20-1691.06 – Coverage summary; certificate 20-1691.06 Coverage summary; certificate A. At the time of initial solicitation, an applicant for a long-term care insurance policy must receive a summary of coverage using means that draw the recipient’s attention to the document and its purpose.
- In the event of direct response solicitations, the coverage summary must be delivered with an application or enrollment form.
- In the case of solicitation by an insurance producer, the insurance producer must provide a summary of coverage prior to the presentation of an application or enrollment form.
The coverage overview must include all of the following: A description of the primary coverage and benefits provided by the insurance.2.A description of the policy’s key exclusions, reductions, and limits.3. A description of the renewal provisions, including any right to adjust rates reserved in the policy and any continuation or conversion provisions of group coverage.
- A statement indicating that the summary of coverage is a summary of the policy issued or applied for and that the policy should be reviewed to ascertain the contractually controlling terms.
- The conditions under which the policy or certificate can be returned and the premium repaid.
- Describe the link between care costs and benefits.
A declaration and explanation of whether the policy is a qualifying long-term care insurance contract.B. An overview of coverage is not needed for a long-term care insurance policy provided to a group as described in section 20-1691, paragraph 4, subdivision (a), if the information mentioned in subsection A of this section is contained in other enrollment-related materials.
- On request, an insurer shall provide the director with the additional materials.C.
- Upon delivery of an individual life insurance policy that includes long-term care benefits within the policy or via a rider, the policyholder must receive a policy summary.
- In the event of direct response solicitations, the insurer must provide the applicant with the policy summary upon request.
If a policy summary is not requested by the applicant, the insurer must give it at the time the policy is delivered. A policy summary must contain: A description of how the long-term care benefits interact with other policy components, such as deductions from death benefits.2.An description of the amount of benefits, duration of benefits, and, if applicable, guaranteed lifetime benefits for each insured individual.
- Any exclusions, cutbacks, or restrictions on long-term care benefits.
- A statement indicating any state-mandated long-term care inflation protection option is not available under the insurance.
- A) A description of the consequences of exercising additional rights under the policy, if appropriate to the type of policy being issued.
b) A disclosure of guarantees connected to insurance premiums for long-term care expenditures. (c) Existing and anticipated maximum lifetime benefits. A description of the monthly reporting requirements for life insurance plans that include an option for accelerated death payouts.D.
The contents of the policy summary required by subsection C of this section may be integrated into any illustration or policy summary required by this section.E. The insurer must provide a monthly report to the insured whenever a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, and the report must include the following information: Any rewards for long-term care given out throughout the month.2.
A description of any modifications to the policy, including death benefits or cash values, resulting from the payment of long-term care benefits. The quantity of existing or remaining long-term care coverage.F. A certificate issued pursuant to a group long-term care insurance policy delivered or issued for delivery in this state must contain all of the following information: A description of the primary coverage and benefits provided by the insurance.2.A description of the policy’s key exclusions, reductions, and limits.
- Statement indicating the group’s master policy should be reviewed to identify the contractual conditions that govern the relationship.G.
- If an application for a contract or certificate for long-term care insurance is accepted, the issuer must send the contract or certificate to the applicant within 30 days after approval.H.
An insurer must inform a claimant of the acceptance or denial of a claim under a long-term care insurance policy within fifteen business days of receiving a claim if the insurer has received the paperwork it reasonably necessary to evaluate responsibility.
If the insurer requires more than fifteen working days, the insurer must notify the claimant of the need for further time and explain why it is necessary within fifteen days. The determination should not exceed sixty days.I. If an insurer denies a claim under a policy for long-term care insurance, the insurer must: 1.
Provide the policyholder, certificate holder, or designated representative of the policyholder or certificate holder with a written explanation of the reasons for the denial, including a reference to any specific policy provision, condition, or exclusion supporting the denial.2.
What is a coverage outline?
20-1691.06 – Coverage summary; certificate 20-1691.06 Coverage summary; certificate A. At the time of initial solicitation, an applicant for a long-term care insurance policy must receive a summary of coverage using means that draw the recipient’s attention to the document and its purpose.
