North Carolina laws and rules
Grandfather plans
Plans that were purchased before March 23 2010
Finger printing
The commissioners requires fingerprinting within 30 days of applying for a resident insurance license
Licensee
A licensee is any person who hold a license
Entire contract
A provision that the policy including the endorsements and the attached papers shall constitute the entire contract between the parties
Address/name change
Agents must report a change in address or name to the commissioner within 10 business days of change
Process
An application for a resident agent license in North Carolina must submit an application to the commissioner and • must be 18 years of age • not have committed any act that is grounds for denial suspicion or revocation •Completed a 20 hour prelicensing course •Have passed the state exam for the lines of authority in which licensure is sought •Submit the application with fees •Not intend to use the license primarily to write controlled business •Be deemed trustworthy and competent
Rate increases
An insurer must provide written notice to individual accident and health policy owners at 30 days before the effective date of a rate increases
Medical treatment in tax supported institutions
Cerebral palsy Other orthopedic and crippling disabilities Mental and nervous diseases or disorders Intellectual disability Alcholism and drug or chemical dependency Respiratory illness
Department
Department is the department of insurance of North Carolina
Business records
Every insurance agent broker must maintain all records books and documents for insurance transactions for a period of not less than five years
Time payment of claims
Indemnity claims will be paid immediately upon receipt of written proof of loss. Disability claims will be paid no less frequently than monthly
Commissions
No person shall pay or except commissions to/from an unlicensed individual for the purpose of selling or negotiating insurance business
Broker
A brokers license must be renewed annually by April 1 and insurance broker in North Carolina is a representative of the insured
Contract of insurance
A contract of insurance is defined in North Carolina statues as an agreement by which the insured is bound to pay money or it's a Quillivant to do some act of value to the insured upon as an indemnity Or reimbursement for the destruction loss or injury of something in which the other party has an interest that insurance department is responsible for regulating the business of transacting insurance contracts in North Carolina all contracts of insurance that are made with the North Carolina are subject to the laws of the state
Reinstatement and renewal
A licensee who allows his or her license to lapse mate within four months from the renewal date re-sign the license without re-taking a pre-licensing course and state licensing exam continue education requirements still need to be met Reinstatement fee applies
Person
A person is an indivisible partnership firm association corporation joint stock company trust or any similar entity •The singular form includes the plural and the masculine form includes the feminine wherever appropriate
Free look
A policyowner has 10 days to return an Accident/Health insurance policy and receive a full refund on premiums. The free look provision of any health policy begins the date the policy is delivered to the insured
Ethical standards
Agents, brokers, and other insurance company representatives must conduct themselves in a professional manner. Below are some important ethical standards to keep in mind •Act fairly and honestly •Immediately and identify yourself and your role •Carry your insurance license while performing insurance duties •DO NOT Except gratuity for Referrals to other providers of service •DO NOT Intimidate or discourage a client from seeking advice or counsel
Newborn Child Coverage
All individual and group health plans which provide coverage to family members of the insured must provide coverage for the insureds Newborn child at the moment of birth. If a premium is required to continue the new borns coverage it must be paid within the first 31 days to continue coverage, Coverage includes injury and sickness including medical care for diagnosed congenital defects and birth abnormalities
Agent appointments
An agent cannot act as an agent for an answer unless here she is appointed to work for an answer is you're the responsible for submitting an appointment notice to the commissioner within 30 days of agents appointment or submission of first insurance application sister is also responsible for paying the agents appointment renewal fee
Non-resident agent's
An agent who holds a resident license in a different state may apply for a nonresident license in North Carolina as long as both states have reciprocal agreement to apply non-residents must submit an application form proof of residence license in good standing in fees non-resident agent applicants do not have to take the North Carolina state licensing exam but must have not committed any act For which the license could be denied suspended or revoked A license resident agent doesn't Need to counter sign any documents policies applications or other insurance forms on behalf of a non-resident agent or doesn't Need to receive commission from the transaction in the state of North Carolina
Termination of agent appointment
And in sure that terminates an agent appointment must notify the commissioner within 30 days of the date of termination within 15 days of such notice then sure must mail a copy of the notice to the terminated agent after which the agent will have 30 days to submit written comments to the commissioner
agent
And individuals who in any manner sells solicits or negotiate insurance on behalf of the insurance companies for compensation is an insurance agent •in North Carolina and individual agent is considered to represent the insurance company • A licensee may not transact insurance business in North Carolina until the licensee is appointed by an insurer
Notice of lapse
And insurance company must provide a notice to the insured 15 days before a policy will be canceled or Lapsed due to nonpayment
