North Dakota Administrative Code
Title 45 - Insurance, Commissioner of
Article 45-06 - Accident and Health Insurance
Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION
Section 45-06-05.1-13 - Reporting requirements

Universal Citation: ND Admin Code ยง 45-06-05.1-13

Current through Supplement No. 394, October, 2024

1. Every insurer shall maintain records for each agent of that agent's amount of replacement sales as a percentage of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percentage of the agent's total annual sales.

2. Every insurer shall report annually by June thirtieth the ten percent of its agents with the greatest percentages of lapses and replacements as measured by subsection 1. (Appendix G)

3. Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance.

4. Every insurer shall report annually by June thirtieth the number of lapsed policies as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the end of the preceding calendar year. (Appendix G)

5. Every insurer shall report annually by June thirtieth the number of replacement policies sold as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the preceding calendar year. (Appendix G)

6. Every insurer shall report annually by June thirtieth, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied. (Appendix E)

7. For purposes of this section:

a. Subject to subdivision c, "claim" means a request for payment of benefits under an in-force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

b. "Denied" means the insurer refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition;

c. "Policy" means only long-term care insurance; and

d. "Report" means on a statewide basis.

8. Reports required under this section shall be filed with the commissioner.

General Authority: NDCC 28-32-02

Law Implemented: NDCC 26.1-45

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