(1) Individual long-term
care insurance policies and certificates shall contain a renewability
provision. Such provision shall be appropriately captioned, shall appear on the
first page of the policy or certificate, and shall clearly state the duration,
where limited, of renewability and the duration of the term of coverage for
which the policy or certificate is issued and for which it may be renewed. This
provision shall not apply to policies which do not contain a renewability
provision, and under which the right to nonrenew is reserved solely to the
(2) Except for riders or endorsements by which the issuer effectuates a request
made in writing by the insured under an individual long-term care
insurance policy or certificate, all riders or endorsements added to an
individual long-term care insurance policy or certificate after date of
issue or at reinstatement or renewal which reduce or eliminate benefits or
coverage in the policy or certificate shall require signed
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 shall be set forth
in the policy, certificate, rider or endorsement.
(3) Along-term care insurance policy or certificate which provides for the
payment of benefits based on standards described as "usual and
customary," "reasonable and customary," or words of similar
import shall include a definition of such terms in the policy or certificate
and an explanation of such terms in its accompanying outline of coverage.
(4) If a
long-term care insurance policy of certificate contains any limitations
with respect to preexisting conditions, such limitations shall appear as a
separate paragraph of the policy or certificate and shall be labeled as
"preexisting condition limitations."
long-term care insurance policy or certificate containing any limitations
or conditions for eligibility other than those prohibited in 33-22-1115(2) ,
MCA, shall 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 shall label such paragraph "limitations of conditions
on eligibility for benefits."
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 advisor. The disclosure
statement shall be prominently displayed on the first page of the policy or rider
and any other related documents.
(7) Activities of daily living and cognitive impairment shall be used to measure an
insured's need for long-term care and shall be described in the policy or
certificate in a separate paragraph and shall be labeled "Eligibility for
the Payment of Benefits." Any additional benefit triggers shall also be
explained in this rule. If these triggers differ for different benefits,
explanation of the trigger shall accompany each benefit description. If an
attending physician or other specified person must certify a certain level of
functional dependency in order to be eligible for benefits, this too shall be
qualified long-term care insurance contract shall include a disclosure
statement in the policy and/or certificate
the outline of coverage that the policy is intended to be a qualified long-term
care insurance contract.