N.Y. Comp. Codes R. & Regs. tit. 11 § 41.2

Current through Register Vol. 46, No. 45, November 2, 2024

Section 41.2 - Definitions

As used in this Part, the following terms shall have the following meanings:

(a)Accelerated death benefit means proceeds payable in part or in full under a life insurance policy to a policyowner or certificateholder during the lifetime of the insured:

(1) upon the diagnosis of terminal illness that would result in a life expectancy as specified in the contract not to exceed 12 months;

(2) upon the diagnosis of a medical condition requiring extraordinary medical care or treatment regardless of life expectancy;

(3) upon certification by a licensed health care practitioner of any condition that requires continuous care for the remainder of the insured's life in an eligible facility or at home when the insured is chronically ill, provided the accelerated payments qualify under section 101(g)(3) of the Internal Revenue Code and all other applicable sections of Federal law in order to maintain favorable tax treatment;

(4) upon certification by a licensed health care practitioner that the insured is chronically ill, provided the accelerated payments qualify under section 101(g)(3) of the Internal Revenue Code and all other applicable sections of Federal law in order to maintain favorable tax treatment;

(5) upon the insured's having been a resident of a nursing home for a period of three months or more and upon certification by a licensed health care practitioner that there is an expectation that the insured will remain a resident of a nursing home until death; or

(6) upon the insured's having been the recipient of end of life or palliative care for a period of three months or more at a residential health care facility, home care services or hospice, and upon certification by a licensed health care practitioner that there is an expectation that the insured will continue to require the services until death.

(b)Chronically ill shall have the meaning set forth in section 7702B of the Internal Revenue Code (26 U.S.C. 7702B [c][2]), as amended, and regulations thereunder.

(c)Discounted accelerated death benefit shall have the meaning set forth in section 41.5(j) of this Part.

(d)Home care services means one or more of the following services provided to persons at home: services provided by a home care services agency, home health aide services, personal care services, homemaker services, or housekeeper or chore services.

(e)Hospice means a coordinated program of home and in-patient care that treats a terminally ill patient and family as a unit, employing an interdisciplinary team acting under the direction of an autonomous hospice administration and where the program provides palliative and supportive care to meet the special needs arising out of physical, psychological, spiritual, social and economic stresses that are experienced during the final stages of illness, and during dying and bereavement.

(f)Insurance producer or producer means an insurance agent or insurance broker.

(g)Licensed health care practitioner shall have the meaning set forth in section 7702B of the Internal Revenue Code (26 U.S.C. section 7702B [c][4]), as amended, and regulations thereunder.

(h)Lien approach shall have the meaning set forth in section 41.5(l) of this Part.

(i)Nursing home means a facility providing therein nursing care to sick, invalid, infirm, disabled or convalescent persons in addition to lodging and board or health-related service, or any combination of the foregoing, and in addition thereto, providing nursing care and health-related service, or either of them, to persons who are not occupants of the facility.

(j)Palliative care means health care treatment, including interdisciplinary end-of-life care, and consultation with patients and family members, to prevent or relieve pain and suffering and to enhance the patient's quality of life, including hospice care.

(k)Policy means any individual life policy, group life policy or group life certificate, fraternal benefit certificate or any rider attached to such policies or certificates providing accelerated payment of the death benefit.

(l)Qualified actuary means a member in good standing of the American Academy of Actuaries meeting any qualifications standard of the Academy or Actuarial Standards Board for practice in life insurance and who represents the insurer or fraternal benefit society.

(m)Qualified long-term care services shall have the meaning set forth in section 7702B of the Internal Revenue Code (26 U.S.C. section 7702B [c][1]), as amended, and regulations thereunder.

(n)Residential health care facility means a nursing home or a facility providing health-related service.

N.Y. Comp. Codes R. & Regs. Tit. 11 § 41.2

Amended New York State Register November 27, 2019/Volume XLI, Issue 48, eff. 11/27/2019