies of Model No. 815 may be obtained from:
The National Association of Insurance Commissioners, 2301
McGee Street, Kansas City, MO 64108-1662; the North
Carolina Department of Insurance, Actuarial Services Division,
1201 Mail Service Center, Raleigh, NC 27699-1201; and from
the Department of Insurance web page at
http://www.ncdoi.com/.
(b) For purposes of this Rule, Section 2 of Model No. 815 shall
read as follows:
The purpose of this regulation is to recognize, permit
and prescribe the use of mortality tables that reflect
differences in mortality between Preferred and Standard
lives in determining minimum reserve liabilities in
accordance with G.S. 58-58-50 (c)(2)(a), 11 NCAC 11F
.0403(a), and 11 NCAC 11F .0403(b).
(c) For purposes of this Rule, Section 4 of Model No. 815 shall
read as follows:
At the election of the company, for each calendar year
of issue, for any one or more specified plans of
insurance and subject to satisfying the conditions stated
in this regulation, the 2001 CSO Preferred Class
Structure Mortality Table may be substituted in place of
the 2001 CSO Smoker or Nonsmoker Mortality Table
as the minimum valuation standard for policies issued
on or after January 1, 2007. For policies issued on or
after January 1, 2005 and before January 1, 2007, these
tables may be substituted with the consent of the
Commissioner and subject to the conditions of Section
5. In determining such consent, the Commissioner shall
consider the consent of the insurance regulator of the
company's state of domicile. No such election shall be
made until the company demonstrates that at least 20%
of the business to be valued on this table is in one or
more of the preferred classes. A table from the 2001
CSO Preferred Class Structure Mortality Table used in
place of a 2001 CSO Mortality Table, pursuant to the
requirements of this regulation, shall be treated as part
of the 2001 CSO Mortality Table only for purposes of
reserve valuation pursuant to the requirements of 11
NCAC 11F .0601, 11 NCAC 11F .0602, 11 NCAC 11F
.0603, and 11 NCAC 11F .0604.
(d) For purposes of this Rule, Paragraph C of Section 3, and
Paragraph C of Section 5 of Model No. 815 are not applicable.
(e) For purposes of this Rule, Sections 1 and 7 of Model No.
815 are not applicable.
History Note: Authority G.S. 58-2-40; 58-58-50(k);
Eff. April 1, 2007;
Amended Eff. March 1, 2010.
* * * * * * * * * * * * * * * * * *
11 NCAC 12 .1902 UNFAIR OR DECEPTIVE ACTS
OR PRACTICES
(a) The following are unfair or deceptive acts or practices in the
business of insurance:
(1) To deny, refuse to issue, renew or reissue,
cancel or otherwise terminate a health benefit
plan, or restrict or exclude health benefit plan
coverage or add a premium differential to any
health benefit plan on the basis of the
applicant's or insured's abuse status;
(2) To exclude or limit coverage for losses or deny
a claim incurred by an insured on the basis of
the insured's abuse status;
(3) To request information relating to acts of
abuse or an applicant's or insured's abuse
status, or make use of that information,
however obtained, except for the limited
purposes of complying with legal obligations
or verifying a person's claim to be a subject of
abuse; or
(4) To terminate group coverage for a subject of
abuse because coverage was originally issued
in the name of the abuser and the abuser has
divorced, separated from, or lost custody of
the subject of abuse, or the abuser's coverage
has terminated voluntarily or involuntarily.
Nothing in this Rule prohibits the insurer or
insurance professional from requiring the
subject of abuse to pay the full premium for
coverage under the health benefit plan or from
requiring as a condition of coverage that the
subject of abuse reside or work within the
insurer's service area, if the requirements are
applied to all insureds of the insurer or
insurance professional. The health carrier or
insurance professional may terminate group
coverage after the continuation coverage
required by this subsection has been in force
for 18 months, if it offers conversion to an
individual plan as provided in Part 2 of Article
53 of Chapter 58 of the General Statutes. The
continuation coverage required by this section
shall be satisfied by coverage required under
P.L. 99-272, the Consolidated Omnibus
Budget Reconciliation Act (COBRA) of 1985,
or under state continuation coverage required
under Part 1 of Article 53 of Chapter 58 of the
General Statutes, and is not intended to be in
addition to coverage provided under COBRA
or state continuation. Nothing in this
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