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Chapter 12 - Life and Health Division

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Chapter 12 - Life and Health Division CHAPTER 12 - LIFE AND HEALTH DIVISION SECTION .0100 - GENERAL ORGANIZATION AND FUNCTIONS 11 NCAC 12 .0101 GENERAL PROVISIONS In this Chapter, unless the context otherwise requires: (1) "Deemer clause" or "deemer provision" shall mean any clause or provision which establishes a period of time certain, e.g. 90 days, etc., within which time the commissioner must disapprove a particular matter before him or set a hearing and which if no action is taken by the commissioner within the period of time certain, said matter before the commissioner is deemed approved. (2) "Division" shall mean the life, accident and health division of the North Carolina Department of Insurance. (3) "Form" shall consist of but not be limited to the application, rider, certificate, policy, etc. History Note: Authority G.S. 58-9; 58-54; 58-254.7; 58-347; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. April 1, 1989; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0102 PURPOSE OF DIVISION 11 NCAC 12 .0103 PERSONNEL OF DIVISION History Note: Authority G.S. 58-4; 58-9; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. July 1, 1988. SECTION .0200 - DESCRIPTIONS OF FORMS 11 NCAC 12 .0201 PRE-EXISTING CONDITIONS AND RENEWABLE AT COMPANY OPTION The notices for pre-existing conditions and policies renewable at the option of the company are used as examples of acceptable wording for stickers placed on or notices printed on the face of accident and health policies identifying the pre-existing condition exclusions and the provisions for a policy renewable at the option of the company. These forms include a heading, descriptive paragraph and other pertinent information. History Note: Authority G.S. 58-2-40; 58-65-1; 58-65-40; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0202 COMPARATIVE INFORMATION FORM 11 NCAC 12 .0203 REPLACEMENT NOTICE History Note: Authority G.S. 58-9; 59-42; 58-42.1; 58-54.4; 58-195; 58-199; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. July 1, 1982; July 5, 1979; Repealed Eff. October 1, 1985. 11 NCAC 12 .0204 NOTICE FOR REVISION OF RATES FOR NON-PROFIT SERVICE CORP The form of notice of public hearing on revision of rates of nonprofit hospital, medical or dental service corporations is a guide for the preparation and publication of the notice of public hearing pursuant to G.S. 58-65-45 on the revision of rates of a nonprofit hospital, medical or dental service corporation. This form includes the time, date and location of the public hearing, the company proposing the revision, a complete description of the proposed revision and any other pertinent information. History Note: Authority G.S. 58-2-40; 58-65-45; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. April 8, 2002; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0205 NC BUYER'S GUIDE TO LIFE INSURANCE 11 NCAC 12 .0206 PRELIMINARY POLICY SUMMARY: WHOLE LIFE 11 NCAC 12 .0207 PRELIMINARY POLICY SUMMARY: TERM POLICIES History Note: Authority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1; 58-54.4; 58-195; 58-198; 58-199; Eff. April 26, 1979; Repealed Eff. June 16, 1979. 11 NCAC 12 .0208 MEDICARE AND MEDICAID - BUYER'S GUIDE (a) The North Carolina Buyer's Guide to Health Insurance and Medicare and Medicaid is provided pursuant to 11 NCAC 12 .0548. This form consists of information regarding North Carolina law and regulations pertaining to the people eligible for Medicare and Medicaid and other pertinent information. (b) The Buyer's Guide shall be printed in at least 14 point type in a 16 point base in contrasting colors of red and black on matte paper with dull ink. The format shall be as prescribed by the commissioner. The commissioner shall consider written requests for deviations on a case by case basis. History Note: Authority G.S. 58-2-40; 58-54-25; 58-249; 58-250.1; 58-252; 58-254.5; 58-254.7; Eff. October 24, 1981; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. SECTION .0300 - GENERAL PROVISIONS 11 NCAC 12 .0301 GENERAL PROVISIONS History Note: Authority G.S. 58-9; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. July 1, 1988. 