40-2228.Same; rules and regulations; prohibitions;preexisting condition provisions; delivery of outline of coverage uponapplication required.(a) The commissioner may adopt reasonable rules and regulations:
(1) To establish specific standards for policy provisions of long-termcare insurance policies. Such standards shall be in addition to and inaccordance with applicable laws of this state, and shall address terms ofrenewability, initial and subsequent conditions of eligibility,nonduplication of coverage provisions, coverage of dependents, preexistingconditions, termination of insurance, probationary periods, limitations,exceptions, reductions, elimination periods, requirements for replacement,recurrent conditions and definitions of terms, except that no regulationshall limit the number of days contained in an elimination period ofconfinementina nursing facility or for all confinements in a nursing facility which are dueto the same or related causes and separated from each other by less than 180days; and
(2) to specify prohibited policy provisions not otherwise specificallyauthorized by statute which, in the opinion of the commissioner, areunjust, unfair or unfairly discriminatory to any person insured under along-term care insurance policy.
(b) Rules and regulations adopted by the commissioner shall:
(1) Recognize the unique, developing and experimental nature oflong-term care insurance; and
(2) recognize the appropriate distinctions necessary between group andindividual long-term care insurance policies.
(c) The commissioner may adopt rules and regulations establishing loss-ratiostandards for long-term care insurance policies if a specific reference tolong-term care insurance policies is contained in the rules and regulations.
(d) No long-term care insurance policy may:
(1) Be canceled, nonrenewed, or otherwise terminated solely on thegrounds of the age or the deterioration of the mental or physical health ofthe insured individual or certificateholder; or
(2) contain a provision establishing any new waiting period in the eventexisting coverage is converted to or replaced by a new or other form withinthe same company, except with respect to an increase in benefitsvoluntarily selected by the insured individual or group policyholder.
(e) (1) No long-term insurance policy or certificate shall use adefinition of preexisting condition which is more restrictive than thefollowing: "Preexisting condition" meansa condition for which medical advice or treatment was recommended by, orreceived from a provider of health care services, within six months precedingthe effective date of coverage of an insured person.
(2) No long-term care insurance policy shall exclude coverage for a lossor confinement which is the result of a preexisting condition unless suchloss or confinement begins within six months following the effectivedate of coverage of an insured person.
(3) The commissioner may extend the limitation periods set forth insubsections (e)(1) and (e)(2) above as to specific age group categories orspecific policy forms upon finding that the extension is not contrary tothe best interest of the public.
(4) The definition of preexisting condition shall not prohibit aninsurer from using an application form designed to elicit the completehealth history of an applicant, and, on the basis of the answers on thatapplication, from underwriting in accordance with that insurer'sestablished underwriting standards.
(f) No long-term care insurance policy shall require priorinstitutionalization as a condition precedent to the payment of benefits.
(g) In order to provide for fair disclosure in the sale of long-termcare insurance policies:
(1) An outline of coverage shall be delivered to an applicant for along-term care insurance policy at the time of application. In the case ofdirect response solicitations, the insurer shall deliver the outline ofcoverage upon the applicant's request, but regardless of request, shallmake such delivery no later than at the time of policy delivery. Suchoutline of coverage shall include:
(A) A description of the principal benefitsand coverage provided in the policy;
(B) a statement of the principal exclusions, reductions and limitationscontained in the policy;
(C) a statement of the renewal provisions, including any reservation inthe policy of a right to change premiums; and
(D) a statement that the outline of coverage is a summary of the policyissued or applied for, and that the policy should be consulted to determinegoverning contractual provisions.
(2) A certificate issued pursuant to a group long-term care insurancepolicy which policy is delivered or issued for delivery in this state shallinclude the information required by subsection (g)(4) of K.S.A. 40-2209,and amendments thereto.
(h) No policy shall be advertised, marketed or offered as long-term careinsurance unless it complies with the provisions of this act.
