(1) meet the applicable requirements of section 4980C of the Internal Revenue Code for a qualified long-term care insurance carrier;

(2) meet all the applicable requirements of section 7702B of the Internal Revenue Code, as amended for a qualified long-term care insurance contract or payments; and

(3) state that it is intended to be a qualified long-term care insurance contract under section 7702B of the Internal Revenue Code. Such statement shall be qualified by the disclosure to the effect that "This is not a health insurance (policy)(certificate) and is not subject to the minimum requirements of New York Law pertaining to Long-Term Care Insurance and does not qualify for the New York State Long-Term Care Partnership Program and is not a Medicare Supplement Policy. The (policy)(certificate) is intended to be a qualified long-term care insurance contract for Federal tax law only."

(1) mental or nervous disorders, however, this shall not permit exclusion or limitation of benefits on the basis of Alzheimer's Disease or demonstrable organic brain disease;

(2) alcoholism and drug addiction;

(3) illness, treatment or medical condition arising out of:

(4) treatment provided in a government facility (unless otherwise required by law), services for which benefits are provided under Medicare or other governmental program (except Medicaid), any State or Federal workers' compensation, employer's liability or occupational disease law, or any mandatory motor vehicle no-fault law, services provided by a member of the covered person's immediate family and services for which no charge is normally made in the absence of insurance; and

(5) treatment or care received by the insured outside the United States and its possessions.

(1) that a policy or certificate that has been in force for at least six months but less than two years may be rescinded or an otherwise valid claim for accelerated benefits may be denied upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought; and

(2) if increases are permitted, that any increase in the policy or certificate that has been in effect for at least six months but less than two years which was applied for and subject to evidence of insurability may be rescinded or an otherwise valid claim for accelerated benefits on the amount of the increase may be denied upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.

(1) the policy or certificate otherwise complies with all requirements of this section; and

(2) the per diem benefit does not exceed the maximum amount eligible under section 101(g)(3) of the Internal Revenue Code and all other applicable sections of Federal law for favorable tax treatment.

(1) The insurer shall follow procedures consistent with those contained in section 52.29 of this Title with respect to determining whether the sale of any such policy or certificate is intended to replace any other similar life policy or any other long-term care insurance, nursing home insurance, home care insurance policy or coverage or long-term care insurance policy or coverage provided under the Partnership for Long-Term Care Program, as defined in Social Services Law section 367-f and Insurance Law section 3229. An insurer that determines that any such policy is intended to replace a similar life policy or any other long-term care insurance, nursing home insurance or home care insurance policy or coverage or long-term care insurance policy or coverage provided under the Partnership for Long-Term Care Program, as defined in Social Services Law section 367-f and Insurance Law section 3229, shall make the disclosures required by section 52.29 of this Title.

(2) The insurer shall follow procedures consistent with those contained in section 52.29 of this Title with respect to determining whether the sale of any life policy providing benefits subject to this section or any other long-term care insurance, nursing home insurance, home care insurance policy or coverage or long-term care insurance policy or coverage provided under the Partnership for Long-Term Care Program, as defined in Social Services Law section 367-f is intended to replace a policy or certificate providing benefits subject to this section. An insurer that determines that such sale is intended to replace a policy or certificate providing benefits subject to this section shall make the disclosures required by section 52.29 of this Title.

(3) If a group policy is replaced by another group policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group policy on its date of termination. Coverage provided or offered to individuals by the insurer and premiums charged to persons under the new group policy shall not vary or otherwise depend on the individual's health or disability status, claim experience or use of long-term care services.

(1) an explanation of how the accelerated benefit interacts with other components of the policy, including deductions from death benefits;

(2) an explanation of the amount of benefits, the length of benefits, and the guaranteed lifetime benefits if any, for each covered person;

(3) any exclusions, reductions and limitations on the accelerated benefits; and

(4) if applicable to the policy type:

(1) The policy and certificate shall not be advertised or marketed as long-term care insurance, nursing home insurance, home care insurance or long-term care insurance provided under the Partnership for Long-Term Care Program, as defined in Social Services Law section 367-f and Insurance Law section 3229. Any advertisement, description, comparison, marketing material or illustration shall state in bold that “This is a life insurance (policy)(certificate) that accelerates the death benefit for qualified long-term care services (The phrase “on account of chronic illness” may be substituted for the phrase “for qualified long-term care services” for policies that are not intended to be qualified long-term care insurance contracts for Federal tax purposes) and is not a health insurance (policy)(certificate) providing long-term care insurance subject to the minimum requirements of New York Law, does not qualify for the New York State Long-Term Care Partnership Program and is not a Medicare supplement (policy)(certificate).”

(2) An insurer may include in any advertisement or marketing materials for such policies that are not intended to be qualified long-term care insurance contracts for Federal tax purposes:

(3) An insurer may include in any advertisement or marketing materials for such policies that are intended to be qualified long-term care insurance contracts for Federal tax purposes:

(1) establish marketing procedures to ensure that any comparison of policies by its producers will be fair and accurate;

(2) establish marketing procedures to assure excessive insurance is not sold or issued;

(3) except as provided in paragraph (4) of this subdivision, display prominently by type, stamp or other appropriate means, on the first page of the outline of coverage and policy the following:

"Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations";

(4) for policies that accelerate death benefits pursuant to Insurance Law section 1113(a)(1)(C) and provide benefits on a per diem basis and are not intended to be qualified long-term care insurance contracts for Federal tax purposes, display prominently by type, stamp or other appropriate means, on the first page of the outline of coverage and the policy the following:

"Notice to buyer: This policy may not cover all of the costs associated with the chronic illness of the insured. The buyer is advised to review carefully the policy benefits";

(5) inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee already has accident and sickness or long-term care insurance and the types and amounts of any such insurance; and

(6) establish auditable procedures for verifying compliance with paragraphs (1) through (5) of this subdivision.

