CHAPTER 12 - LIFE AND HEALTH DIVISION SECTION .0100 .
CHAPTER 12 - LIFE AND HEALTH DIVISIONSECTION .0100 - GENERAL ORGANIZATION AND FUNCTIONS11 NCAC 12 .0101GENERAL PROVISIONSIn this Chapter, unless the context otherwise requires:(1)"Deemer clause" or "deemer provision" shall mean any clause or provision which establishes aperiod of time certain, e.g. 90 days, etc., within which time the commissioner must disapprove aparticular matter before him or set a hearing and which if no action is taken by the commissionerwithin the period of time certain, said matter before the commissioner is deemed approved.(2)"Division" shall mean the life, accident and health division of the North Carolina Department ofInsurance.(3)"Form" shall consist of but not be limited to the application, rider, certificate, policy, etc.History Note:Authority G.S. 58-9; 58-54; 58-254.7; 58-347;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. April 1, 1989;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .010211 NCAC 12 .0103History Note:PURPOSE OF DIVISIONPERSONNEL OF DIVISIONAuthority G.S. 58-4; 58-9;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. July 1, 1988.SECTION .0200 - DESCRIPTIONS OF FORMS11 NCAC 12 .0201PRE-EXISTING CONDITIONS AND RENEWABLE AT COMPANY OPTIONThe notices for pre-existing conditions and policies renewable at the option of the company are used as examples ofacceptable wording for stickers placed on or notices printed on the face of accident and health policies identifyingthe pre-existing condition exclusions and the provisions for a policy renewable at the option of the company. Theseforms include a heading, descriptive paragraph and other pertinent information.History Note:Authority G.S. 58-2-40; 58-65-1; 58-65-40;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .020211 NCAC 12 .0203History Note:COMPARATIVE INFORMATION FORMREPLACEMENT NOTICEAuthority G.S. 58-9; 59-42; 58-42.1; 58-54.4; 58-195; 58-199;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. July 1, 1982; July 5, 1979;Repealed Eff. October 1, 1985.11 NCAC 12 .0204NOTICE FOR REVISION OF RATES FOR NON-PROFIT SERVICE CORPThe form of notice of public hearing on revision of rates of nonprofit hospital, medical or dental service corporationsis a guide for the preparation and publication of the notice of public hearing pursuant to G.S. 58-65-45 on therevision of rates of a nonprofit hospital, medical or dental service corporation. This form includes the time, date and
location of the public hearing, the company proposing the revision, a complete description of the proposed revisionand any other pertinent information.History Note:Authority G.S. 58-2-40; 58-65-45;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. April 8, 2002;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .020511 NCAC 12 .020611 NCAC 12 .0207History Note:NC BUYER'S GUIDE TO LIFE INSURANCEPRELIMINARY POLICY SUMMARY: WHOLE LIFEPRELIMINARY POLICY SUMMARY: TERM POLICIESAuthority G.S. 58-9; 58-25.1; 58-26; 58-33; 58-42; 58-42.1;58-54.4; 58-195; 58-198; 58-199;Eff. April 26, 1979;Repealed Eff. June 16, 1979.11 NCAC 12 .0208MEDICARE AND MEDICAID - BUYER'S GUIDE(a) The North Carolina Buyer's Guide to Health Insurance and Medicare and Medicaid is provided pursuant to 11NCAC 12 .0548. This form consists of information regarding North Carolina law and regulations pertaining to thepeople eligible for Medicare and Medicaid and other pertinent information.(b) The Buyer's Guide shall be printed in at least 14 point type in a 16 point base in contrasting colors of red andblack on matte paper with dull ink. The format shall be as prescribed by the commissioner. The commissioner shallconsider written requests for deviations on a case by case basis.History Note:Authority G.S. 58-2-40; 58-54-25; 58-249; 58-250.1; 58-252; 58-254.5; 58-254.7;Eff. October 24, 1981;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.SECTION .0300 - GENERAL PROVISIONS11 NCAC 12 .0301History Note:Authority G.S. 58-9;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. July 1, 1988.11 NCAC 12 .0302History Note:APPLICATION FOR INSURANCE REQUIREDAuthority G.S. 58-344;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. July 1, 1986;Repealed Eff. April 1, 1989.11 NCAC 12 .0303History Note:GENERAL PROVISIONSREBATES ON INSURANCE COMPANIES EMPLOYEES: PROHIBITEDAuthority G.S. 58-54.4(8);Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. February 1, 1992.
