HEARING - U.S. Senate Special Committee on Aging
HEARING - U.S. Senate Special Committee on Aging HEARING - U.S. Senate Special Committee on Aging
157 An association or to a trust or to the trustee(s) of a fund established, created, or maintained for the benefit of members of one 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, shell file evidence with the Commissioner that the association or essocietions have at the outset e minimum of 100 persons and hove been organized and maintained In good faith for purposes other than that of obtaining insurance; hive been in active existence for at least one year; and have a constitution and by-laws which provide that (i) the association or associations hold regular meetings not less then annually to further purposes of the members, Cii) 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 hoard and committees. Thirty (30) days after such filing the association or associations will be deemed to satisfy such organizational requirements, unless the Commissuioner makes a finding that the association or associations do not satisfy those organizational requirements. (4) A group other then as described in subsections ECl), E(2) and E(3), subject to a finding by the Commissioner that: (a) The Issuance of the group policy is not contrary to the best interest of the public; -6-
158 (b) The issuance of the group policy would result in economies of acquisition or administration; and (c) The benefits are reasonable in relation to the premiums charged. F. "Policy means, for the purposes of this Act, any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, nonprofit health, hospital, or medical service corporation, prepaid health plan, health maintenance organization or any similar organization. Drafting Note: This Act is intended to apply to the specified group and individual policies, contracts, and certificates whether issued by insurers, fraternal benefit societies, non-profit health, hospital, and medical service corporations, prepaid health plans, health maintenance organizations, or any similar organization. In order to include such organizations, each state should identify them in accordance with its statutory terminology or by specific statutory citation. Depending upon state law, insurance department jurisdiction, and other factors, separate legislation may be reQuired. In any event, the legislation should provide that the particular terminology used by these plans and organizations may be substituted for, or added to, the corresponding terms used in this Act, The term "regulations" should be replaced by the terms "rules and regulations" or rules as may be appropriate under state law, The definition of "long-term care insurance" under this Act is designed to allow maximum flexibility in benefit scope, intensity and level, while assuring that the purchaser's reasonable expectations for a long-term care insurance policy are met. The Act is intended to permit long-term care insurance policies to cover either diagnostic, preventive,. therapeutic, rehabilitative, maintenance, or personal care services, or any combination thereof, and not to mandate coverage for each of these types of services. Pursuant to the definition, long-term care insurance may be either a group or individual insurance policy or a rider to such a policy, *e.g, life, or accident and sickness~ The language in the definition concerning other then an acute care unit of a hospital is intended to allow payment of benefits when a portion of a hospitel has been designated for, and duly licensed or certified as a long-term care provider or swing bed. -7-
- Page 109 and 110: 106 29), but fails to acknowledge t
- Page 111 and 112: 108 explore all alternatives to lon
- Page 113 and 114: 110 adds to the complexity of Medic
- Page 115 and 116: 112 - 10- Consider first the propos
- Page 117 and 118: 114 - 12- insurance premiums and me
- Page 119 and 120: Consunmer Unon Pubtishcr of Consume
- Page 121 and 122: FOR RELEASE AT 9:00 P.M. H2ST) TUES
- Page 123 and 124: 120 Itema I CENTER FOR MEDICARE ALw
- Page 125 and 126: Page 3 122 aide services, however,
- Page 127 and 128: Page 5 state treasuries." 124 Judge
- Page 129 and 130: 126 462 6485 New Developments 10,05
- Page 131 and 132: 128 462 6-85 New Developments 10,05
- Page 133 and 134: 130 462 6-85 New Developments 10,05
- Page 135 and 136: 132 10,930 New Developments tI.PZ ;
- Page 137 and 138: 10,932 134 New Davelopments 492 346
- Page 139 and 140: 136 10,934 New Developments It! ;6
- Page 141 and 142: 10,936 138 New Developmenlt I. Thc
- Page 143 and 144: 140 10,938 New Development. 492 S-8
- Page 145 and 146: 10,940 142 New Developments i92 586
- Page 147 and 148: ATroR EYS -HARLES C. -ULiIN JUDITH
- Page 149 and 150: 146 reformed its decision-making pr
- Page 151 and 152: 148 : 14 2i57 New Developments 13,1
- Page 153 and 154: ~ 150 a>, rsn Cdw ~w (e d rum 0A7,.
