NDAC 45-06-05-05
Required disclosure provisions
Cite as N.D. Admin. Code ยง 45-06-05-05
1.
Renewability. Individual long-term care insurance policies must contain a renewability
provision. Such provision must be appropriately captioned, must appear on the first page of
the policy, and must clearly state the duration, where limited, of renewability and the duration
of the term of coverage for which the policy is issued and for which it may be renewed.
2.
Riders and endorsements. Except for riders or endorsements by which the insurer
effectuates a request made in writing by the insured under an individual long-term care
insurance policy, all riders or endorsements added to an individual long-term care insurance
policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or
coverage in the policy must require signed acceptance by the individual insured. After the date
of policy issue, any rider or endorsement which increases benefits or coverage with a
concomitant increase in premium during the policy term must be agreed to in writing signed by
the insured, except if the increased benefits or coverage are required by law. Where a
separate additional premium is charged for benefits provided in connection with riders or
endorsements, such premium charge must be set forth in the policy, rider, or endorsement.
3.
Payment of benefits. A long-term care insurance policy which provides for the payment of
benefits based on standards described as "usual and customary", "reasonable and
customary", or words of similar import must include a definition of such terms and an
explanation of such terms in its accompanying outline of coverage.
4.
Limitations. If a long-term care insurance policy or certificate contains any limitations with
respect to preexisting conditions, such limitations must appear as a separate paragraph of the
policy or certificate and be labeled as "preexisting condition limitations".
5.
Other limitations or conditions on eligibility for benefits. Effective July 1, 1990, a
long-term care insurance policy or certificate containing any limitations or conditions for
eligibility other than those prohibited in subsection 2 of North Dakota Century Code section
26.1-45-07 must set forth a description of such limitations or conditions, including any required
number of days of confinement, in a separate paragraph of the policy or certificate and must
label such paragraph "limitations or conditions on eligibility for benefits".
6.
Disclosure of tax consequences. With regard to life insurance policies that provide an
accelerated benefit for long-term care, a disclosure statement is required at the time of
application for the policy or rider and at the time the accelerated benefit payment request is
submitted that receipt of these accelerated benefits may be taxable, and that assistance
should be sought from a personal tax adviser. The disclosure statement must be prominently
displayed on the first page of the policy or rider and any other related documents.