11 NCAC 12 .0304SEX DISCRIMINATION ON APPLICATIONSAn insurer may not discriminate based on sex in any manner on a life or accident and health insurance application.History Note:Authority G.S. 57-1; 57-4; 58-9; 58-44;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0305History Note:TWISTING OR OTHER PRACTICES INJURIOUS TO THE PUBLICAuthority G.S. 58-9(1); 58-42.1; 58-54.4;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. February 1, 1992.11 NCAC 12 .0306LIFE: HEALTH AND ACCIDENT COVERAGES: POLICY OUT OF STATEWhere a group master policy is written upon application taken outside this jurisdiction covering individuals in thisstate the certificate covering lives within this state shall be considered "North Carolina business" and reportedthrough the office of some general agent, resident in or having territory within the state. This Rule does not apply togroup mortgage and blanket scholastic policies where the policy must be issued in North Carolina.History Note:Authority G.S. 58-3-1; 58-2-40;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. February 1, 1992; July 1, 1986;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0307History Note:Authority G.S. 58-2-40; 58-6-5; 58-51-1; 58-54-35; 58-55-30; 58-58-1; 58-65-1; 58-65-40;58-67-50; 58-67-150;Eff. February 1, 1976;Amended Eff. November 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. August 1, 2002; February 1, 1996; February 1, 1992; April 1, 1989;Repealed Eff. July 1, 2006.11 NCAC 12 .0308History Note:FILING APPROVAL: LIFE: ACCIDENT AND HEALTH FORMSBANK CREDIT CARD FACILITY AVAILABLE FOR PREMIUM PAYMENTAuthority G.S. 58-61.2;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. April 1, 1989;Temporary Repeal Eff. December 1, 1999;Repealed Eff. July 1, 2000.11 NCAC 12 .0309APPLICATION: BYLAWS: RULES: PART OF THE POLICY CONTRACTThe bylaws or constitution of a mutual insurance company, association, order, society, or reciprocal exchange neednot be attached to each policy in order to be a part of the policy contract if the policy contract contains all of thebenefits available to the insured.History Note:Authority G.S. 58-2-40; 58-51-1; 58-51-15; 58-58-1;Eff. February 1, 1976;Readopted Eff. September 26, 1978;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0310INDUSTRIAL INSURANCEThe following is departmental policy on industrial insurance.With respect to industrial business in this state an agent shall not be permitted to accept any money in payment ofthe premiums which are in arrears on any industrial insurance policy that has lapsed and which the insured seeks toreinstate unless the insured is enabled thereby to reinstate the policy. In other words, the agent cannot acceptpayment of part of the arrears and hold the money in his hands until he can collect the balance.Any advance premium which is paid by an industrial policyholder shall be recorded in the receipt book of theinsured and the record book of the agent in exactly the same manner as current premiums are recorded. There shallbe no such things as blind entries in either book and the policyholder's receipt book and the record book of the agentshall be in exact agreement at all times.Violation of this Rule will result in the initiation of license revocation proceedings. Companies will be expected toreport any violation of this Rule to the commissioner.History Note:Authority G.S. 58-9(1);Eff. February 1, 1976;Readopted Eff. September 26, 1978;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0311History Note:LIMITATION ON AMOUNT OF CREDIT INSURANCE WRITTENAuthority G.S. 57-1; 57-4; 58-9; 58-344;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. April 1, 1989.11 NCAC 12 .0312ACCIDENTAL DEATH BENEFIT: INHALATION OF GAS: ETCA policy or rider providing benefits for accidental death may not exclude the following:(1)The involuntary inhalation of gas and fumes and the involuntary taking of poison.(2)Accidental death as a result of involuntary exposure to nuclear explosion, nuclear energy ornuclear elements.(3)The involuntary exposure to hazardous waste and other toxins.(4)Unintentionally self-inflicted bodily injury.(5)Bacterial infection resulting from accidental injury.(6)Accidental ptomaine poisoning.History Note:Authority G.S. 58-2-40; 58-3-30; 58-3-150; 58-51-1; 58-51-95;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Amended Eff. February 1, 1992; April 1, 1989;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0313DISABILITY BENEFIT: CONFINEMENT INDOORSA policy or rider providing benefits for disability may not require confinement indoors or at home.History Note:Authority G.S. 58-2-40(1);Eff. February 1, 1976;Readopted Eff. September 26, 1978;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0314INSURER LIABILITY: PREMIUM ACCEPTED FROM INELIGIBLE DEBTOR
