(1)(a) An outline of coverage shall be delivered to a prospective applicant at the time of initial solicitation through means which prominently direct the attention of the recipient to the document and its purpose.

Terms Used In Nebraska Statutes 44-4516

  • Applicant: shall mean (1) in the case of an individual policy, the person who seeks to contract for such benefits and (2) in the case of a group policy, the proposed certificate holder. See Nebraska Statutes 44-4505
  • Certificate: shall mean any certificate issued under a group policy, which policy has been delivered or issued for delivery in this state. See Nebraska Statutes 44-4506
  • Contract: A legal written agreement that becomes binding when signed.
  • Director: shall mean the Director of Insurance. See Nebraska Statutes 44-4507
  • Group policy: shall mean 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 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. See Nebraska Statutes 44-4508

  • Insurer shall: include all companies, exchanges, societies, or associations whether organized on the stock, mutual, assessment, or fraternal plan of insurance and reciprocal insurance exchanges. See Nebraska Statutes 44-103
  • Month: shall mean calendar month. See Nebraska Statutes 49-801
  • Person: shall include bodies politic and corporate, societies, communities, the public generally, individuals, partnerships, limited liability companies, joint-stock companies, and associations. See Nebraska Statutes 49-801
  • Policy: shall mean any individual or group policy, contract, subscriber agreement, rider, or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, prepaid health plan, health maintenance organization, or any similar organization. See Nebraska Statutes 44-4510
  • State: when applied to different states of the United States shall be construed to extend to and include the District of Columbia and the several territories organized by Congress. See Nebraska Statutes 49-801

(b) The director shall prescribe a standard format, including style, arrangement, and overall appearance, and the content of an outline of coverage.

(c) In the case of agent solicitations, an agent shall deliver the outline of coverage prior to the presentation of an application or enrollment form.

(d) In the case of direct-response solicitations, the outline of coverage shall be presented in conjunction with any application or enrollment form.

(2) The outline of coverage shall include:

(a) A description of the principal benefits and coverage provided in the policy;

(b) A statement of the principal exclusions, reductions, and limitations contained in the policy;

(c) A statement of the terms under which the policy or certificate, or both, may be continued in force or discontinued, including any reservation in the policy of a right to change premiums. Continuation or conversion provisions of group coverage shall be specifically described;

(d) A statement that the outline of coverage is a summary only, not a contract of insurance, and that the policy or group master policy contains governing contractual provisions;

(e) A description of the terms under which the policy or certificate may be returned and premium refunded; and

(f) A brief description of the relationship of cost of care and benefits.

(3) A certificate issued pursuant to a group policy that is delivered or issued for delivery in this state shall include:

(a) A description of the principal benefits and coverage provided in the policy;

(b) A statement of the principal exclusions, reductions, and limitations contained in the policy; and

(c) A statement that the group master policy contains governing contractual provisions.

(4) At the time of policy delivery, a policy summary shall be delivered for an individual life insurance policy which provides long-term care benefits within the policy or by rider. In the case of direct-response solicitations, the insurer shall deliver the policy summary upon the applicant’s request, but regardless of request shall make such delivery no later than at the time of policy delivery. The summary shall include:

(a) An explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits;

(b) An illustration of the amount of benefits, the length of benefit, and the guaranteed lifetime benefits, if any, for each covered person;

(c) Any exclusions, reductions, and limitations on benefits of long-term care; and

(d) If applicable to the policy type:

(i) A disclosure of the effects of exercising other rights under the policy;

(ii) A disclosure of guarantees related to long-term care costs of insurance charges; and

(iii) Current and projected maximum lifetime benefits.

(5) Any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefit is in benefit-payment status, a monthly report shall be provided to the policyholder. Such report shall include:

(a) Any long-term care benefits paid out during the month;

(b) An explanation of any changes in the policy, such as death benefits or cash values, due to long-term care benefits being paid out; and

(c) The amount of long-term care benefits existing or remaining.

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