58-17B-2 Definition of terms.
58-17B-2.
Definition of terms.
Terms used in this chapter mean:
(1)
"Applicant,"
(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," 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," the director of the Division of Insurance in this state;
(4)
"Group long-term care insurance," a long-term care insurance policy which is delivered
or issued for delivery in this state and issued to:
(a)
One or more employers or labor organizations, or to a trust or to the trustees of a
fund established by one 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 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, shall file evidence with the director
that the association or associations have at the outset a minimum of one hundred
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 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.
Thirty days after such filing the association or associations will be considered to
have satisfied such organizational requirements, unless the director makes a finding
that the association or associations have not satisfied those organizational
requirements.
(d)
A group other than as described in this section 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)
The issuance of the group policy would result in economies of acquisition
or administration; and
(iii)
The benefits are reasonable in relation to the premiums charged;
(5)
"Guaranteed renewable,"
(a)
The insured has the right to continue the long-term care insurance in force by the
timely payment of premiums; and
(b)
The insurer has no unilateral right to make any change in provisions of the policy
or rider while the insurance is in force and cannot decline to renew the policy.
However, rates may be revised by the insurer on a class basis subject to approval
by the Division of Insurance;
(6)
"Long-term care insurance," any insurance policy or rider advertised, marketed, offered,
or designed to provide coverage for not less than twelve consecutive months for each
covered person on an expense incurred, indemnity, prepaid, or other basis; for one or
more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative,
maintenance or personal care services, provided in a setting other than an acute care unit
of a hospital. Such term includes group and individual policies or riders whether issued
by insurers; fraternal benefit societies; nonprofit health, hospital and medical service
corporations; prepaid health plans; health maintenance organizations or any similar
organization. Long-term care insurance does not include any insurance policy which is
offered primarily to provide basic medicare supplement coverage, basic hospital expense
coverage, basic medical-surgical expense coverage, hospital confinement, accident only
coverage, specified disease or specified accident coverage or limited benefit health
coverage;
(7)
"Mental or nervous disorder," may not be defined more restrictively than including
neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or
disorder. However, no policy, contract or rider may exclude or limit benefits on the basis
of organic brain disease, including alzheimer's disease or senile dementia;
(8)
"Policy," 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.
Source: SL 1989, ch 440, § 2; SL 2007, ch 289, § 1.