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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171 d. uicide (sane or insane), attempted suicide or intentionally elf-inflicted injury, or C. aviation; 5. Treatment provided in a government facility (unless otherwise required by law), services for which benefits are available under Medicare or other governmental program (except Medicaid), any state or federal workers' compensation, employer's liability or occupational disease law, or any motor vehicle no-fault lav; services provided by a member of the covered person's immediate family; and services for which no charge is normally made in the absence of insurance; or 6. Territorial limitations Other provisions of this regulation shall not impair or limit the use of waivers to exclude, limit or reduce coverage or benefits for specifically named or described pre-existing diseases physical condition or extra hazardous activities. Where waivers are required as a condition of issuance, renewal or reinstatement, signed acceptance by the insured is required unless on initial issuance the full text of the waiver is contained either on the first page or specification page. D. Extension of Benefits: Termination of long-term care insurance coverage shall be without prejudice to any benefits payable for institutionalization if such institutionalization began while the coverage was in force and continues without interruption after termination. Such

172 extension of benefits beyond the period the coverage was in force may be limited to the duration of the benefit period, if any, or to payment of the magimum benefits and may be subject to any policy waiting period. Sectin, 7 RCQUired Dislc1iru Proviginn A. Individual long-term care insurance policies shall contain a renewal. continuation or nonrenewal provision. The language or specifications of such provision must be consistent with the type of policy issued. Such provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed. B. Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured or exercises a specifically reserved right under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured. After the date of policy issue, any rider or endorsement which 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 is required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, such premium charge shall be set forth in the policy.

172<br />

extensi<strong>on</strong> of benefits bey<strong>on</strong>d the period the coverage was in force may<br />

be limited to the durati<strong>on</strong> of the benefit period, if any, or to payment of<br />

the magimum benefits and may be subject to any policy waiting period.<br />

Sectin, 7 RCQUired Dislc1iru Proviginn<br />

A. Individual l<strong>on</strong>g-term care insurance policies shall c<strong>on</strong>tain a renewal.<br />

c<strong>on</strong>tinuati<strong>on</strong> or n<strong>on</strong>renewal provisi<strong>on</strong>. The language or specificati<strong>on</strong>s of<br />

such provisi<strong>on</strong> must be c<strong>on</strong>sistent with the type of policy issued. Such<br />

provisi<strong>on</strong> shall be appropriately capti<strong>on</strong>ed, shall appear <strong>on</strong> the first page<br />

of the policy, and shall clearly state the durati<strong>on</strong>, where limited, of<br />

renewability and the durati<strong>on</strong> of the term of coverage for which the policy<br />

is issued and for which it may be renewed.<br />

B. Except for riders or endorsements by which the insurer effectuates a<br />

request made in writing by the insured or exercises a specifically<br />

reserved right under an individual l<strong>on</strong>g-term care insurance policy, all<br />

riders or endorsements added to an individual l<strong>on</strong>g-term care insurance<br />

policy after date of issue or at reinstatement or renewal which reduce or<br />

eliminate benefits or coverage in the policy shall require signed<br />

acceptance by the individual insured. After the date of policy issue, any<br />

rider or endorsement which increases benefits or coverage with a<br />

c<strong>on</strong>comitant increase in premium during the policy term must be agreed to<br />

in writing signed by the insured, except if the increased benefits or<br />

coverage is required by law. Where a separate additi<strong>on</strong>al premium is<br />

charged for benefits provided in c<strong>on</strong>necti<strong>on</strong> with riders or endorsements,<br />

such premium charge shall be set forth in the policy.

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