Partnership Long-Term Care Insurance Policies or
Certificates shall contain:
(a) a
provision that gives the Policy or Certificate holder the option to elect, no
less frequently than on each anniversary date after the Policy or Certificate
is issued, to pay an extra premium for one or all of the following three
riders:
(1) a rider for a Nursing Facility and
Residential Care Facility Only expense reimbursable Policy or Certificate to
increase the amount of the nursing facility per diem benefit, so long as the
increase in the per diem amount is issued in multiples of ten (10) in ten
dollar ($10) increments;
(2) a
rider for a Comprehensive Benefit expense reimbursable Policy or Certificate to
increase the amount of the nursing facility per diem and the monthly home and
community-based care benefit, so long as the increase in the nursing facility
per diem amount is issued in multiples of ten (10) in ten dollar ($10)
increments and the monthly home and community-based care benefit is issued in
multiples of ten (10) and in the same ratio to the nursing facility per diem as
the ratio in the original Policy or Certificate;
(3) a rider for an expense reimbursable or
expense incurred Policy or Certificate to increase the lifetime maximum benefit
of either a Nursing Facility and Residential Care Facility Only or a
Comprehensive Benefits Policy or Certificate.
The Issuer may require the Policy or Certificate holder
to undergo new underwriting, in addition to the payment of an additional
premium, to qualify for the rider(s) elected. The Issuer may restrict the
aggregate amount of additional coverage a Policy or Certificate holder may
acquire by rider(s) to the maximum coverage allowed by this Section or the
maximum the Issuer allows when issuing a new Partnership Policy or Certificate,
whichever is less. The Issuer may use the same age restrictions for the
issuance of any rider governed by this section as the age limits, if any, that
the Issuer uses for the issuance or delivery of a new Partnership Policy or
Certificate. The extra premium for the increased coverages elected by the
Policy or Certificate holder shall be calculated in accordance with Section
58066(a).
(b) a provision that, in the event the Issuer
develops new benefits and/or provisions not included in its original
Partnership Policy or Certificate or markets a replacement Policy, the Issuer
will grant current holders of its Partnership Policies or Certificates who are
not in benefit or within the Elimination Period the following rights:
(1) they will be notified by the Issuer of
the availability of the new benefits and/or provisions within twelve
months;
(2) they will be afforded
an opportunity by the Issuer to acquire the new benefits and/or provisions in
one of the following ways:
(A) by adding a
rider to the original Partnership Policy or Certificate, in which case a
separate premium will be calculated for the rider based on the Policy or
Certificate holder's attained age; the premium for the original Policy or
Certificate will remain unchanged based on age at issuance;
(B) by replacing their existing Partnership
Policy or Certificate with a subsequent Partnership Policy or Certificate
issued by the current Issuer, in which case consideration for past insured
status shall be recognized by giving a five percent (5%) premium credit for
each full year the original Partnership Policy or Certificate was in force
toward all subsequent premium payments for the replacement Partnership Policy
or Certificate as specified in Section
58066(b);
(C) by replacing their existing Partnership
Policy or Certificate with a subsequent Partnership Policy or Certificate with
a premium based on the insured's original issue age.
(3) they may have to undergo new
underwriting, but the underwriting can be no more restrictive than if the
Policy or Certificate holder were applying for a new Partnership Policy or
Certificate.
(4) the Issuer of
Partnership group Policies must offer current group Policy holders the
opportunity to have the new benefits and/or provisions extended to current
Certificate holders, but the Issuer is relieved of the obligations imposed by
this provision if the holder of the group Policy declines the Issuer's
offer.
