[§431:10H-205]  Continuation or conversion. 
(a)  Group long-term care insurance issued in this State beginning July 1,
2000, shall provide covered individuals with a basis for continuation or
conversion of coverage.



(b)  For purposes of this section, "a
basis for continuation of coverage" means a policy provision that
maintains coverage under the existing group policy when the coverage would
otherwise terminate and which is subject only to the continued timely payment
of premium when due.  Group policies that restrict provision of benefits and
services to, or contain incentives to use certain providers or facilities may
provide continuation benefits that are substantially equivalent to the benefits
of the existing group policy.  The commissioner shall make a determination as
to the substantial equivalency of benefits, and in doing so, shall take into
consideration the differences between managed care and non-managed care plans,
including but not limited to, provider system arrangements, service availability,
benefit levels, and administrative complexity.



(c)  For purposes of this section, "a
basis for conversion of coverage" means a policy provision that entitles
an individual, whose coverage under the group policy would otherwise terminate
or has been terminated for any reason including discontinuance of the group
policy in its entirety or with respect to an insured class, and who has been
continuously insured under the group policy or any group policy that it
replaced for at least six months immediately prior to termination shall be
entitled to the issuance of a converted policy by the insurer under whose group
policy the individual is covered, without evidence of insurability.



(d)  For purposes of this section,
"converted policy" means an individual policy of long-term care
insurance providing benefits identical to or benefits determined by the
commissioner to be substantially equivalent to or in excess of those provided
under the group policy from which conversion is made.  Where the group policy
from which conversion is made restricts provision of benefits and services to,
or contains incentives to use certain providers or facilities, the
commissioner, in making a determination as to substantial equivalency of
benefits, shall take into consideration the differences between managed care
and non-managed care plans, including but not limited to, provider system
arrangements, service availability, benefit levels, and administrative
complexity.



(e)  Written application for the converted
policy shall be made and the first premium, if any, shall be paid as directed
by the insurer no later than thirty-one days after termination of coverage
under the group policy.  The converted policy shall be issued effective on the
day following the termination of coverage under the group policy, and shall be
renewable annually.



(f)  Unless the group policy from which
conversion is made replaced previous group policy coverage, the premium for the
converted policy shall be calculated on the basis of the insured's age at
inception of coverage under the group policy from which conversion is made. 
Where the group policy from which conversion is made replaced a previous group
coverage, the premium for the converted policy shall be calculated on the basis
of the insured's age at inception of coverage under the group policy replaced.



(g)  Continuation of coverage or issuance of a
converted policy shall be mandatory, except where:



(1)  Termination of group coverage resulted from an
individual's failure to make any required payment of premium or contribution
when due; or



(2)  The terminating coverage is replaced not later
than thirty-one days after termination by another group coverage effective on
the day following the termination of coverage:



(A)  Providing benefits or benefits determined
by the commissioner to be identical substantially equivalent to or in excess of
those provided by the terminating coverage; and



(B)  The premium for which is calculated in a
manner consistent with the requirements of subsection (f).



(h)  Notwithstanding any other provision of
this section, a converted policy issued to an individual who at the time of
conversion is covered by another long-term care insurance policy that provides
benefits on the basis of incurred expenses, may contain a provision that results
in a reduction of benefits payable if the benefits provided under the
additional coverage, together with the full benefits provided by the converted
policy, would result in payment of more than one hundred per cent of incurred
expenses.  The provision shall only be included in the converted policy if the
converted policy also provides for a premium decrease or refund which reflects
the reduction in benefits payable.



(i)  The converted policy may provide that the
benefits payable under the converted policy, together with the benefits payable
under the group policy from which conversion is made, shall not exceed those
that would have been payable had the individual's coverage under the group
policy remained in force and effect.



(j)  Notwithstanding any other provision of
this section, an insured individual whose eligibility for group long-term care
coverage is based upon the individual's relationship to another person shall be
entitled to continuation of coverage under the group policy upon termination of
the qualifying relationship by death or dissolution of marriage or reciprocal
beneficiary relationship.



(k)  For purposes of this section "managed
care plan" is a health care or assisted living arrangement designed to
coordinate patient care or control costs through utilization review, case
management, or use of specific provider networks. [L 1999, c 93, pt of §2]