As used in this chapter, unless the context requires otherwise:
1. "Applicant" means either of the following:
a. A person seeking to contract for an individual long-term care insurance policy for the benefit of that person.
b. The proposed certificate holder of a group long-term care insurance policy.
2. "Certificate" means a certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this state.
3. "Commissioner" means the insurance commissioner.
4. "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 to 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.
b. A professional, trade, or occupational association for its members or former or retired members, or a combination thereof, if the association is both:
(1) Composed of individuals all of whom are or were actively engaged in the same profession, trade, or occupation.
(2) Maintained in good faith for purposes other than obtaining insurance.
c. An association, a trust, or the trustee of a fund established, created, or maintained for the benefit of members of one or more associations.
d. A group other than as described in paragraphs "a" through "c", subject to a finding by the commissioner that all of the following are true:
(1) The issuance of a 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.
(3) The benefits are reasonable in relation to the premiums charged.
5. "Long-term care insurance" means an insurance policy, insurance contract, insurance certificate, or rider, which is 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; and includes group and individual policies or riders whether issued by insurers, fraternal benefit societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, health maintenance organizations, or any similar organization. "Long-term care insurance" does not include an 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 protection coverage, accident only coverage, specified disease or specified accident coverage, or limited benefit health coverage.
6. "Policy" means a 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.
87 Acts, ch 131, §4
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