2009 California Insurance Code - Section 10231-10231.8 :: Article 1. Definitions

10231.  Unless the context requires otherwise, the definitions in
this article shall govern the construction of this chapter.

10231.2.  "Long-term care insurance" includes any insurance policy,
certificate, or rider advertised, marketed, offered, solicited, or
designed to provide coverage for diagnostic, preventive, therapeutic,
rehabilitative, maintenance, or personal care services that are
provided in a setting other than an acute care unit of a hospital.
Long-term care insurance includes all products containing any of the
following benefit types: coverage for institutional care including
care in a nursing home, convalescent facility, extended care
facility, custodial care facility, skilled nursing facility, or
personal care home; home care coverage including home health care,
personal care, homemaker services, hospice, or respite care; or
community-based coverage including adult day care, hospice, or
respite care. Long-term care insurance includes disability based
long-term care policies but does not include insurance designed
primarily to provide Medicare supplement or major medical expense
coverage.
   Long-term care policies, certificates, and riders shall be
regulated under this chapter. The commissioner shall review and
approve individual and group policies, certificates, riders, and
outlines of coverage. Other applicable laws and regulations shall
also apply to long-term care insurance insofar as they do not
conflict with the provisions in this chapter. Long-term care benefits
designed to provide coverage of 12 months or more that are contained
in or amended to Medicare supplement or other disability policies
and certificates shall be regulated under this chapter.

10231.4.  "Applicant" means either of the following:
   (a) In the case of an individual long-term care insurance policy,
the person who seeks to contract for benefits.
   (b) In the case of a group long-term care insurance policy, the
proposed certificate holder.

10231.5.  "Certificate" means any certificate issued under a group
long-term care insurance policy, which policy has been delivered or
issued for delivery in this state.

10231.6.  "Group long-term care insurance" means a long-term care
insurance policy which is delivered or issued for delivery in this
state and issued to any of the following:
   (a) One or more employers or labor organizations, or a trust or to
the trustees of a fund established by one or more employers or labor
organizations, or a combination thereof, for employees or former
employees or a combination thereof or for members or former members
or a combination thereof, of the labor organization.
   (b) Any professional, trade, or occupational association for its
members or former or retired members, or combination thereof, if that
association meets both of the following:
   (1) Is composed of individuals all of whom are or were actively
engaged in the same profession, trade, or occupation.
   (2) Has been maintained in good faith for purposes other than
obtaining insurance.
   (c) An association or a trust or the trustees of a fund
established, created, or maintained for the benefit of members of one
or more associations. Prior to advertising, marketing, or offering
that policy or a certificate within this state, the association or
associations, or the insurer of the association or associations,
shall file evidence with the commissioner that the association or
associations have at the outset a minimum of 100 persons and have
been organized and maintained in good faith for a primary purpose
other than that of obtaining insurance, have been in active existence
for at least one year, have a constitution and bylaws which provide
all of the following, and provide evidence that the following have
been consistently implemented:
   (1) The association or associations hold regular meetings, not
less than annually, to further purposes of the members.
   (2) Except for credit unions, the association or associations
collect dues or solicit contributions from members.
   (3) The members have voting privileges and representation on the
governing board and committees.
   Thirty days after that filing the association or associations
shall be deemed to satisfy these organizational requirements, unless
the commissioner makes a finding that the association or associations
do not satisfy those organizational requirements.
   (d) A group other than as described in subdivisions (a), (b), and
(c), subject to all of the following findings by the commissioner:
   (1) The issuance of the group policy or certificate is not
contrary to the best interest of the public.
   (2) The issuance of the group policy will result in economies of
acquisition or administration.
   (3) The benefits are reasonable in relation to the premiums
charged.
   (4) The use of the true or fictitious name of the group, group
master policyholder, group policy, certificate, or any trust or other
entity created or used for the marketing of the group policy or
certificates is not deceptive or misleading with regard to the
status, character, or proprietary or representative capacity of the
insurer, group, trust, or other entity.
   (5) The group's main revenue source is not related to the
marketing of insurance.
   (6) The group's outreach method to obtain new members is not
related to the solicitation of insurance.
   (7) The group provides benefits or services, other than insurance,
of significant value to its members. The commissioner shall
investigate the percentage of members using the other services and
the monetary value of those services.
   (e) A life care contract provider which has received a certificate
of authority in accordance with Chapter 10 (commencing with Section
1770) of Division 2 of the Health and Safety Code. Any life care
contract provider which has not received the certificate of authority
from the State Department of Social Services shall be subject to
this chapter.

10231.8.  "Policy" means any policy, contract, subscriber agreement,
rider or endorsement delivered or issued for delivery in this state
by an insurer, fraternal benefit society, nonprofit hospital service
plan, or any similar organization, regulated by the commissioner.