HEARING - U.S. Senate Special Committee on Aging

HEARING - U.S. Senate Special Committee on Aging HEARING - U.S. Senate Special Committee on Aging

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159 section S. Limits of Srow Long Term Care ZIturmice 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 E(4M, unless this state or another *tete having statutory and regulatory Long Term Care Insurance requirements substantially similar to those adopted in this atete has made a determination that such requirements have bean et. Section 6. Disclosure and Performance Standards tor Long-Temr Care Inmurance A. The Commissioner may adopt regulations 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 end subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, pre-existing conditions, termination of insurance, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms. Cements: This subsection permits the adoption of regulations establishing disclosure standards, renewability and eligibility terms and condition6, and other performance requirements for long-term care insurance. Regulations under this subsection should recognize the developing and unique nature of long-term care insurance and the distinction between group and individual long-term care Insurance policies. B. No long-term care insurance policy may: (1) 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,

160 (2) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other torm within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder. C. Pre-existing Condition (1) No long-term care insurance policy or certificate shall use a definition of "pre-existing condition" which is more restrictive then the following: Pre-existing condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis. care or treatment, or a condition for which. medical advice or treatment was recommended by, or received trom a provider of health care services, within the limitation periods specified in (a) and (b) below: (a) 6 months preceding the effective date of coverage of an insured person who is 65 years of age or older on the etfective date of coverage; or (b3 24 months preceding the effective date of coverage of an insured pereon who is under age 65 on the effective date of coverage. -9-

159<br />

secti<strong>on</strong> S. Limits of Srow L<strong>on</strong>g Term Care ZIturmice<br />

No Group L<strong>on</strong>g Term Care Insurance Coverage may be offered to a resident<br />

of this state under a group policy issued in another state to a group<br />

described in E(4M, unless this state or another *tete having statutory<br />

and regulatory L<strong>on</strong>g Term Care Insurance requirements substantially<br />

similar to those adopted in this atete has made a determinati<strong>on</strong> that<br />

such requirements have bean et.<br />

Secti<strong>on</strong> 6. Disclosure and Performance Standards tor L<strong>on</strong>g-Temr Care<br />

Inmurance<br />

A. The Commissi<strong>on</strong>er may adopt regulati<strong>on</strong>s that include standards for full<br />

and fair disclosure setting forth the manner, c<strong>on</strong>tent, and required<br />

disclosures for the sale of l<strong>on</strong>g-term care insurance policies, terms of<br />

renewability, initial end subsequent c<strong>on</strong>diti<strong>on</strong>s of eligibility,<br />

n<strong>on</strong>duplicati<strong>on</strong> of coverage provisi<strong>on</strong>s, coverage of dependents,<br />

pre-existing c<strong>on</strong>diti<strong>on</strong>s, terminati<strong>on</strong> of insurance, probati<strong>on</strong>ary<br />

periods, limitati<strong>on</strong>s, excepti<strong>on</strong>s, reducti<strong>on</strong>s, eliminati<strong>on</strong> periods,<br />

requirements for replacement, recurrent c<strong>on</strong>diti<strong>on</strong>s, and definiti<strong>on</strong>s of<br />

terms.<br />

Cements: This subsecti<strong>on</strong> permits the adopti<strong>on</strong> of regulati<strong>on</strong>s establishing<br />

disclosure standards, renewability and eligibility terms and c<strong>on</strong>diti<strong>on</strong>6,<br />

and other performance requirements for l<strong>on</strong>g-term care insurance.<br />

Regulati<strong>on</strong>s under this subsecti<strong>on</strong> should recognize the developing and<br />

unique nature of l<strong>on</strong>g-term care insurance and the distincti<strong>on</strong> between group<br />

and individual l<strong>on</strong>g-term care Insurance policies.<br />

B. No l<strong>on</strong>g-term care insurance policy may:<br />

(1) Be cancelled, n<strong>on</strong>renewed, or otherwise terminated <strong>on</strong> the<br />

grounds of the age or the deteriorati<strong>on</strong> of the mental or<br />

physical health of the insured individual or certificate<br />

holder; or,

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