Claim forms
And insurance company will send a form for filing proof of loss to acclimate within 15 days after company receive notice of a claim
Prohibited discrimination/sickle cell trait
Answers may not discriminate against applicants who are diagnosed with sickle cell trait or hemoglobin C-Trait
Form classification and rates
Before an insurance policy is issued or delivered the form, classification or risk, and premium rates Must be filed with the commissioner of insurance
Company
Company insurance company or an insurer include any corporation association partnership society order individual or aggregation of individuals and gauging or attempting to engage in the insurance business
Direct response
Direct response solicitation means any offer by an insurance company to persons in the state either directly or through a third-party to affect life or health insurance coverage which enables the individual to apply for the insurance on the basis of the offer
Complaint records
Each ensure or his agent must maintain for at least five years a log of all written complaint listing the following - Department file number. Name of insured nature of the complaint department subject to the complaint policy or claim number of the insured and deposition of the complaint
Fraternal benefit society
Fraternal benefit society's or corporation society or order that I have a representative form of government and organize their lot system. Fraternal benefit society exist for the benefit of its members and their beneficiaries •Fraternal benefit society may provide that benefit endowment benefit annuity benefits disability benefits and hospital/medical/nursing benefit •Agents for fraternal benefit society must be licensed in accordance with the general insurance laws that they are receiving a commission or if they are soliciting outside of the membership •Fraternal benefit society agents do not need to pass an exam or be licensed if they do not receive commission •If fraternal benefit society is a nonprofit in entity
Industrial health insurance
Have a minimum grace period of 4 weeks for additional death benefit premium Have a maximum of 2 years incontestability provision of the death benefit Have a no cancel labor death benefit unless due to nonpayment of premium
Reporting of actions
If a Licensee is convicted in any court for any crime or offense other than a motor vehicle in fraction the licensee must notify the commissioner 10 days after the date of conviction when an agent reports a final disposition Of an in ministry live action against the agent to the commissioner the report must include a copy of the order or other relevant legal document
Reinstatement
If a health policy is reinstated after It had lapsed for nonpayment there's a waiting period for 10 days before a claim covering sickness will be covered: injuries sustained in the accident however will be covered imediately
False pretenses and cheats
If an insurance agent broker Or administrator in embezzles or fraudulently uses or withhold any money received as a result of acting as an agent broker or administrator he or she can be charged with a felony
Denial of license
If the commissioner refuses to issue a license for any reasons a license may be suspended revoked or denied the applicant will be notified in writing within 30 days after service of a notification that applicant may make a written appeal to the commissioner for review the review must be completed without undue delay and the applicant must be notified promptly in writing as to the outcome of the review if the applicant still disagrees with the outcome here she may apply for a hearing within 30 days
Binder as evidence
Leaders must except binders or temporary insurance contracts as evidence of insurance as long as they meet the following criteria -Include standard insurance contract provisions -They include applicable contract endorsements -Thank you the paid receipt from full year premium The law doesn't prohibit a lender from refusing to accept a binder as evidence, as long as the payment option is available to all existing clients and if the insurer pays all applicable credit card processing fees
New residents
Licensed agents moving to North Carolina from another state have 90 days within canceling their previous license to apply for a resident license here after 90 days the applicant must complete pre-license education and pass the state exam in North Carolina
Continuing education
Resident agent must complete 24 hours of continuing education every two years to keep your license active three of those hours must be ethics •The board of insurance agent education develops the continuation education program and submit the proposal to the commissioner for approval • nonresident agents are not required to complete North Carolina continuing education requirements as long as their home state requirements are met •The commissioner will appoint an advisory committee and the committee will recommend rules which the commissioner may accept or reject
Nc Life and health guaranty association
The North Carolina life and guaranty Association provides claim payments of admitted into living financially incapacitated insurance agents are prohibited from using the existence of the North Carolina guaranty Association for selling soliciting or Inducing purchase of an insurance policy for any one person the Guaranty association will provide: -contractual obligations provided by the insurer -300,000 in life insurance death benefit and 300,000 in cash value -300,000 for coverage is not defined in health benefit plans -No more than 500,000 in health benefit plans -300,000 in health insurance disability long-term care insurance -Do you thousand and present value annuity benefits -5 million in benefits for those covered by any unallocated annuity of $1,000,000 in benefits and cash value The North Carolina life and health guaranty Association is not obligated to cover more than 300,000 in benefits The life and health guaranty Association is funded by insurance companies through assessments .