(c) a provision
that gives the Policy or Certificate holder a right, exercisable any time after
the first year, to retain a Policy or Certificate meeting all the requirements
of certification while lowering the premium subject to the following
conditions:
(1) the Policy or Certificate
holder of an expense reimbursable Policy or Certificate may:
(A) reduce the nursing facility per diem and
the monthly home and community-based care benefit (but not below the minimum
specified in Section
58050(a) or (b)),
and/or;
(B) reduce the lifetime
maximum benefit, but not below the dollar equivalent of one hundred eight-two
(182) times seventy percent (70%) of the Average Daily Private Pay Rate for
Nursing Facilities;
(2)
the Policy or Certificate holder of an expense incurred Policy may;
(A) reduce the lifetime maximum benefit, but
not below the dollar equivalent of one hundred eight-two (182) times seventy
percent (70%) of the Average Daily Private Pay Rate for Nursing
Facilities;
(3) the
Policy or Certificate holder of either an expense reimbursable or expense
incurred Comprehensive Benefits Policy or Certificate may convert to a Nursing
Facility and Residential Care Facility Only Policy or Certificate with per diem
not less than the minimums specified in Section
58050(b) and a
lifetime maximum benefit no less than the dollar equivalent of one hundred
eight-two (182) times seventy percent (70%) of the Average Daily Private Pay
Rate for Nursing Facilities;
(4)
the reduced nursing facility per diem benefit, lifetime maximum benefit, and,
if a Comprehensive Benefits Policy or Certificate, monthly home and
community-based care benefit, of an expense reimbursable Policy or Certificate,
must increase each year in the same amount and be computed in the same manner
as the inflation protection provision issued with the original Policy or
Certificate as specified in subsection (k) of Section
58059;
(5) the lower premium for any reduced
coverage Policy or Certificate shall be calculated in accordance with
58066(c);
(6) in the event a Policy
or Certificate is about to lapse, the Issuer shall advise the Policy or
Certificate holder of the options to lower the premium by reducing coverage and
of the premiums, applicable to the reduced coverage; if the Policy or
Certificate has a Non-Forfeiture Benefit rider, the Issuer shall also advise
the Policy or Certificate holder that the the original policy may be kept in
force for a shortened benefit period under the Non-Forfeiture Benefit
rider.
Notes
Cal. Code Regs. Tit. 22, §
58061
1. New
section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
Submitted for printing only pursuant to section
22009,
Welfare and Institutions Code.
2. Certificate of Compliance as to
8-30-93 order, including amendment of subsections (a), (a)(2), (a)(3),
(b)(2)(B), (c)(5) and (c)(6), incorporation (and amendment) of former
subsection (a)(4) into subsection (a)(3), and repealer of subsection (a)(5)
transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
4).
3. Amendment of subsections (c)(1)(B), (c)(2)(A) and (c)(4)
filed 9-6-95 as an emergency; operative 9-6-95. Submitted to OAL for printing
only pursuant to Welfare and Institutions Code section
22009(d)
(Register 95, No. 36). A Certificate of Compliance must be transmitted to OAL
by 1-4-96 or emergency language will be repealed by operation of law on the
following day.
4. Editorial correction of HISTORY 3 (Register 95,
No. 42).
5. Amendment of subsections (c)(1)(B), (c)(2)(A) and (c)(4)
refiled 1-2-96 as an emergency; operative 1-2-96 (Register 96, No. 1). A
Certificate of Compliance must be transmitted to OAL by 5-1-96 or emergency
language will be repealed by operation of law on the following
day.
6. Certificate of Compliance as to 9-6-95 order, including
amendment of subsection (c)(4), transmitted to OAL 4-3-96 and filed 5-2-96
(Register 96, No. 18).
7. Amendment of section heading and section
filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing
only pursuant to Welfare and Institutions Code section
22009(d)
(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
by 1-29-99 or emergency language will be repealed by operation of law on the
following day.
8. Certificate of Compliance as to 10-1-98 order
transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
12).
Note: Authority cited: Section
22009(a),
Welfare and Institutions Code. Reference: Section
22005,
Welfare and Institutions Code.
1. New section
filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
Submitted for printing only pursuant to section
22009,
Welfare and Institutions Code.
2. Certificate of Compliance as to
8-30-93 order, including amendment of subsections (a), (a)(2), (a)(3),
(b)(2)(B), (c)(5) and (c)(6), incorporation (and amendment) of former
subsection (a)(4) into subsection (a)(3), and repealer of subsection (a)(5)
transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of subsections (c)(1)(B), (c)(2)(A) and (c)(4) filed 9-6-95 as an
emergency; operative 9-6-95. Submitted to OAL for printing only pursuant to
Welfare and Institutions Code section
22009(d)
(Register 95, No. 36). A Certificate of Compliance must be transmitted to OAL
by 1-4-96 or emergency language will be repealed by operation of law on the
following day.
4. Editorial correction of History 3 (Register 95,
No. 42).
5. Amendment of subsections (c)(1)(B), (c)(2)(A) and
(c)(4) refiled 1-2-96 as an emergency; operative 1-2-96 (Register 96, No. 1). A
Certificate of Compliance must be transmitted to OAL by 5-1-96 or emergency
language will be repealed by operation of law on the following day.
6. Certificate of Compliance as to 9-6-95 order, including amendment of
subsection (c)(4), transmitted to OAL 4-3-96 and filed 5-2-96 (Register 96, No.
18).
7. Amendment of section heading and section filed 10-1-98 as
an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
Welfare and Institutions Code section
22009(d)
(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
by 1-29-99 or emergency language will be repealed by operation of law on the
following day.
8. Certificate of Compliance as to 10-1-98 order
transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
12).