§ 26.1-45-01 — Definitions

In this chapter, unless the context requires otherwise:
1. "Applicant" means:
a. In the case of an individual long-term care insurance policy, the person who
seeks to contract for benefits.
b. In the case of a group long-term care insurance policy, the proposed certificate
holder.
2. "Certificate" means any certificate issued under a group long-term care insurance
policy that has been delivered or issued for delivery in this state.
3. "Group long-term care insurance" means a long-term care insurance policy that is
delivered or issued for delivery in this state 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.
b. Any professional, trade, or occupational association for its members or former or
retired members, or combination thereof, if the association:
(1) Is composed of individuals all of whom are or were actively engaged in the
same profession, trade, or occupation; and
(2) Has been maintained in good faith for purposes other than obtaining
insurance.
c. An association, a trust, or the trustee of a fund established, created, or
maintained for the benefit of members of one or more associations meeting the
requirements of section 26.1-45-02.
d. A group other than a group described in subdivision a, b, or c if the commissioner
finds that:
(1) The issuance of the group policy is not contrary to the best interest of the
public;
(2) The issuance of the group policy would result in economies of acquisition or
administration; and
(3) The benefits are reasonable in relation to the premiums charged.
4. "Long-term care insurance" means any insurance policy or rider primarily 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. The term includes
group and individual annuities and life insurance policies or riders, whether issued by
insurers, fraternal benefit societies, nonprofit health service corporations, prepaid
health plans, health maintenance organizations, or any similar entity, which provide
directly or which supplement long-term care insurance. The term also includes home
health care type insurance policies or riders which provide directly or which
supplement long-term care insurance; and includes a policy or rider which provides for
payment of benefits based upon cognitive impairment or the loss of functional capacity.
The term includes qualified long-term care insurance contracts. The term includes
long-term care insurance products issued by insurers; fraternal benefit societies;
nonprofit health, hospital, and medical service corporations; prepaid health plans;
health maintenance organizations; or a similar organization to the extent that the
organization is otherwise authorized to issue life or health insurance. The term does
not include any insurance policy that is offered primarily to provide basic Medicare
supplement coverage, basic hospital expense coverage, basic medical-surgical
expenses 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. With regard to life insurance, this term does not include life insurance
policies which 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 which 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.
Notwithstanding any other provision contained herein, any product advertised,
marketed, or offered as a long-term care insurance is subject to the provisions of this
chapter.
5. "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 health, hospital, or medical service corporation, prepaid health plan, health
maintenance organization, or any similar entity.
6. 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 section 7702B(b) of the Internal Revenue Code of
1986, as amended, as follows:
(1) The only insurance protection provided under the contract is coverage of
qualified long-term care services. A contract satisfies the requirements of
this paragraph even if payments are made on a per diem or other periodic
basis without regard to the period in which the expenses are incurred;
(2) 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 Social Security Act, as amended, or would be so reimbursable but for
the application of a deductible or coinsurance amount. The requirements of
this paragraph do not apply to expenses that are reimbursable under title
XVIII of the Social Security Act only as a secondary payer. A contract
satisfies the requirements of this paragraph even if payments are made on a
per diem or other periodic basis without regard to the period in which the
expenses are incurred;
(3) The contract is guaranteed renewable, within the meaning of section
7702B(b)(1)(c) of the Internal Revenue Code of 1986, as amended;
(4) 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 paragraph 5;
(5) 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 refund on the event of death of the
insured or a complete surrender or cancellation of the contract cannot
exceed the aggregate premiums paid under the contract; and
(6) The contract meets the consumer protection provisions set forth in section
7702B(g) of the 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 sections 7702B(b) and (e) of the Internal
Revenue Code of 1986, as amended.