Cease and desist order
The commissioner has the authority to exam and investigate the affairs Of any person engage in the business of insurance in the state. Based on the investigation the commissioner may issue a cease and desist order. Any person who willfully violating a cease and desist order of the commissioner may be subject to a fine from 1000 to 5000 for each violation
Notice and hearing
The commissioner may call and hold hearings for any purpose deemed necessary. At least 10 days written notice will be given to all persons affected by the hearing
Examination of records
The commissioner may conduct a financial examination of any insurance company as often as deemed appropriate. At the very least a company shall be exams every five years
Car rental company licenses
The commissioner may issue a limited license to A rental car company allowing it to sell certain insurance coverage associated with vehicle rental
Temporary license
The commissioner may issue a temporary insurance agent license for maximum period of 180 days or longer for good cause without requiring an examination if the commissioner deems that the temporary license is necessary for the servicing of an insurance business • A temporary license may be issued in cases where an agent has become disabled or dies requiring a replacement To service the agents business • A temporary license may also be issued in cases where the agent becomes activated for military service
Restricted license
The commissioner may issue in annually renewable restricted license valid for representing and in sure in a foreign country or on the US military base
Probation suspension revocation Refusal to issue or renewof licenses
The commissioner must give written notice to the agent before holding a hearing that may lead to the suspension or revocation of the agents license. The commissioner may placed on probation suspend revoke refuse to renew or deny a license to any person who has... •Provided incorrect miss leading incomplete or untrue information in the license application •Violating any insurance laws regulations Subpoena or orders from the commissioner •Obtaining to obtain a license through fraud or misrepresentation •Initially misrepresent the terms of an insurance contract • been convicted of a felony •Committed any insurance unfair trade practices • Using fraudulent or diss honest practices or demonstrating incompetence Untrustworthiness or financial irresponsibility in this or any other state •Had an insurance license to denied suspended or revoked by another state •Forged a name to an insurance document or application • cheated on an insurance license examination •Knowingly accepting insurance business from an unlicensed individual •Failed to comply with the court order imposing child support •Failed to pay state income tax •attempted to obtain a license through fraud or misrepresentation •Initially misrepresented the terms of an insurance contract
Commissioner of insurance
The commissioner of insurance in force is all laws of the state government insurance companies and make rules and regulations related to the business of insurance the commissioner is elected to office and the term last for four years The commissioners powers and duties include •Enforcing and caring out all the provisions of the general statues •Adopting rules and regulations to enforce provisions of the general statues •Adapting rules pertaining to solicitation of proxies,Including financial reporting of equity Securities of any domestic stock insurance company • Approving forms use for companies association orders or bureaus •Receiving and thoroughly examining all financial records •Reporting in detail to the attorney general any violation of insurance laws •Instituting civil actions or criminal prosecution by the attorney general for any violation • when requested by any citizen of the state providing a synopsis of the provisions Of any insurance contract which is offered or issued •Compiling and making available to the public lists of rates charged, including deviations, and Explanations of coverages that are provided by insurers
Free look.
The free look. Allows the policy owner time to decide whether not to keep it at the policy owner decides not to keep the policy with in the free look. A full refund will be given. In North Carolina life insurance policies must provide a minimum free look. Of 10 days upon policy delivery a delivery receipt is signed document that states the free look.
Insurance information privacy Protection act
The purpose of this act is just our standards for the collection use and disclosure of information gathered during insurance transaction Insurance information and privacy protection act is assigned to limit or direct information collection activities of •Agents and limited representatives -Insurance support organizations and insurance companies -The insurance information and privacy protection act requires an applicant for an individual insurance policy be notified of an investigation into his personal character general reputation and mode of living -And insurance company must Clearly specify questions designed to obtain information solely for marketing research in any insurance transaction -When access to record it personal information is requested following an adverse underwriting decision the insurer must make the information available within 30 business days -Any reported violation of this act require the commissioner of insurance issue and serve a statement of charges and notice of hearing the day of such a hearing she'll be at least 10 days after service of charges -Pretax interviews and 18 is prohibited from conducting interviews that misrepresents The agent orange shirts I didn't get it or the nature of the interview to obtain information in connection with an insurance transaction -Notice of information practices agents and ensures must provide written notice of information practices no later than the time of policy delivery or at the time of collection of personal information -An agent or insurer must make any requested Corrections or amendments or changes or notification of refusal to And individuals personal information with in 30 days from the date of the request -An agent or insurer must provide notice With a list of reasons of any adverse Underwriting decisions. -An agent or insured cannot share or disclose personal information about a customer unless they have written authorization from the customer
Metal levels
There are 4 tiers of qualifying health plans. They range from lower quality but more affordable "bronze plans" to "silver plans" to a more expensive plan with better coverage called a "golden plan" there is also a "platinum plan" which is the highest quality and cost plan. Lower premium plans will have higher deductibles, less benefits and larger out of pocket costs, Bronze plans 60% coverage provided Silver plans 70% Gold plans 80% Platinum 90%
Legal action
There is a waiting period of 60 days to file a lawsuit after a claim for loss has been filed by the insured no lawsuit may be filed after 3 years has passed from when the claim was submitted
Notice of claim
Written notice of claim for entry or for sickness must be given to the insurer insurer within 20 days after the date of occurrence
Proof of loss
Written proof of loss must be furnished to the insurer within 180 days after the date of such loss
Buyer's Guide and Policy Summary
an insurer must provide these to any prospective purchaser upon request or prior to accepting the applicant's initial premium or premium deposit unless there is a 14 day free-look provision.
