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31.14.01.00.htm 31.14.01.00. Title 31 MARYLAND INSURANCE ADMINISTRATION Subtitle 14 LONG-TERM CARE Chapter 01 Long-Term Care Insurance Authority: Health-General Article, §19-705; Insurance Article, §2-109, 14-124, Title 18, Subtitle 1, and Title 27; Annotated Code of Maryland
31.14.01.01.htm 31.14.01.01. 01 Applicability and Scope.. Except as otherwise specifically provided, this chapter applies to all long-term care insurance policies delivered or issued for delivery in this State on or after the effective date by insurers, nonprofit health service plans, and health maintenance organizations. These regulations are not intended to supersede other applicable insurance laws or regulations which do not conflict with this chapter.
31.14.01.02.htm 31.14.01.02. 02 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) "Activities of daily living" means at least bathing, continence, dressing, eating, toileting, and transferring.2) "Acute condition" means that the individual is medically unstable and requires frequent monitoring by physicians, registered nurses, or other medical professionals in order to maintain the individual's health status.3) "Adult day care" means
31.14.01.03.htm 31.14.01.03. 03 Policy Terms.. A. A long-term care policy shall define "skilled nursing care" "intermediate care" "domiciliary care" "custodial care" "personal care" "home care" "specialized care" "assisted living care" and other services in relation to the level of skill required, the nature of the care, and the setting in which care shall be delivered.B. Definitions in Contracts Regarding Providers of Services.. 1) A long-term care insurance policy shall define all providers of services
31.14.01.04.htm 31.14.01.04. 04 Policy Practices and Provisions.. A. Renewability and Premium Charges.. 1) Renewability Provision.. a) Individual long-term care insurance policies shall contain an appropriately captioned renewability provision on the first page of the policy form.b) The renewability provision shall clearly state that the coverage is guaranteed renewable or noncancellable.c) Section A(1)a) of this regulation is not applicable to policies that do not contain a renewability provision and under whi
31.14.01.05.htm 31.14.01.05. 05 Disclosure.. A. Riders and Endorsements.. 1) Except for riders or endorsements by which the insurer fulfills a request made in writing by the policyholder under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after the date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage of the policy shall require signed acceptance by the policyholder.2) After the date of poli
31.14.01.06.htm 31.14.01.06. 06 Requirements for Applications.. A. If the application for a long-term care insurance policy is to be made part of the policy or certificate, the insurer shall print:1) Conspicuously and in close conjunction with the applicant's signature block on the application form for the policy or certificate:CAUTION: If your answers on this application are incorrect or untrue, the insurance company may have the right to deny benefits or rescind your policy.
31.14.01.07.htm 31.14.01.07. 07 Person To Be Notified.. A. Except as provided in §E of this regulation, an insurer may not issue an individual long-term care insurance policy or certificate to an insured until the insurer has received from the applicant either a written:1) Designation of at least one person in addition to the insured who is to receive notice of termination of the policy or certificate for nonpayment of premium; or2) Waiver dated and signed by the applicant electing not to designate addit
31.14.01.08.htm 31.14.01.08. 08 Applicant's Options.. A. Except as provided in §B and C of this regulation, the application for a long-term care insurance policy or certificate, or a form attached to the policy or certificate, shall contain a statement to be signed separately by the applicant to the effect that the:1) Applicant has been informed of the applicant's right to:. a) Designate a person to receive any notice of termination;. b) Purchase:. i) Inflation protection,.
31.14.01.09.htm 31.14.01.09. 09 Prohibition Against Post-Claims Underwriting.. A. Except in a case of guaranteed issue, application forms for long-term care insurance policies or certificates shall contain clear and unambiguous questions designed to ascertain the condition of health of the applicant.B. Medical Condition―Medication.. 1) If an application for long-term care insurance contains a question which asks whether the applicant has had medication prescribed by a physician, it shall also ask the appl
31.14.01.10.htm 31.14.01.10. 10 Preexisting Condition and Waiting Period Provisions in Replacement Policies.. If a long-term care insurance policy or certificate replaces other long-term care coverage, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods in the new long-term care policy or certificate for similar benefits to the extent that corresponding time periods have been satisfied under the original policy.
31.14.01.11.htm 31.14.01.11. 11 Minimum Standards for Home Health Care Benefits in Long-Term Insurance Policies.. A. Optional Home Health Care Benefit.. 1) An insurer issuing a long-term care insurance policy shall offer the applicant for the policy the option to purchase a policy that provides for home health care benefits in addition to the benefits provided for nursing home care.2) The benefits required to be offered for home health care under this section are as follows:. a) If the benefit for nur
31.14.01.12.htm 31.14.01.12. 12 Requirement To Offer Inflation Protection.. A. An insurer issuing a long-term care insurance policy shall offer the applicant for the policy the option to purchase a policy that provides for benefit levels to increase at a rate not less than 5 percent compounded annually.B. Instead of the requirement of §A of this regulation, the insurer may offer a policy that guarantees the policyholder the right to increase periodically benefit levels without providing evidence of
31.14.01.13.htm 31.14.01.13. 13 Nonforfeiture Benefit Requirement.. A. This regulation does not apply to life insurance policies or riders containing accelerated death benefits for long-term care.B. Required Option.. 1) An insurer may not deliver or issue a long-term care insurance policy in Maryland unless the option of purchasing a policy including a nonforfeiture benefit has been offered to the:a) Applicant, when the policy is an individual long-term care insurance policy;.
