As used in this article 19, unless the context
otherwise requires:
(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.
(1.5) Repealed.
(2) Certificate means any certificate issued under a group long-term care
insurance policy, which policy has been delivered or issued for delivery in this state.
(3) Commissioner means the commissioner of insurance.
(3.5) Dementia diseases and related disabilities has the same meaning set
forth in section 10-16-102 (16.5).
(4) Group long-term care insurance means a long-term care insurance
policy which is delivered or issued for delivery in this state and issued to one of the
following:
(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;
(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;
(c) (I) 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
the insurer of the association shall file evidence with the commissioner that the
association has at the outset a minimum of one hundred persons and has been
organized and maintained in good faith for purposes other than that of obtaining
insurance, has been in active existence for at least one year, and has a constitution
and bylaws which provide that:
(A) The association holds regular meetings not less than annually to further
purposes of the members;
(B) Except for credit unions, the association collects dues or solicits
contributions from members; and
(C) The members have voting privileges and representation on the governing
board and committees.
(II) Thirty days after such filing, the association will be deemed to satisfy
such organizational requirements, unless the commissioner makes a finding that
the association does not satisfy those organizational requirements.
(d) A group other than as described in paragraph (a), (b), or (c) of this
subsection (4), subject to a finding by the commissioner 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) Long-term care insurance means 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. Long-term care insurance includes group and individual annuities and life insurance
policies or riders that provide directly or that supplement long-term care insurance.
The term shall also include qualified long-term care insurance contracts. This term
does not include life insurance policies that accelerate the death benefit
specifically for one or more of the qualifying events of terminal illness, medical
conditions requiring extraordinary medical intervention, or permanent institutional
confinement and that provide the option of a lump-sum payment for those benefits
and in which neither the benefits nor the eligibility for the benefits is conditioned
upon the receipt of long-term care. Long-term care insurance also includes a
policy or rider that provides for payment of benefits based upon cognitive
impairment or the loss of functional capacity. Long-term care insurance may be
issued by insurers, fraternal benefit societies, nonprofit hospital, medical-surgical,
and health service corporations, prepaid health plans, health maintenance
organizations, or any similar organizations to the extent they are otherwise
authorized to issue life or health insurance. Long-term health-care insurance shall
not include any insurance policy that is offered primarily to provide basic medicare
supplement coverage, basic hospital expense coverage, basic medical-surgical
expense coverage, hospital confinement indemnity coverage, major medical
expense coverage, disability income or related asset protection coverage, accident-only coverage, specified disease or specified accident coverage, or limited-benefit
health coverage. Notwithstanding any other provisions contained herein, any
product advertised, marketed, or offered as long-term care insurance shall be
subject to the provisions of this article.
(6) Policy means any policy, contract, subscriber agreement, rider, or
endorsement delivered or issued for delivery in this state by an insurer, fraternal
benefit society, nonprofit hospital, medical-surgical, or health service corporation,
prepaid health plan, health maintenance organization, or any similar organization.
(7) Repealed.
(8) (a) Qualified long-term care insurance contract or federally tax-qualified long-term care insurance contract means an individual or group
insurance contract that meets the requirements of 26 U.S.C. sec. 7702B (b) of the
federal Internal Revenue Code of 1986, as amended, as follows:
(I) The only insurance protection provided under the contract is coverage of
qualified long-term care services. A contract shall not fail to satisfy the
requirements of this subparagraph (I) by reason of payments being made on a per
diem or other periodic basis without regard to the expenses incurred during the
period to which the payments relate.
(II) The contract does not pay or reimburse expenses incurred for services or
items to the extent that the expenses are reimbursable under Title XVIII of the
federal Social Security Act, as added by the Social Security Amendments of
1965, Pub.L. 89-97, as amended, or would be so reimbursable but for the
application of a deductible or coinsurance amount. The requirements of this
subparagraph (II) do not apply to expenses that are reimbursable under said Title
XVIII only as a secondary payer. A contract shall not fail to satisfy the requirements
of this subparagraph (II) by reason of payments being 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, within the meaning of 26 U.S.C.
sec. 7702B (b)(1)(C) of the federal Internal Revenue Code of 1986, as amended;
(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 subparagraph (V) of this paragraph (a);
(V) All refunds of premiums and all 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 cash refund may be issued in the event of
death of the insured or a complete surrender or cancellation of the contract, so
long as the refund does not exceed the aggregate premiums paid under the
contract;
(VI) The contract meets the consumer protection provisions set forth in 26
U.S.C. sec. 7702B (g) of the federal Internal Revenue Code of 1986, as amended.
(b) Qualified long-term care insurance contract or federally tax-qualified
long-term care insurance contract also means 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 26 U.S.C. sec. 7702B (b) and (e) of
the federal Internal Revenue Code of 1986, as amended.