NAC687B.122. General requirements for converted policy.

     1. A written application by an insured for a converted policy must be made, and the first premium due, if any, must be paid as directed by the insurer within 31 days of the date of termination of coverage under a group long-term care insurance contract. The converted policy must be issued effective on the day following the termination of coverage under the group long-term care insurance contract and must be renewable annually.

     2. Unless the group long-term care insurance contract from which conversion is made replaced previous group coverage, the premium for the converted policy must be calculated on the basis of the insured’s age at inception of coverage under the group long-term care insurance contract from which conversion is made. If the group long-term care insurance contract from which conversion is made replaced previous group coverage, the premium for the converted policy must be calculated on the basis of the insured’s age at inception of coverage under the initial group long-term care insurance contract that was replaced.

     3. Upon termination of coverage under a group long-term care insurance contract, the insurer shall provide each insured continuation of coverage or shall issue each insured a converted policy unless:

     (a) Termination of group coverage resulted from the failure to make any required payment of premium or contribution when due; or

     (b) Within 31 days from the date of termination of coverage, the long-term care insurance contract is replaced by a group long-term care insurance contract:

          (1) Effective on the day following the date of termination of coverage.

          (2) The premium for which is calculated as set forth in subsection 2.

          (3) Providing benefits identical to, or benefits determined by the Commissioner to be substantially equivalent to, or in excess of, those provided by the previous long-term care insurance contract.

     4. A converted policy may provide that the benefits payable under the converted policy, together with the benefits payable under the group long-term care insurance contract from which conversion is made, must not exceed those that would have been payable had the person’s coverage under the group long-term care insurance contract remained in force and effect.

     5. Notwithstanding any other provision of this section, a converted policy issued to a person who at the time of conversion is covered by another long-term care insurance contract or certificate which provides benefits on the basis of incurred expenses, may contain a provision which results in a reduction of benefits payable if the benefits provided under the additional coverage, together with the full benefits provided by the converted policy, would result in payment of more than 100 percent of incurred expenses. The provision may be included in the converted policy only if the converted policy also provides for a decrease in the premium or a refund of a part of the premium which reflects the reduction in benefits payable.

     6. Notwithstanding any other provision of this section, an insured individual whose eligibility for group long-term care coverage is based upon his or her relationship to another person is entitled to continuation of coverage under the group long-term care insurance contract upon termination of the qualifying relationship by death or dissolution of marriage.

     (Added to NAC by Comm’r of Insurance, eff. 12-15-94; A by R028-10, 12-16-2010, eff. 10-1-2011)