40-2228.Same; rules and regulations; prohibitions;preexisting condition provisions; delivery of outline of coverage uponapplication required.(a) The commissioner may adopt reasonable rules and regulations:
(1) To establish specific standards for policy provisions of long-termcare insurance policies. Such standards shall be in addition to and inaccordance with applicable laws of this state, and shall address terms ofrenewability, initial and subsequent conditions of eligibility,nonduplication of coverage provisions, coverage of dependents, preexistingconditions, termination of insurance, probationary periods, limitations,exceptions, reductions, elimination periods, requirements for replacement,recurrent conditions and definitions of terms, except that no regulationshall limit the number of days contained in an elimination period ofconfinementina nursing facility or for all confinements in a nursing facility which are dueto the same or related causes and separated from each other by less than 180days; and
(2) to specify prohibited policy provisions not otherwise specificallyauthorized by statute which, in the opinion of the commissioner, areunjust, unfair or unfairly discriminatory to any person insured under along-term care insurance policy.
(b) Rules and regulations adopted by the commissioner shall:
(1) Recognize the unique, developing and experimental nature oflong-term care insurance; and
(2) recognize the appropriate distinctions necessary between group andindividual long-term care insurance policies.
(c) The commissioner may adopt rules and regulations establishing loss-ratiostandards for long-term care insurance policies if a specific reference tolong-term care insurance policies is contained in the rules and regulations.
(d) No long-term care insurance policy may:
(1) Be canceled, nonrenewed, or otherwise terminated solely on thegrounds of the age or the deterioration of the mental or physical health ofthe insured individual or certificateholder; or
(2) contain a provision establishing any new waiting period in the eventexisting coverage is converted to or replaced by a new or other form withinthe same company, except with respect to an increase in benefitsvoluntarily selected by the insured individual or group policyholder.
(e) (1) No long-term insurance policy or certificate shall use adefinition of preexisting condition which is more restrictive than thefollowing: "Preexisting condition" meansa condition for which medical advice or treatment was recommended by, orreceived from a provider of health care services, within six months precedingthe effective date of coverage of an insured person.
(2) No long-term care insurance policy shall exclude coverage for a lossor confinement which is the result of a preexisting condition unless suchloss or confinement begins within six months following the effectivedate of coverage of an insured person.
(3) The commissioner may extend the limitation periods set forth insubsections (e)(1) and (e)(2) above as to specific age group categories orspecific policy forms upon finding that the extension is not contrary tothe best interest of the public.
(4) The definition of preexisting condition shall not prohibit aninsurer from using an application form designed to elicit the completehealth history of an applicant, and, on the basis of the answers on thatapplication, from underwriting in accordance with that insurer'sestablished underwriting standards.
(f) No long-term care insurance policy shall require priorinstitutionalization as a condition precedent to the payment of benefits.
(g) In order to provide for fair disclosure in the sale of long-termcare insurance policies:
(1) An outline of coverage shall be delivered to an applicant for along-term care insurance policy at the time of application. In the case ofdirect response solicitations, the insurer shall deliver the outline ofcoverage upon the applicant's request, but regardless of request, shallmake such delivery no later than at the time of policy delivery. Suchoutline of coverage shall include:
(A) A description of the principal benefitsand coverage provided in the policy;
(B) a statement of the principal exclusions, reductions and limitationscontained in the policy;
(C) a statement of the renewal provisions, including any reservation inthe policy of a right to change premiums; and
(D) a statement that the outline of coverage is a summary of the policyissued or applied for, and that the policy should be consulted to determinegoverning contractual provisions.
(2) A certificate issued pursuant to a group long-term care insurancepolicy which policy is delivered or issued for delivery in this state shallinclude the information required by subsection (g)(4) of K.S.A. 40-2209,and amendments thereto.
(h) No policy shall be advertised, marketed or offered as long-term careinsurance unless it complies with the provisions of this act.
