Section 21.53.060. Long-term care benefits under life insurance policies; denial of claims.

   (a) In addition to the requirements of AS 21.45, at the time of policy delivery, a policy summary shall be included with an individual life insurance policy if the policy or policy rider provides long-term care benefits. In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant's request but, regardless of request, shall deliver a policy summary not later than the time of policy delivery. The summary must include
        (1) an explanation of how the long-term care benefits interact with other components of the policy, including deductions from death benefits;
        (2) an illustration of the amount and length of benefits, and guaranteed lifetime benefits, if any, for each covered person;
        (3) an explanation of each exclusion, reduction, and limitation on long-term care benefits;
        (4) if applicable to the policy type,
             (A) disclosure of the effects of exercising other rights under the policy;
             (B) disclosure of guarantees related to the long-term care costs of insurance charges; and
             (C) current and projected maximum lifetime benefits; and
        (5) if the director adopts a regulation that permits but does not require inflation protection, and the policy does not provide for inflation protection, a statement that inflation protection is not available under the policy.
   (b) If a long-term care benefit is paid under a life insurance policy by the acceleration of the policy death benefit, and is in benefit payment status, a monthly report shall be provided to the policyholder.  The report must include
        (1) long-term care benefits paid out during the month;
        (2) an explanation of changes in the policy, including changes in death benefits or cash values, due to long-term care benefits being paid out; and
        (3) the amount of long-term care benefits remaining.
   (c) If a claim under a long-term care insurance policy is denied by an insurer, the insurer shall, within 60 days after the date of a written request by a policyholder or a representative of a policyholder,
        (1) provide a written explanation of the reasons for the denial; and
        (2) make available all information directly related to the denial.

Notes

History

(Sec. 2 ch 106 SLA 1990; am Sec. 71, 72 ch 23 SLA 2011)