(a) With respect to the obligations set forth in this section, the primary responsibility of an association as defined in paragraph (2) of the definition of “group long-term care insurance” under § 431:10H-104, when endorsing or selling long-term care insurance, shall be to educate its members concerning long-term care issues in general so that its members can make informed decisions. Associations shall provide objective information regarding long-term care insurance policies or certificates endorsed or sold through the association to ensure that members of the association receive a balanced and complete explanation of the features in the policies or certificates that are being endorsed or sold.

Terms Used In Hawaii Revised Statutes 431:10H-230

  • Certificate: means , for the purposes of this article, any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this State. See Hawaii Revised Statutes 431:10H-104
  • 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:

    (1) 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 organizations; or

    (2) Any professional, trade, or occupational association for its members or former or retired members, or combination thereof, if the association:

    (A) Is composed of individuals all of whom are or were actively engaged in the same profession, trade, or occupation; and

    (B) Has been maintained in good faith for purposes other than obtaining insurance; or

    (3) 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. See Hawaii Revised Statutes 431:10H-104

  • Long-term care insurance: means any insurance policy or rider advertised, marketed, offered, or designed to provide coverage for not less than twelve consecutive months for each covered person on an expense incurred, indemnity, prepaid, or other basis, for one 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. See Hawaii Revised Statutes 431:10H-104
  • Policy: means , for the purposes of this article, any policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this State by an insurer; fraternal benefit society; nonprofit health, hospital, or medical service corporation; prepaid health plan; health maintenance organization; or any similar organization. See Hawaii Revised Statutes 431:10H-104
  • Trustee: A person or institution holding and administering property in trust.
(b) The insurer shall file the following information with the commissioner:

(1) The policy and certificate;
(2) A corresponding outline of coverage; and
(3) All advertisements requested by the commissioner.
(c) The association shall disclose in any long-term care insurance solicitation:

(1) The specific nature and amount of the compensation arrangements (including all fees, commissions, administrative fees, and other forms of financial support) that the association receives from endorsement or sale of the policy or certificate to its members; and
(2) A brief description of the process under which the policies and the insurer issuing the policies were selected.
(d) If the association and the insurer have interlocking directorates or trustee arrangements, the association shall disclose that fact to its members.
(e) The board of directors of an association endorsing or selling long-term care insurance policies or certificates shall review and approve the insurance policies as well as the compensation arrangements made with the insurer.
(f) The association shall also:

(1) At the time of the association’s decision to endorse, engage the services of a person with expertise in long-term care insurance not affiliated with the insurer to conduct an examination of the policies, including benefits, features, and rates, and update the examination thereafter in the event of material change;
(2) Actively monitor the marketing efforts of the insurer and its producers; and
(3) Review and approve all marketing materials or other insurance communications used to promote sales or sent to members regarding the policies or certificates.

This subsection shall not apply to qualified long-term care insurance contracts.

(g) No group long-term care insurance policy or certificate may be issued to an association unless the insurer files with the commissioner the information required in this section.
(h) The insurer shall not issue a long-term care policy or certificate to an association or continue to market such a policy or certificate unless the insurer certifies annually that the association has complied with the requirements set forth in this section.
(i) Failure to comply with the filing and certification requirements of this section constitutes an unfair trade practice in violation of article 13 of this chapter.

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