In this chapter,

1. (1) "applicant" has the meaning given in AS 21.53.200(1);
2. (2) "benefit trigger", for the purposes of independent review, means a contractual provision in the insured's policy of long-term care insurance conditioning the payment of benefits on a determination of the insured's ability to perform activities of daily living and on cognitive impairment; for purposes of a tax-qualified long-term care insurance contract within the meaning given in 26 U.S.C. 7702B(b) (Internal Revenue Code), a "benefit trigger" does not occur without a determination by a licensed health care practitioner that an insured is a chronically ill individual;
3. (3) "certificate" has the meaning given in AS 21.53.200(2);
4. (4) "group long-term care insurance" has the meaning given in AS 21.53.200(3);
5. (5) "independent review organization" means an organization that conducts independent reviews of long-term care benefit trigger decisions;
6. (6) "licensed health care professional" means an individual qualified by education and experience in an appropriate field, to determine, by record review, an insured's actual functional or cognitive impairment;
7. (7) "long-term care insurance" has the meaning given in AS 21.53.200(4);
8. (8) "qualified actuary" means a member in good standing of the American Academy of Actuaries;
9. (9) "qualified long-term care insurance" means an insurance contract that pays only for qualified long-term care services within the meaning given in 3 AAC 28.584(f)(1);

10. (10) "similar policy forms" means all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered; certificates of groups that meet the definition in AS 21.53.200(3)(A) are not considered similar to certificates or policies otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications; for purposes of this paragraph, long-term care benefit classifications are defined as follows:

    1. (A) institutional long-term care benefits only;
    2. (B) non-institutional long-term care benefits only; or
    3. (C) comprehensive long-term care benefits.

(Eff. 3/27/2022, Register 241)

Authority: AS 21.06.090, AS 21.53.090, AS 21.53.200