Current through Supplement No. 394, October, 2024
Each insurer offering long-term care insurance shall, as a
protection against unintentional lapse, comply with the following:
1.
a.
Notice before lapse or termination. No individual long-term care
policy or certificate shall be issued until the insurer has received from the
applicant either a written designation of at least one person, in addition to
the applicant, who is to receive notice of lapse or termination of the policy
or certificate for nonpayment of premium, or a written waiver dated and signed
by the applicant electing not to designate additional persons to receive
notice. The applicant has the right to designate at least one person who is to
receive the notice of termination, in addition to the insured. Designation
shall not constitute acceptance of any liability on the third party for
services provided to the insured. The form used for the written designation
must provide space clearly designated for listing at least one person. The
designation shall include each person's full name and home address. In the case
of an applicant who elects not to designate an additional person, the waiver
shall state: "Protection against unintended lapse. I understand that I have the
right to designate at least one person other than myself to receive notice of
lapse or termination of this long-term care insurance policy for nonpayment of
premium. I understand that notice will not be given until thirty (30) days
after a premium is due and unpaid. I elect NOT to designate a person to receive
this notice."
The insurer shall notify the insured of the right to change
this written designation, no less often than once every two years.
b. When the policyholder or
certificate holder pays premium for a long-term care insurance policy or
certificate through a payroll or pension deduction plan, the requirements
contained in subdivision a need not be met until sixty days after the
policyholder or certificate holder is no longer on such a payment plan. The
application or enrollment form for such policies or certificates shall clearly
indicate the payment plan selected by the applicant.
c. Lapse or termination for nonpayment of
premium. No individual long-term care policy or certificate shall lapse or be
terminated for nonpayment of premium unless the insurer, at least thirty days
before the effective date of the lapse or termination, has given notice to the
insured and to those persons designated pursuant to subdivision a, at the
address provided by the insured for purposes of receiving notice of lapse or
termination. Notice shall be given by first-class United States mail, postage
prepaid, and notice may not be given until thirty days after a premium is due
and unpaid. Notice shall be deemed to have been given as of five days after the
date of mailing.
2.
Reinstatement. In addition to the requirement in subsection 1, a long-term care
insurance policy or certificate shall include a provision that provides for
reinstatement of coverage, in the event of lapse if the insurer is provided
proof that the policyholder or certificate holder was cognitively impaired or
had a loss of functional capacity before the grace period contained in the
policy expired. This option shall be available to the insured if requested
within five months after termination and shall allow for the collection of
past-due premium, when appropriate. The standard of proof of cognitive
impairment or loss of functional capacity shall not be more stringent than the
benefit eligibility criteria on cognitive impairment or the loss of functional
capacity contained in the policy and certificate.
General Authority: NDCC 28-32-02
Law Implemented: NDCC
26.1-45