31.14.01.14.htm 31.14.01.14. 14 Group Coverage.. Group long-term care insurance coverage may not be offered to a resident of this State under a group policy issued in another jurisdiction unless the coverage complies with the statutes and regulations pertaining to group long-term care insurance issued in this State.
31.14.01.15.htm 31.14.01.15. 15 Advertising.. A. An insurer soliciting long-term care insurance in the State shall provide the Commissioner with a copy of any long-term care insurance advertisement intended for use in the State. For purposes of this regulation, "advertising" includes any material:1) Published, disseminated, circulated, or placed before the public in a newspaper, magazine, or other publication;2) In the form of a notice, circular, pamphlet, letter, or poster;.
31.14.01.16.htm 31.14.01.16. 16 Standards for Marketing.. A. An insurer marketing long-term care insurance coverage in Maryland, either directly or through its producers, shall:1) Establish marketing procedures and insurance producer requirements to ensure that:. a) Any comparison of policies by its producers is fair and accurate; and. b) Excessive insurance is not sold or issued;. 2) Display prominently by type, stamp, or other appropriate means, on the first page of the outline of coverage and of the po
31.14.01.17.htm 31.14.01.17. 17 Appropriateness of Recommended Purchase.. A. In recommending the purchase or replacement of any long-term care insurance policy or certificate, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.B. In recommending the purchase or replacement of any long-term care insurance policy or certificate, the insurer or its agent shall make a reasonable effort to identify whether a prospective applicant for long-term care insu
31.14.01.18.htm 31.14.01.18. 18 Outline of Coverage.. A. An insurer or the agent soliciting long-term care coverage shall deliver to a prospective applicant, at the time of the initial solicitation, an outline of coverage in a manner which prominently directs the attention of the recipient to the document and its purpose.B. Time of Delivery. In the case of:. 1) Solicitation by an agent, the agent shall deliver the outline of coverage before presenting an applicant or enrollment form to the prospective appl
31.14.01.19.htm 31.14.01.19. 19 Requirement To Deliver Buyer's Guide.. A. An insurer or agent shall deliver a long-term care insurance buyer's guide to prospective applicants of long-term care coverage in a format developed by the National Association of Insurance Commissioners or in a format approved by the Commissioner.B. The insurer shall include in the buyer's guide information regarding the purchase of a long-term care insurance policy, including a reference of the right of the purchaser
31.14.01.20.htm 31.14.01.20. 20 Waivers.. The Commissioner may issue, upon written request and after an administrative hearing, an order to modify or suspend a specific provision or provisions of this chapter with respect to a specific long-term care insurance policy or certificate upon a written finding that:A. The modification or suspension would be in the best interest of the insureds;. B. The purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and
31.14.01.21.htm 31.14.01.21. 21 Form of Outline of Coverage.. The format and the required text of the outline of coverage referred to in Regulation .18E of this chapter shall read as follows:COMPANY NAME] ADDRESS―CITY AND STATE] TELEPHONE NUMBER] LONG-TERM CARE INSURANCE OUTLINE OF COVERAGE. Policy Number or Group Master Policy and Certificate Number). Except for policies or certificates which are guaranteed issue, the following caution statement, or language substantially similar, must appear as fol
31.14.01.22.htm 31.14.01.22. 22 Replacement Notice.. The notice to an applicant regarding replacement of individual long-term care policies or other health insurance referred to in Regulation .06E of this chapter shall read as follows:NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL LONG-TERM CARE OR HEALTH INSURANCE (Insurance company's name and address) SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.According to [your application] [information you have furnished] you intend
31.14.01.23.htm 31.14.01.23. 23 Replacement Notice for Direct Response Business.. The notice to an applicant with respect to direct response solicitation of individual long-term care policies or other health insurance referred to in Regulation .06F of this chapter shall read as follows:NOTICE TO APPLICANT REGARDING REPLACEMENT OF LONG-TERM CARE OR HEALTH INSURANCE (Insurance company's name and address) SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTUREAccording to [your application] [information you h
31.14.01.24.htm 31.14.01.24. 24 Reporting Requirements.. A. Every insurer shall maintain records for each insurance producer of the:. 1) Insurance producer's amount of replacement sales as a percent of the insurance producer's total annual sales; and2) Amount of lapses of long-term care insurance policies sold by the insurance producer as a percent of the insurance producer's total annual sales.B. Each insurer shall report annually by June 30 the 10 percent of its insurance producers with the
31.14.01.25.htm 31.14.01.25. 25 Suitability.. A. This regulation does not apply to life insurance policies that accelerate the death benefits for long-term care.B. Each insurer shall:. 1) Develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the applicant;2) Train its insurance producers in the use of its suitability standards; and. 3) Maintain a copy of its suitability standards and make them available for
31.14.01.26.htm 31.14.01.26. 26 Standards for Benefit Triggers.. A. Conditions for Payment of Benefits.. 1) A long-term care insurance policy shall condition the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment.2) An insurer may not establish the eligibility criteria for the payment of benefits on a more restrictive basis than:a) A deficiency in the ability to perform not more than three of the activities of daily living; or.