- Page 155 and 156: 152 All Of these figures are based
- Page 157 and 158: 154 The requirements of this Act sh
- Page 159: 156 Drefting Note: Where the word "
- Page 163 and 164: 160 (2) Contain a provision establi
- Page 165 and 166: 162 and competitive reasons. It is
- Page 167 and 168: 164 -13- E. Affordability of Long T
- Page 169 and 170: NAIC LTC ADVISORY COMMITEE EXPOSURE
- Page 171 and 172: Setinzn IS. Poicyx D~efinitieno aid
- Page 173 and 174: 170 3. The term "noncancellable' ma
- Page 175 and 176: 172 extension of benefits beyond th
- Page 177 and 178: artinM B Requirmnts for Rplnmacwt 1
- Page 179 and 180: 176 The above "Notice to Applicant"
- Page 181 and 182: (pinnal Rasting &mdsninn 178 Benefi
- Page 183 and 184: APPEMI!X B 180 OCWARISCN OF lVLCY i
- Page 185 and 186: COMPAIeSON OF LOtG TEIM CoAt PfLtCI
- Page 187 and 188: COMPABI:SZN OF LC#C TE" CAiE -OLICI
- Page 189 and 190: COWaPAISON Of LOSt TERM CARE POLICI
- Page 191 and 192: cowRiiSOi or touTE reM CasE nOuczcS
- Page 193 and 194: COGPARISON OF LONG TERM CARE POLICI
- Page 195 and 196: SOME BASIC THINGS YOU SHOULD KNOW M
- Page 197 and 198: Private health insurance is availab
- Page 199 and 200: WHAT MEDICARE PART B PAYS 196 MEDIC
- Page 201 and 202: EXPENSES NOT COVERED BY MEDICARE Me
157<br />
An associati<strong>on</strong> or to a trust or to the trustee(s) of a fund<br />
established, created, or maintained for the benefit of<br />
members of <strong>on</strong>e or more associati<strong>on</strong>s. Prior to advertising,<br />
marketing or offering such policy within this state, the<br />
associati<strong>on</strong> or associati<strong>on</strong>s, or the insurer of the<br />
associati<strong>on</strong> or associati<strong>on</strong>s, shell file evidence with the<br />
Commissi<strong>on</strong>er that the associati<strong>on</strong> or essocieti<strong>on</strong>s have at the<br />
outset e minimum of 100 pers<strong>on</strong>s and hove been organized and<br />
maintained In good faith for purposes other than that of<br />
obtaining insurance; hive been in active existence for at<br />
least <strong>on</strong>e year; and have a c<strong>on</strong>stituti<strong>on</strong> and by-laws which<br />
provide that (i) the associati<strong>on</strong> or associati<strong>on</strong>s hold regular<br />
meetings not less then annually to further purposes of the<br />
members, Cii) except for credit uni<strong>on</strong>s, the associati<strong>on</strong> or<br />
associati<strong>on</strong>s collect dues or solicit c<strong>on</strong>tributi<strong>on</strong>s from<br />
members, and (iii) the members have voting privileges and<br />
representati<strong>on</strong> <strong>on</strong> the governing hoard and committees. Thirty<br />
(30) days after such filing the associati<strong>on</strong> or associati<strong>on</strong>s<br />
will be deemed to satisfy such organizati<strong>on</strong>al requirements,<br />
unless the Commissui<strong>on</strong>er makes a finding that the associati<strong>on</strong><br />
or associati<strong>on</strong>s do not satisfy those organizati<strong>on</strong>al<br />
requirements.<br />
(4) A group other then as described in subsecti<strong>on</strong>s ECl), E(2)<br />
and E(3), subject to a finding by the Commissi<strong>on</strong>er that:<br />
(a) The Issuance of the group policy is not c<strong>on</strong>trary to the<br />
best interest of the public;<br />
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