History Note:Authority G.S. 57-1; 57-4; 58-9; 58-344;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. April 1, 1989.11 NCAC 12 .031511 NCAC 12 .0316History Note:CALCULATION OF UNEARNED PREMIUM REFUNDS: CREDIT INSURANCEMISSTATEMENT OF AGE: CREDITAuthority G.S. 58-346; 58-351;Eff. February 1, 1976;Readopted Eff. September 26, 1978;Repealed Eff. April 1, 1989.11 NCAC 12 .0317ORIGIN OF SICKNESS: DESCRIPTIONThe use of a term more restrictive than "first manifested" in the determination of when a disease or sickness beginsis prohibited. The term "prudent person" cannot be used as a condition to establish when a disease or sicknessbegins.History Note:Authority G.S. 58-2-40; 58-51-95; 58-58-1; 58-65-1; 58-65-40; 58-67-50; 58-67-150;Eff. September 26, 1978;Amended Eff. February 1, 1992;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0318History Note:PREMIUM INCREASES: GROUPAuthority G.S. 57-1; 57-4; 58-9; 58-195; 58-249; 58-254.7; 58-293;Eff. September 26, 1978;Repealed Eff. February 1, 1992.11 NCAC 12 .0319SUBROGATION PROHIBITEDLife or accident and health insurance forms shall not contain a provision allowing subrogation of benefits.History Note:Authority G.S. 58-2-40; 58-51-1; 58-51-85; 58-51-95; 58-58-1; 58-65-1; 58-65-40;Eff. September 26, 1978;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0320SOUND HEALTH SHALL BE DEFINEDAn application for life and accident and health insurance shall not contain a question asking if the applicant is insound or good health unless the term is defined.History Note:Authority G.S. 58-2-40; 58-58-1; 58-65-1; 58-65-40;Eff. September 26, 1978;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0321History Note:RATE FILING: HMOAuthority G.S. 58-67-50; 58-67-150;Eff. January 22, 1980;Amended Eff. February 1, 1992;Repealed Eff. July 1, 2020.11 NCAC 12 .0322REGULAR CARE AND ATTENDANCE OF A PHYSICIAN
As used in life, accident and health and disability policies, "regular care and attendance of a physician" shall not beconstrued to require insureds to see or be under the care of a physician on a regular basis if it can be shown that theinsured has reached his maximum point of recovery yet is still disabled under the terms of the insurance contract.This requirement shall not, however, restrict the right of the insurer, at its own expense, to periodically examine orcause to have examined the insured according to the terms of the contract of insurance.History Note:Authority G.S. 58-2-40; 58-51-1; 58-65-1;Eff. April 1, 1989;Amended Eff. February 1, 1992;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0323COMPLICATION OF PREGNANCYComplications of pregnancy may not be treated differently from any other illness or sickness under the contract. Anon-elective cesarean section is considered a complication of pregnancy.History Note:Authority G.S. 58-2-40; 58-3-120; 58-51-1; 58-51-95; 58-63-15(7);Eff. April 1, 1989;Amended Eff. February 1, 1992;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0324HIV AND AIDS DISCRIMINATION PROHIBITEDHuman Immunodeficiency Virus (HIV) infection (symptomatic and asymptomatic) and Acquired ImmuneDeficiency Syndrome (AIDS) must be treated as any other illness or sickness under health insurance policyprovisions and policy applications. HIV and AIDS must be defined within the application if any questions are askedabout HIV and AIDS.History Note:Authority G.S. 58-2-40; 58-3-150; 58-51-1; 58-51.85; 58-51-95;Eff. April 1, 1989;Amended Eff. October 1, 1994;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0325History Note:OCCUPATIONAL INJURIES OR DISEASESAuthority G.S. 58-2-40; 58-3-150; 58-51-1; 58-51-85; 58-51-95;Eff. February 1, 1992;Amended Eff. October 1, 1994;Repealed Eff. July 1, 2012.11 NCAC 12 .0326APPLICATION FOR INSURANCE REQUIRED(a) Applications for individual life, and accident or health insurance and annuities intended to insure North Carolinaresidents shall, except in the case of direct response business, be signed by a North Carolina licensed agent. Thesignature of the licensed agent must be his or her actual signature.(b) Applications for insurance shall not include questions related to membership in substance or chemicaldependency support groups. The applicant may be required to complete any medical question related to actualtreatment, confinement, or diagnosis of such conditions.History Note:Authority G.S. 58-2-40; 58-33-25(o)(5); 58-50-5;Eff. February 1, 1992;Amended Eff. February 1, 1996;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.11 NCAC 12 .0327Y2K INTERIM CLAIM PAYMENTS