31.14.01.27.htm 31.14.01.27. 27 Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts.. A. In this regulation, the following terms have the meanings indicated.. B. Terms Defined.. 1) Chronically Ill Individual.. a) "Chronically ill individual" means any individual who has been certified by a licensed health care practitioner as:i) Being unable to perform, without substantial assistance from another individual, at least two activities of daily living f
31.14.01.28.htm 31.14.01.28. 28 Penalties.. In addition to any other penalties provided by the laws of this State, any insurer and any insurance producer found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of long-term care insurance shall be subject to a penalty of up to three times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater.
31.14.01.29.htm 31.14.01.29. 29 Rescission.. Reporting Form for Long-Term Care Policies. The following form is to be used for reporting rescissions made by each insurer as required by Regulation .09C of this chapter:RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE STATE OFFOR THE REPORTING YEAR 20[. Company Name: _. Address: _. Phone Number: _. Due: March 1 annually. Instructions:. The purpose of this form is to report all rescissions of long-term care insurance policies or certif
31.14.01.30.htm 31.14.01.30. 30 Things You Should Know Before You Buy Long-Term Care Insurance.. The following form is to be used for providing the disclosure required by Regulation .25F of this chapter:Things You Should Know Before You Buy Long-Term Care Insurance. Long-Term Care Insurance. A long-term care insurance policy may pay most of the costs for your care in a nursing home. Many policies also pay for care at home or other community settings. Since policies can vary in coverage, y
31.14.01.31.htm 31.14.01.31. 31 Long-Term Care Insurance Suitability Letter.. The following form is to be used for providing the disclosure required by Regulation .25G of this chapter:Long-Term Care Insurance Suitability Letter. Dear [Applicant]. Your recent application for long-term care insurance included a "personal worksheet, which asked questions about your finances and your reasons for buying long-term care insurance. For your protection, State law requires us to consider this informati
31.14.01.32.htm 31.14.01.32. 32 Claims Denial Reporting Form.. The following form is to be used for reporting claim denials made by each insurer as required by Regulation .24G of this chapter:Claims Denial Reporting Form Long-Term Care Insurance. For the State of. For the Reporting Year of. Company Name: _ Due: June 30 annually. Company Address: _. Company NAIC Number: _. Contact Person: _ Phone Number: _. Line of Business: _ Individual _ Group. Instructions. The purpose of this form is to report all long-ter
31.14.01.33.htm 31.14.01.33. 33 Incontestability Period.. A. Except as provided in §G of this regulation, §B―F of this regulation apply to each qualified long-term care insurance policy.B. Policies In Force Less Than 6 Months.. 1) This section applies to a long-term care insurance policy that has been in force for less than 6 months.2) Unless the insurer demonstrates that the applicant misrepresented information on the application for the long-term insurance policy that is material to the acceptance for c
31.14.01.34.htm 31.14.01.34. 34 Producer Training Requirements.. A. An insurance producer is not authorized to sell, solicit, or negotiate with respect to long-term care insurance except as authorized by Insurance Article, Title 10, Subtitle 1, Annotated Code of Maryland.B. An individual may not sell, solicit, or negotiate long-term care insurance unless the individual is licensed as an insurance producer for health insurance or life insurance and complies with the following training requirements:
31.14.01.35.htm 31.14.01.35. 35 Availability of New Services or Providers.. A. Notice Requirement.. 1) Except as provided in §B of this regulation, an insurer shall notify policyholders and certificate holders of the availability of a new long-term care insurance policy series that provides coverage for new long-term care services or providers, material in nature, and not previously available through the insurer to the general public.2) The notice required by §A(1) of this regulation shall be provided within
31.14.01.36.htm 31.14.01.36. 36 Right to Reduce Coverage and Lower Premiums.. A. Unless otherwise specified, the requirements of this regulation shall apply to any long-term care policy issued in Maryland on or after September 10, 2008.B. Required Provision in Long-Term Care Insurance Policies and Certificates.. 1) Every long-term care insurance policy and certificate shall include a provision that allows the policyholder or certificate holder to reduce coverage and lower the policy or certificate premium in
31.14.01.9999.htm 31.14.01.9999. Administrative History Effective date: September 1, 1994 (21:13 Md. R. 1156) ―. Chapter recodified from COMAR 09.30.88 to COMAR 31.14.01 effective September 7, 1998 (25:18 Md. R. 1439)Chapter revised effective April 1, 2002 (29:6 Md. R. 570) ―. Chapter revised effective September 10, 2007 (34:18 Md. R. 1581). Regulation .01 amended effective September 1, 2014 (41:17 Md. R. 972). Regulation .13E amended effective February 27, 2017 (44:4 Md. R. 256).
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