11 NCAC 12 .0302 APPLICATION FOR INSURANCE REQUIRED History Note: Authority G.S. 58-344; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. July 1, 1986; Repealed Eff. April 1, 1989. 11 NCAC 12 .0303 REBATES ON INSURANCE COMPANIES EMPLOYEES: PROHIBITED History Note: Authority G.S. 58-54.4(8); Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. February 1, 1992. 11 NCAC 12 .0304 SEX DISCRIMINATION ON APPLICATIONS An insurer may not discriminate based on sex in any manner on a life or accident and health insurance application. History Note: Authority G.S. 57-1; 57-4; 58-9; 58-44; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0305 TWISTING OR OTHER PRACTICES INJURIOUS TO THE PUBLIC History Note: Authority G.S. 58-9(1); 58-42.1; 58-54.4; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. February 1, 1992. 11 NCAC 12 .0306 LIFE: HEALTH AND ACCIDENT COVERAGES: POLICY OUT OF STATE Where a group master policy is written upon application taken outside this jurisdiction covering individuals in this state the certificate covering lives within this state shall be considered "North Carolina business" and reported through the office of some general agent, resident in or having territory within the state. This Rule does not apply to group mortgage and blanket scholastic policies where the policy must be issued in North Carolina. History Note: Authority G.S. 58-3-1; 58-2-40; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. February 1, 1992; July 1, 1986; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0307 FILING APPROVAL: LIFE: ACCIDENT AND HEALTH FORMS History Note: Authority G.S. 58-2-40; 58-6-5; 58-51-1; 58-54-35; 58-55-30; 58-58-1; 58-65-1; 58-65-40; 58-67-50; 58-67-150; Eff. February 1, 1976; Amended Eff. November 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. August 1, 2002; February 1, 1996; February 1, 1992; April 1, 1989; Repealed Eff. July 1, 2006. 11 NCAC 12 .0308 BANK CREDIT CARD FACILITY AVAILABLE FOR PREMIUM PAYMENT History Note: Authority G.S. 58-61.2; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Amended Eff. April 1, 1989; Temporary Repeal Eff. December 1, 1999; Repealed Eff. July 1, 2000. 11 NCAC 12 .0309 APPLICATION: BYLAWS: RULES: PART OF THE POLICY CONTRACT The bylaws or constitution of a mutual insurance company, association, order, society, or reciprocal exchange need not be attached to each policy in order to be a part of the policy contract if the policy contract contains all of the benefits available to the insured. History Note: Authority G.S. 58-2-40; 58-51-1; 58-51-15; 58-58-1; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0310 INDUSTRIAL INSURANCE The following is departmental policy on industrial insurance. With respect to industrial business in this state an agent shall not be permitted to accept any money in payment of the premiums which are in arrears on any industrial insurance policy that has lapsed and which the insured seeks to reinstate unless the insured is enabled thereby to reinstate the policy. In other words, the agent cannot accept payment of part of the arrears and hold the money in his hands until he can collect the balance. Any advance premium which is paid by an industrial policyholder shall be recorded in the receipt book of the insured and the record book of the agent in exactly the same manner as current premiums are recorded. There shall be no such things as blind entries in either book and the policyholder's receipt book and the record book of the agent shall be in exact agreement at all times. Violation of this Rule will result in the initiation of license revocation proceedings. Companies will be expected to report any violation of this Rule to the commissioner. History Note: Authority G.S. 58-9(1); Eff. February 1, 1976; Readopted Eff. September 26, 1978; Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1, 2018. 11 NCAC 12 .0311 LIMITATION ON AMOUNT OF CREDIT INSURANCE WRITTEN History Note: Authority G.S. 57-1; 57-4; 58-9; 58-344; Eff. February 1, 1976; Readopted Eff. September 26, 1978; Repealed Eff. April 1, 1989. 11 NCAC 12 .0312 ACCIDENTAL DEATH BENEFIT: INHALATION OF GAS: ETC A policy or rider providing benefits for accidental death may not exclude the following: (1) The involuntary inhalation of gas and fumes and the involuntary taking of poison.
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