NAC687B.056. Standards of suitability: Development; use.

     1. The provisions of this section do not apply to a policy of life insurance or a rider or endorsement to a policy of life insurance that contains accelerated benefits for long-term care.

     2. Every insurer or other organization that markets or offers long-term care insurance contracts or certificates in this State shall:

     (a) Develop standards of suitability to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of an applicant;

     (b) Train its agents in the use of the standards of suitability; and

     (c) Maintain a copy of the standards of suitability and make the standards available for inspection upon request by the Commissioner.

     3. An insurer shall use the standards of suitability developed pursuant to subsection 2 in determining whether it is appropriate to issue long-term care insurance to an applicant.

     4. An agent shall use the standards of suitability developed by the insurer pursuant to subsection 2 in marketing long-term care insurance.

     5. To determine whether an applicant meets the standards of suitability developed pursuant to subsection 2 for the purchase or replacement of long-term care insurance, the insurer and its agents shall develop policies and procedures that take into consideration:

     (a) The ability of the applicant to pay for the proposed coverage;

     (b) Any other pertinent financial information relating to the proposed purchase;

     (c) The goals or needs of the applicant with respect to long-term care and the advantages and disadvantages of insurance to meet those goals or needs; and

     (d) The values, benefits and costs of the existing insurance of the applicant, if any, as compared to the values, benefits and costs of the proposed purchase or replacement.

     6. The insurer and its agents shall make reasonable efforts to obtain the information required pursuant to subsection 5, including, without limitation, presenting to the applicant at or before the time of application the worksheet described in subsection 9. The insurer may request that the applicant provide additional information to comply with the standards of suitability.

     7. An insurer shall not consider an application unless the applicant completes the worksheet described in subsection 9 and returns the completed worksheet to the insurer, except that the insurer may consider an application without receiving a completed worksheet if the applicant is offered the coverage through a sale of group long-term care insurance to employees and their spouses.

     8. An insurer and its agents shall not sell or disseminate outside the company any information obtained from a worksheet described in subsection 9.

     9. An insurer shall provide to each applicant form NDOI-949, which is available from the Division, or a “Long-Term Care Insurance Personal Worksheet” which must contain a statement, set out conspicuously and in not less than 12-point type, that is substantially in the format of form NDOI-949.

     10. An insurer shall file with the Commissioner a copy of the worksheet described in subsection 9.

     (Added to NAC by Comm’r of Insurance by R121-07, 9-18-2008, eff. 10-1-2008; A by R028-10, 12-16-2010, eff. 10-1-2011)