California § 10231.6

§ 10231.6.

“Group long-term care insurance” means a long-term care insurance policy which is delivered or issued for delivery in this state and issued to any of the following: (a) One or more employers or labor organizations, or a trust or to the trustees of a fund established by one 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 organization. (b) Any professional, trade, or occupational association for its members or former or retired members, or combination thereof, if that association meets both of the following: (1) Is composed of individuals all of whom are or were actively engaged in the same profession, trade, or occupation. (2) Has been maintained in good faith for purposes other than obtaining insurance. (c) An association or a trust or the trustees of a fund established, created, or maintained for the benefit of members of one or more associations. Prior to advertising, marketing, or offering that policy or a certificate within this state, the association or associations, or the insurer of the association or associations, shall file evidence with the commissioner that the association or associations have at the outset a minimum of 100 persons and have been organized and maintained in good faith for a primary purpose other than that of obtaining insurance, have been in active existence for at least one year, have a constitution and bylaws which provide all of the following, and provide evidence that the following have been consistently implemented: (1) The association or associations hold regular meetings, not less than annually, to further purposes of the members. (2) Except for credit unions, the association or associations collect dues or solicit contributions from members. (3) The members have voting privileges and representation on the governing board and committees. Thirty days after that filing the association or associations shall be deemed to satisfy these organizational requirements, unless the commissioner makes a finding that the association or associations do not satisfy those organizational requirements. (d) A group other than as described in subdivisions (a), (b), and (c), subject to all of the following findings by the commissioner: (1) The issuance of the group policy or certificate is not contrary to the best interest of the public. (2) The issuance of the group policy will result in economies of acquisition or administration. (3) The benefits are reasonable in relation to the premiums charged. (4) The use of the true or fictitious name of the group, group master policyholder, group policy, certificate, or any trust or other entity created or used for the marketing of the group policy or certificates is not deceptive or misleading with regard to the status, character, or proprietary or representative capacity of the insurer, group, trust, or other entity. (5) The group’s main revenue source is not related to the marketing of insurance. (6) The group’s outreach method to obtain new members is not related to the solicitation of insurance. (7) The group provides benefits or services, other than insurance, of significant value to its members. The commissioner shall investigate the percentage of members using the other services and the monetary value of those services. (e) A life care contract provider which has received a certificate of authority in accordance with Chapter 10 (commencing with Section 1770) of Division 2 of the Health and Safety Code. Any life care contract provider which has not received the certificate of authority from the State Department of Social Services shall be subject to this chapter.