KRS 304.14-600: Definitions for KRS 304.14-600 to 304.14-625.

As used in KRS 304.14-600 to 304.14-625, unless the context requires otherwise:

(1) "Incidental" indicates that the value of the long -term care benefits provided in a

policy is less than ten percent (10%) of the total value of the benefits provided over

the life of the policy. Policies may include life insurance, disability insurance, and

annuities. These values shall be measured as of the date of issue;

(2) "Long-term care insurance" means any insurance policy or rider advertised,

marketed, offered, or des igned to provide coverage for not less than twelve (12)

consecutive months for each covered person on an expense -incurred, indemnity,

prepaid, or other basis for one (1) or more necessary or medically necessary

diagnostic, preventive, therapeutic, rehabili tative, maintenance, or personal care

services, provided in a setting other than an acute care unit of a hospital unless the

hospital or unit is licensed or certified to provide long -term services. This term

includes group and individual annuities and life insurance policies or riders which

provide directly or which supplement long -term care insurance. This term includes

a policy or rider which provides for payment of benefits based upon cognitive

impairment or the loss of functional capacity. This term als o includes qualified

long-term care insurance contracts as defined in 26 U.S.C. sec. 7702B(b). Long -

term care insurance may be issued by insurers, fraternal benefit societies, nonprofit

hospital, medical -surgical, dental, and health service corporations, h ealth

maintenance organizations, or any similar organization to the extent they are

otherwise authorized to issue life or health insurance. Long -term care insurance

shall not include any 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 or related asset -protection coverage, accident

only coverage, specifi ed disease or specified accident coverage, or limited benefit

coverage. With regard to life insurance, this term does not include life insurance

policies which accelerate the death benefit specifically for one (1) or more of the

qualifying events of termin al illness, medical conditions requiring extraordinary

medical intervention, or permanent institutional confinement, and which provide the

option of a lump -sum payment for those benefits and in which neither the benefits

nor the eligibility for the benefit s is conditioned upon the receipt of long -term care.

Any product advertised, marketed, or offered as long-term care insurance or nursing

home insurance which otherwise meets the definition of long -term care insurance

shall be subject to the provisions of KRS 304.14-600 to 304.14-625;

(3) "Applicant" means:

(a) In the case of an individual long -term care insurance policy, the person who

seeks to contract for benefits; and

(b) In the case of a group long-term care insurance policy, the proposed certificate

holder;

(4) "Certificate" means any certificate issued under a group long -term care insurance

policy, which policy has been delivered or issued for delivery in Kentucky, except

as provided in KRS 304.14-610;

(5) "Group long-term care insurance" means a long-term care insurance policy which is

delivered or issued for delivery in Kentucky by an insurer, fraternal benefit society,

nonprofit health service corporation, or health maintenance organization, and which

is issued to:

(a) One (1) or more employers or la bor organizations, or to a trust or to the

trustees of a fund established by one (1) 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) Any professional, trade, or occupational association for its members or former

or retired members, or combination thereof, if the association:

1. Is composed of individuals all of whom are or were actively en gaged in

the same profession, trade, or occupation; and

2. Has been maintained in good faith for purposes other than obtaining

insurance;

(c) An association or a trust or the trustee of a fund established, created, or

maintained for the benefit of members of one (1) or more associations. Prior

to advertising, marketing, or offering the policy within Kentucky, the insurer

of the association shall file with the commissioner evidence that the

association has at the outset a minimum of one hundred (100) persons and has

been organized and maintained in good faith for purposes other than that of

obtaining insurance, has been in active existence for at least one (1) year, and

has a constitution and bylaws which provide:

1. The association holds regular meetings not less than annually to further

the purposes of the members;

2. Except for credit unions, the association collects dues or solicits

contributions from members; and

3. The members have voting privileges and representation on the governing

board and committees.

The association shall be deemed to satisfy the organizational requirements

unless the commissioner makes a finding that the association does not satisfy

those organizational requirements within the time set fort h in KRS 304.14 -

120; or

(d) A group other than that described in paragraphs (a), (b), and (c) of this

subsection, subject to a finding by the commissioner that:

1. The issuance of the 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; and

3. The benefits are reasonable in relation to the premiums charged; and

(6) "Policy" means any policy, contract, subscriber, agreement, enrollment agreement,

rider, or endorsement delivered or issued for delivery in Kentucky.