History Note:Authority G.S. 58-2-40; 58-2-235;Temporary Adoption Eff. January 1, 2000;Amended Eff. July 1, 2000;Repealed Eff. September 1, 2002.11 NCAC 12 .0328ELIGIBLE INDIVIDUAL COVERAGE(a) As used in this Rule, "designated health plan" means a guaranteed available plan an insurer must issue to aneligible individual under G.S. 58-68-60.(b) As used in this Rule, "eligible individual" has the same meaning as in G.S. 58-68-60(b).(c) As used in this Rule, "insurer" means an entity licensed under G.S. Chapter 58 that offers health insurancecoverage in the individual market in this State.(d) An insurer shall market each of its designated health plan(s) to eligible individuals.(e) In marketing the designated health plan(s) to eligible individuals, an insurer shall use at least the same sourcesand methods of distribution that it uses to market other health benefit plans to individuals. An agent authorized by aninsurer to market health benefit plans to individuals in this State shall also be authorized to market to eligibleindividuals.(f) An insurer shall offer at least the designated health plan(s) to any eligible individual who applies for or makes aninquiry regarding health insurance coverage from the insurer. The offer may be provided directly to the eligibleindividual or delivered through an agent. The offer shall be in writing and shall include at least the followinginformation:(1)A general description of the benefits contained in the designated health plan(s) and any otherhealth benefit plan being offered to the eligible individual; and(2)Information describing how the eligible individual may enroll in the plans.(g) An insurer shall provide a price quote to an eligible individual (directly or through an authorized agent) within10 working days of receiving a request for a quote and information necessary to provide the quote. An insurer shallnotify an eligible individual within five working days of receiving a request for a quote of any additionalinformation needed by the insurer to provide the quote.(h) An insurer shall not apply more stringent or detailed requirements related to the application process for aneligible individual than are applied for other individual applicants for other health benefit plans offered by theinsurer.(i) If an insurer denies coverage under a health benefit plan to an eligible individual, the denial shall be in writingand shall state with specificity the reasons for the denial, subject to any restrictions related to confidentiality ofmedical information. The written denial shall be accompanied by a written explanation of the guaranteed availabilityof coverage under the designated health plan(s) from the insurer. The explanation shall include at least thefollowing:(1)A general description of the benefit contained in each designated health plan;(2)A price quote for each designated health plan; and(3)Information describing how the eligible individual may enroll in a designated health plan.(j) The written information described in Paragraph (i) of this Rule shall be provided within the time periodsprovided in Paragraph (g) of this Rule and may be provided directly to the eligible individual or delivered throughan authorized agent.(k) An insurer shall maintain a toll-free telephone service that answers its telephone calls in a timely manner toprovide information to eligible individuals about the availability of the designated health plan(s) in this State. Theservice shall provide information to callers on how to apply for designated health plan coverage from the insurer.The information may include the names and telephone numbers of agents located near to the caller or otherinformation designed to assist the caller to locate an authorized agent or to otherwise apply for coverage.(l) An insurer shall not require, as a condition to the offer or sale of a designated health plan to an eligibleindividual, that the eligible individual purchase or qualify for any other insurance product or service.(m) An insurer shall not create financial incentives or disincentives for agents to sell or to not sell any of itsindividual heath benefit plans, including designated health plans.History Note:Authority G.S. 58-2-40(1); 58-68-60;Eff. April 1, 2003;Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. May 1,2018.
