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304.14-600 Definitions for KRS 304.14-600 to 304.14-625.
As used in KRS 304.14-600 to 304.14-625, unless the context requires otherwise:
(1) "Incidental" indicates that the value of the long-term care benefits provided in a
policy is less than ten percent (10%) of the total value of the benefits provided
over the life of the policy. Policies may include life insurance, disability
insurance, and annuities. These values shall be measured as of the date of
issue;
(2) "Long-term care insurance" means any insurance policy or rider advertised,
marketed, offered, or designed to provide coverage for not less than twelve
(12) consecutive months for each covered person on an expense-incurred,
indemnity, prepaid, or other basis for one (1) or more necessary or medically
necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or
personal care services, provided in a setting other than an acute care unit of a
hospital unless the hospital or unit is licensed or certified to provide long-term
services. This term includes group and individual annuities and life insurance
policies or riders which provide directly or which supplement long-term care
insurance. This term includes a policy or rider which provides for payment of
benefits based upon cognitive impairment or the loss of functional capacity.
This term also includes qualified long-term care insurance contracts as defined
in 26 U.S.C. sec. 7702B(b). Long-term care insurance may be issued by
insurers, fraternal benefit societies, nonprofit hospital, medical-surgical, dental,
and health service corporations, health maintenance organizations, or any
similar organization to the extent they are otherwise authorized to issue life or
health insurance. Long-term care insurance shall not include any insurance
policy which is offered primarily to provide basic Medicare supplement
coverage, basic hospital expense coverage, basic medical-surgical expense
coverage, hospital confinement indemnity coverage, major medical expense
coverage, disability income or related asset-protection coverage, accident only
coverage, specified disease or specified accident coverage, or limited benefit
coverage. With regard to life insurance, this term does not include life
insurance policies which accelerate the death benefit specifically for one (1) or
more of the qualifying events of terminal illness, medical conditions requiring
extraordinary medical intervention, or permanent institutional confinement, and
which provide the option of a lump-sum payment for those benefits and in
which neither the benefits nor the eligibility for the benefits is conditioned upon
the receipt of long-term care. Any product advertised, marketed, or offered as
long-term care insurance or nursing home insurance which otherwise meets
the definition of long-term care insurance shall be subject to the provisions of
KRS 304.14-600 to 304.14-625;
(3) "Applicant" means:
(a) In the case of an individual long-term care insurance policy, the person
who seeks to contract for benefits; and
(b) In the case of a group long-term care insurance policy, the proposed
certificate holder;
(4) "Certificate" means any certificate issued under a group long-term care
insurance policy, which policy has been delivered or issued for delivery in
Kentucky, except as provided in KRS 304.14-610;
(5)
(6)
"Group long-term care insurance" means a long-term care insurance policy
which is delivered or issued for delivery in Kentucky by an insurer, fraternal
benefit society, nonprofit health service corporation, or health maintenance
organization, and which is issued to:
(a) One (1) or more employers or labor organizations, or to a trust or to the
trustees of a fund established by one (1) 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 organizations;
(b) Any professional, trade, or occupational association for its members or
former or retired members, or combination thereof, if the association:
1.
Is composed of individuals all of whom are or were actively engaged
in the same profession, trade, or occupation; and
2.
Has been maintained in good faith for purposes other than obtaining
insurance;
(c) An association or a trust or the trustee of a fund established, created, or
maintained for the benefit of members of one (1) or more associations.
Prior to advertising, marketing, or offering the policy within Kentucky, the
insurer of the association shall file with the commissioner evidence that
the association has at the outset a minimum of one hundred (100)
persons and has been organized and maintained in good faith for
purposes other than that of obtaining insurance, has been in active
existence for at least one (1) year, and has a constitution and bylaws
which provide:
1.
The association holds regular meetings not less than annually to
further the purposes of the members;
2.
Except for credit unions, the association collects dues or solicits
contributions from members; and
3.
The members have voting privileges and representation on the
governing board and committees.
The association shall be deemed to satisfy the organizational
requirements unless the commissioner makes a finding that the
association does not satisfy those organizational requirements within the
time set forth in KRS 304.14-120; or
(d) A group other than that described in paragraphs (a), (b), and (c) of this
subsection, subject to a finding by the commissioner that:
1.
The issuance of the group policy is not contrary to the best interest
of the public;
2.
The issuance of the group policy would result in economies of
acquisition or administration; and
3.
The benefits are reasonable in relation to the premiums charged;
and
"Policy" means any policy, contract, subscriber, agreement, enrollment
agreement, rider, or endorsement delivered or issued for delivery in Kentucky.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1163, effective July 15, 2010. -Amended 2002 Ky. Acts ch. 304, sec. 12, effective July 15, 2002. -- Created
1992 Ky. Acts ch. 423, sec. 1, effective July 14, 1992.
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