In the event of direct response solicitations, the coverage summary must be delivered with an application or enrollment form. In the case of solicitation by an insurance producer, the insurance producer must provide a summary of coverage prior to the presentation of an application or enrollment form.
The coverage overview must include all of the following: A description of the primary coverage and benefits provided by the insurance.2.A description of the policy’s key exclusions, reductions, and limits.3. A description of the renewal provisions, including any right to adjust rates reserved in the policy and any continuation or conversion provisions of group coverage.
A statement indicating that the summary of coverage is a summary of the policy issued or applied for and that the policy should be reviewed to ascertain the contractually controlling terms. The conditions under which the policy or certificate can be returned and the premium repaid. Describe the link between care costs and benefits.
A declaration and explanation of whether the policy is a qualifying long-term care insurance contract.B. An overview of coverage is not needed for a long-term care insurance policy provided to a group as described in section 20-1691, paragraph 4, subdivision (a), if the information mentioned in subsection A of this section is contained in other enrollment-related materials.
On request, an insurer shall provide the director with the additional materials.C. Upon delivery of an individual life insurance policy that includes long-term care benefits within the policy or via a rider, the policyholder must receive a policy summary. In the event of direct response solicitations, the insurer must provide the applicant with the policy summary upon request.
If a policy summary is not requested by the applicant, the insurer must give it at the time the policy is delivered. A policy summary must contain: A description of how the long-term care benefits interact with other policy components, such as deductions from death benefits.2.An description of the amount of benefits, duration of benefits, and, if applicable, guaranteed lifetime benefits for each insured individual.
Any exclusions, cutbacks, or restrictions on long-term care benefits. A statement indicating any state-mandated long-term care inflation protection option is not available under the insurance. A) A description of the consequences of exercising additional rights under the policy, if appropriate to the type of policy being issued.
(b) A disclosure of assurances that are connected to long-term care expenditures of insurance payments. (c) Existing and anticipated maximum lifetime benefits. A description of the monthly reporting requirements for life insurance plans that include an option for accelerated death payouts.D.
The contents of the policy summary required by subsection C of this section may be integrated into any illustration or policy summary required by this section.E. The insurer must provide a monthly report to the insured whenever a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, and the report must include the following information: Any rewards for long-term care given out throughout the month.2.
A description of any modifications to the policy, including death benefits or cash values, resulting from the payment of long-term care benefits. The quantity of existing or remaining long-term care coverage.F. A certificate issued pursuant to a group long-term care insurance policy delivered or issued for delivery in this state must contain all of the following information: A description of the primary coverage and benefits provided by the insurance.2.A description of the policy’s key exclusions, reductions, and limits.
Statement indicating the group’s master policy should be reviewed to identify the contractual conditions that govern the relationship.G. If an application for a contract or certificate for long-term care insurance is accepted, the issuer must send the contract or certificate to the applicant within 30 days after approval.H.
An insurer must inform a claimant of the acceptance or denial of a claim under a long-term care insurance policy within fifteen business days of receiving a claim if the insurer has received the paperwork it reasonably necessary to evaluate responsibility.
- If the insurer requires more than fifteen working days, the insurer must notify the claimant of the need for further time and explain why it is necessary within fifteen days.
- The determination should not exceed sixty days.I.
- If an insurer denies a claim under a policy for long-term care insurance, the insurer must: 1.
Provide the policyholder, certificate holder, or designated representative of the policyholder or certificate holder with a written explanation of the reasons for the denial, including a reference to any specific policy provision, condition, or exclusion supporting the denial.2.
There are five sections to any insurance policy: declarations, insuring agreements, definitions, exclusions, and conditions. Many policies feature a sixth part: endorsements. Utilize the following parts as a help when examining the policies.
Which of the following do shareholders own?
The owners of a corporation are their investors.
In a transaction involving a long-term care insurance policy, an Outline of Coverage must be provided to the applicant prior to the submission of the application form.