40-2228.Same; rules and regulations; prohibitions;preexisting condition provisions; delivery of outline of coverage uponapplication required.(a) The commissioner may adopt reasonable rules and regulations:
(1) To establish specific standards for policy provisions of long-termcare insurance policies. Such standards shall be in addition to and inaccordance with applicable laws of this state, and shall address terms ofrenewability, initial and subsequent conditions of eligibility,nonduplication of coverage provisions, coverage of dependents, preexistingconditions, termination of insurance, probationary periods, limitations,exceptions, reductions, elimination periods, requirements for replacement,recurrent conditions and definitions of terms, except that no regulationshall limit the number of days contained in an elimination period ofconfinementina nursing facility or for all confinements in a nursing facility which are dueto the same or related causes and separated from each other by less than 180days; and
(2) to specify prohibited policy provisions not otherwise specificallyauthorized by statute which, in the opinion of the commissioner, areunjust, unfair or unfairly discriminatory to any person insured under along-term care insurance policy.
(b) Rules and regulations adopted by the commissioner shall:
(1) Recognize the unique, developing and experimental nature oflong-term care insurance; and
(2) recognize the appropriate distinctions necessary between group andindividual long-term care insurance policies.
(c) The commissioner may adopt rules and regulations establishing loss-ratiostandards for long-term care insurance policies if a specific reference tolong-term care insurance policies is contained in the rules and regulations.
(d) No long-term care insurance policy may:
(1) Be canceled, nonrenewed, or otherwise terminated solely on thegrounds of the age or the deterioration of the mental or physical health ofthe insured individual or certificateholder; or
(2) contain a provision establishing any new waiting period in the eventexisting coverage is converted to or replaced by a new or other form withinthe same company, except with respect to an increase in benefitsvoluntarily selected by the insured individual or group policyholder.
(e) (1) No long-term insurance policy or certificate shall use adefinition of preexisting condition which is more restrictive than thefollowing: "Preexisting condition" meansa condition for which medical advice or treatment was recommended by, orreceived from a provider of health care services, within six months precedingthe effective date of coverage of an insured person.
(2) No long-term care insurance policy shall exclude coverage for a lossor confinement which is the result of a preexisting condition unless suchloss or confinement begins within six months following the effectivedate of coverage of an insured person.
(3) The commissioner may extend the limitation periods set forth insubsections (e)(1) and (e)(2) above as to specific age group categories orspecific policy forms upon finding that the extension is not contrary tothe best interest of the public.
(4) The definition of preexisting condition shall not prohibit aninsurer from using an application form designed to elicit the completehealth history of an applicant, and, on the basis of the answers on thatapplication, from underwriting in accordance with that insurer'sestablished underwriting standards.
(f) No long-term care insurance policy shall require priorinstitutionalization as a condition precedent to the payment of benefits.
(g) In order to provide for fair disclosure in the sale of long-termcare insurance policies:
(1) An outline of coverage shall be delivered to an applicant for along-term care insurance policy at the time of application. In the case ofdirect response solicitations, the insurer shall deliver the outline ofcoverage upon the applicant's request, but regardless of request, shallmake such delivery no later than at the time of policy delivery. Suchoutline of coverage shall include:
(A) A description of the principal benefitsand coverage provided in the policy;
(B) a statement of the principal exclusions, reductions and limitationscontained in the policy;
(C) a statement of the renewal provisions, including any reservation inthe policy of a right to change premiums; and
(D) a statement that the outline of coverage is a summary of the policyissued or applied for, and that the policy should be consulted to determinegoverning contractual provisions.
(2) A certificate issued pursuant to a group long-term care insurancepolicy which policy is delivered or issued for delivery in this state shallinclude the information required by subsection (g)(4) of K.S.A. 40-2209,and amendments thereto.
(h) No policy shall be advertised, marketed or offered as long-term careinsurance unless it complies with the provisions of this act.
