§ 23-97-304 — Definitions

As used in this subchapter: (1) "Applicant" means: (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) "Association" means a professional, trade, or occupational association or associations, if the association: (A) Is composed entirely of individuals that are or were actively engaged in the same profession, trade, or occupation; and (B) Has been maintained in good faith for purposes other than obtaining insurance; (3) "Certificate" means any certificate issued under a group long-term care insurance policy delivered or issued for delivery in this state; (4) "Commissioner" means the Insurance Commissioner; (5) "Federally tax-qualified long-term care insurance contract" means: (A) An individual or group insurance contract that meets the following requirements of section 7702B(b) of the Internal Revenue Code of 1986: (i) (a) The only insurance protection provided under the contract is coverage of qualified long-term care services. (b) A contract satisfies the requirements of this subdivision (5)(A)(i) even though payments are made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (ii) (a) The contract does not pay or reimburse expenses incurred for services or items to the extent that the expenses: (1) Are reimbursable under Title XVIII of the Social Security Act; or (2) Would be reimbursable but for the application of a deductible or coinsurance amount. (b) The requirements of this subdivision (5)(A)(ii) do not apply to expenses that are reimbursable under Title XVIII of the Social Security Act only as a secondary payor. (c) A contract satisfies the requirements of this subdivision (5)(A)(ii) even though payments are made on a per diem or other periodic basis without regard to the expenses incurred during the period to which the payments relate; (iii) The contract is guaranteed renewable under section 7702B(b)(1)(C) of the Internal Revenue Code of 1986; (iv) The contract does not provide for a cash surrender value or other money that can be paid, assigned, pledged as collateral for a loan, or borrowed, except as provided in subdivision (5)(A)(v) of this section; (v) All refunds of premiums, policyholder dividends, or similar amounts under the contract are to be applied as a reduction in future premiums or to increase future benefits, except that a refund in the event of the death of the insured or a complete surrender or cancellation of the contract cannot exceed the aggregate premiums paid under the contract; and (vi) The contract meets the consumer protection provisions set forth in section 7702B(g) of the Internal Revenue Code of 1986; or (B) The portion of a life insurance contract that provides long-term care insurance coverage by rider or as part of the contract and that satisfies the requirements of sections 7702B(b) and 7702B(e) of the Internal Revenue Code of 1986; (6) "Group long-term care insurance" means a long-term care insurance policy that is delivered or issued for delivery in this state and issued for the benefit of its current, former, or retired employees or members to one (1) or more: (A) Employers, labor organizations, associations, or a trust or to the trustees of a fund established by one (1) or more employers or labor organizations; or (B) Any other group if the commissioner finds that the issuance of the group policy: (i) Is not contrary to the best interest of the public; (ii) Results in economies of acquisition or administration; and (iii) Results in benefits that are reasonable in relation to the premiums charged; (7) (A) "Long-term care insurance" means any insurance policy or rider advertised, marketed, offered, or designed to provide coverage for one (1) or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services: (i) For not less than twelve (12) consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis; and (ii) Provided in a setting other than an acute care unit of a hospital. (B) "Long-term care insurance" includes, but is not limited to: (i) Group and individual annuities and life insurance policies or riders that provide directly or supplement long-term care insurance; (ii) A policy or rider that provides for payment of benefits based upon cognitive impairment or the loss of functional capacity; and (iii) Qualified long-term care insurance contracts. (C) Long-term care insurance may be issued by: (i) Insurers; (ii) Fraternal benefit societies; (iii) Nonprofit health, hospital, and medical service corporations; (iv) Prepaid health plans; (v) Health maintenance organizations; or (vi) Any similar organization to the extent that the organization is otherwise authorized to issue life or health insurance. (D) "Long-term care insurance" shall not include any insurance policy that is offered primarily to provide: (i) Basic Medicare supplement coverage; (ii) Basic hospital expense coverage; (iii) Basic medical-surgical expense coverage; (iv) Hospital confinement indemnity coverage; (v) Major medical expense coverage; (vi) Disability income or related asset-protection coverage; (vii) Accident-only coverage; (viii) Specified disease or specified accident coverage; or (ix) Limited benefit health coverage. (E) "Long-term care insurance" does not include life insurance policies: (i) That accelerate the death benefit specifically for: (a) One (1) or more of the qualifying events of terminal illness; or (b) Medical conditions requiring extraordinary medical intervention or permanent institutional confinement; (ii) That provide the option of a lump-sum payment for those benefits; and (iii) When neither the benefits nor the eligibility for the benefits is conditioned upon the receipt of long-term care. (F) Notwithstanding any other provision of this subchapter, any product advertised, marketed, or offered as long-term care insurance is subject to the provisions of this subchapter; (8) "Policy" means any policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this state by: (A) An insurer; (B) A fraternal benefit society; (C) A nonprofit health, hospital, medical service corporation, or hospital medical service corporation; (D) A prepaid health plan; (E) A health maintenance organization; or (F) Any similar organization; and (9) "Qualified long-term care insurance contract" means the same as "federally tax-qualified long-term care insurance contract".

Legislative History

Acts 2005, No. 1697, § 31; 2007, No. 496, § 20; 2007, No. 827, § 188.