(1) Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on or convert any insurance policy or to take out a policy of insurance with another insurer.

(2) High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.

(3) Cold lead advertising. Making use directly or indirectly of any method of marketing that fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance producer or insurer.

(1) For purposes of this subdivision, association shall mean any professional, trade or occupational association for its members or former or retired members, or combination thereof, if the association:

(2) An insurer shall not issue insurance under this section to an association, as defined in paragraph (1) of this subdivision, or its members unless the insurer has filed with the superintendent:

(3) The insurer shall certify to the superintendent, before a new policy and the first certificate is issued, and annually thereafter by December 31st:

(4) This subdivision shall not apply to any individual policy of life insurance issued to a member of an association where the sale of the policy was entirely independent from the association.

(1) For insurers that elect to coordinate benefits and that will only make payments if the payments will receive favorable tax treatment by the Federal government, the claim form to receive benefits pursuant to this section shall include the following statement: "Benefit payments will only be made if the payments are subject to favorable tax treatment by the Federal government. Receipt of benefit payments from multiple policies exceeding the applicable limits may result in tax consequences. Therefore, when determining whether the benefit payments will receive favorable tax treatment, the payment of benefits from all insurance policies must be considered."

(2) For insurers that do not elect to coordinate benefits, the claim form to receive benefits pursuant to this section shall include the following statement: “Benefit payments may not be subject to favorable tax treatment by the Federal government. When determining whether the benefit payments will receive favorable tax treatment, the payment of benefits from all insurance policies must be considered. Receipt of benefit payments under multiple policies exceeding the applicable limits may result in tax consequences. This insurer does not coordinate benefits to ensure that the payments receive favorable tax treatment by the Federal government. Accordingly, prior to applying for benefits, you should seek assistance from a qualified tax advisor.”

(1) No individual policy or certificate shall be issued until the insurer has received from the applicant either, a written designation of at least one person, in addition to the applicant, who is to receive notice of lapse or termination of the policy or certificate for nonpayment of premium; or a written waiver dated and signed by the applicant electing not to designate additional persons to receive notice. The applicant has the right to designate at least one person who is to receive the notice of termination, in addition to the insured. Designation shall not constitute acceptance of any liability on the third party for services provided to the insured. The form used for the written designation shall provide space clearly designated for listing at least one person. The designation shall include each person's full name and home address. In the case of an applicant who elects not to designate an additional person, the waiver shall state: "Protection against unintended lapse. I understand that I have the right to designate at least one person other than myself to receive notice of lapse or termination of this long-term care insurance policy for nonpayment of premium. I understand that notice will not be given until thirty (30) days after a premium is due and unpaid. I elect NOT to designate any person to receive such notice." The insurer shall notify the insured of the right to change this written designation, no less often than once every two years.

(2) When the policyowner or certificateholder pays premium for the policy or certificate through a payroll or pension deduction plan, the requirements contained in paragraph (1) of this subdivision need not be met until 60 days after the policyowner or certificateholder is no longer on such a payment plan. The application or enrollment form for such policies or certificates shall clearly indicate the payment plan selected by the applicant.

(3) No individual policy or certificate shall lapse or be terminated for nonpayment of premium unless the insurer, at least 30 days before the effective date of the lapse or termination, has given notice to the insured and to those persons designated to receive notice, at the address provided by the insured for purposes of receiving notice of lapse or termination. Notice shall be given by first class United States mail, postage prepaid; and notice may not be given until 30 days after a premium is due and unpaid. Notice shall be deemed to have been given as of five days after the date of mailing.

(4) In addition to the requirements of Insurance Law section 3203(a)(10), the policy or certificate shall include a provision which provides for reinstatement of coverage, in the event of lapse if the insurer is provided proof of the policyowner’s or certificateholder's cognitive impairment or the loss of functional capacity. This option shall be available to the insured if requested within five months after termination and shall allow for the collection of past due premium, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity, if any, contained in the policy and certificate.

(1) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under a policy, all riders or endorsements added to a policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured.

(2) After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the insured, except if the increased benefits or coverage are required by law.

(3) Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, such premium charge shall be set forth in the policy, rider or endorsement.

(1) insurers, whether or not they have obtained information concerning the applicant's health condition prior to the issuance of the policy or certificate, are prohibited from post-claim underwriting;

(2) if an insurer requests information on an application concerning medications being taken by the applicant and the medications listed in such application were known to the insurer, or should have been known by the insurer at the time of application to be directly related to a medical condition for which coverage would have been otherwise denied, then the policy or certificate shall not be rescinded for that condition; and

(3) except for policies or certificates that are guaranteed issue:

(4) A copy of the completed application or enrollment form (whichever is applicable) shall be delivered to the insured no later than at the time of delivery of the policy or certificate unless it was retained by the applicant at the time of application.

(5) Prior to the issuance of a policy or certificate to an applicant age 80 or older, the insurer shall obtain one or more of the following:

(1) a policy shall not, if it provides benefits for home health care or community care services, limit or exclude benefits:

(2) A policy, if it provides for home health or community care services, shall provide total home health or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, at the time covered home health or community care services are being received. This requirement shall not apply to policies issued to residents of continuing care retirement communities.

(3) Home health care coverage may be applied to the nonhome health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.