Ga. Comp. R. & Regs. R. 120-2-16-.08 - Required Disclosure Provisions
(1) Renewability. Individual long-term care
insurance policies shall contain a renewability provision.
(a) The provision shall be appropriately
captioned, shall appear on the first page of the policy, and shall clearly
state that the coverage is guaranteed renewable or noncancellable. This
provision shall not apply to policies that do not contain a renewability
provision, and under which the right to nonrenew is reserved solely to the
policyholder.
(b) A long-term care
insurance policy or certificate, other than one where the insurer does not have
the right to change the premium, shall include a statement that premium rates
may change.
(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 that reduce or eliminate benefits or coverage in the
policy shall 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, the premium
charge shall be set forth in the policy, rider or endorsement.
(3) Payment of Benefits. A long-term care
insurance policy that 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 these terms and an explanation of
the 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, the limitations shall appear as a separate paragraph of
the policy or certificate and shall be labeled as "Preexisting Condition
Limitations."
(5) Other Limitations
or Conditions on Eligibility for Benefits. A long-term care insurance policy or
certificate containing any limitations or conditions for eligibility other than
those prohibited in O.C.G.A. Section
33-42-6shall set forth a
description of the 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 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
advisor. The disclosure statement shall be prominently displayed on the first
page of the policy or rider and any other related documents. This subsection
shall not apply to qualified long-term care insurance contracts.
(7) Benefit Triggers. 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
section. 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 specified.
(8) A qualified long-term care insurance
contract shall include a disclosure statement in the policy and in the outline
of coverage as contained in Section
120-2-16-.31(5)
that the policy is intended to be a qualified long-term care insurance contract
under Section 7702B(b) of the Internal Revenue Code of 1986, as
amended.
(9) A nonqualified
long-term care insurance contract shall include a disclosure statement in the
policy and in the outline of coverage as contained in Section
120-2-16-.31(5)
that the policy is not intended to be a qualified long-term care insurance
contract.
Notes
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