11 NCAC 12 .0329SUBMISSION REQUIREMENTS: FORM AND RATE FILINGSAny insurer, as defined by G.S. 58-1-5(3), that files with the Commissioner for review or approval product forms oflife, annuity, accident and health, multiple employer welfare arrangements or managed care provider contract formsand supporting documents, or premium rates, shall comply with the following:(1)Include a cover letter, or the NAIC Adopted Uniform Transmittal Document in lieu thereof, that:(a)Includes the name and address of the submitting company.(b)States the company issuing the form.(c)Includes the toll-free telephone number and valid electronic e-mail address of the filer.(d)Provides a
11 ncac 12 .0309 application: bylaws: rules: part of the policy contract The bylaws or constitution of a mutual insurance company, association, order, society, or reciprocal exchange need not be attached to each policy in order to be a part of the p
Part One: Heir of Ash Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26 Chapter 27 Chapter 28 Chapter 29 Chapter 30 .
TO KILL A MOCKINGBIRD. Contents Dedication Epigraph Part One Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Part Two Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18. Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 Chapter 24 Chapter 25 Chapter 26
DEDICATION PART ONE Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 PART TWO Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 Chapter 21 Chapter 22 Chapter 23 .
Mary Barton A Tale of Manchester Life by Elizabeth Cleghorn Gaskell Styled byLimpidSoft. Contents PREFACE1 CHAPTER I6 CHAPTER II32 CHAPTER III51 CHAPTER IV77 CHAPTER V109 CHAPTER VI166 CHAPTER VII218 i. CHAPTER VIII243 CHAPTER IX291 CHAPTER X341 CHAPTER XI381 CHAPTER XII423 CHAPTER XIII450 CHAPTER XIV479 CHAPTER XV513 CHAPTER XVI551
About the husband’s secret. Dedication Epigraph Pandora Monday Chapter One Chapter Two Chapter Three Chapter Four Chapter Five Tuesday Chapter Six Chapter Seven. Chapter Eight Chapter Nine Chapter Ten Chapter Eleven Chapter Twelve Chapter Thirteen Chapter Fourteen Chapter Fifteen Chapter Sixteen Chapter Seventeen Chapter Eighteen
18.4 35 18.5 35 I Solutions to Applying the Concepts Questions II Answers to End-of-chapter Conceptual Questions Chapter 1 37 Chapter 2 38 Chapter 3 39 Chapter 4 40 Chapter 5 43 Chapter 6 45 Chapter 7 46 Chapter 8 47 Chapter 9 50 Chapter 10 52 Chapter 11 55 Chapter 12 56 Chapter 13 57 Chapter 14 61 Chapter 15 62 Chapter 16 63 Chapter 17 65 .
HUNTER. Special thanks to Kate Cary. Contents Cover Title Page Prologue Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter
Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9 Chapter 10 Chapter 11 Chapter 12 Chapter 13 Chapter 14 Chapter 15 Chapter 16 Chapter 17 Chapter 18 Chapter 19 Chapter 20 . Within was a room as familiar to her as her home back in Oparium. A large desk was situated i
