Ga. Comp. R. & Regs. R. 120-2-16-.26 - Availability of New Services or Providers
(1) An insurer shall notify policyholders of
the availability of a new long-term policy series that provides coverage for
new long-term care services or providers material in nature and not previously
available through the insurer to the general public. The notice shall be
provided within 12 months of the date of the new policy series is made
available for sale in this state.
(2) Notwithstanding subsection (1) above,
notification is not required for any policy issued prior to the effective date
of this section or to any policyholder or certificateholder who is currently
eligible for benefits, within an elimination period or on a claim, or who
previously had been in claim status, or who would not be eligible to apply for
coverage due to issue age limitations under the new policy. The insurer may
require that policyholders meet all eligibility requirements, including
underwriting and payment of the required premium to add such new services or
providers.
(3) The insurer shall
make the new coverage available in one of the following ways:
(a) By adding a rider to the existing policy
and charging a separate premium for the new rider based on the insured's
attained age;
(b) By exchanging the
existing policy or certificate for one with an issue age based on the present
age of the insured and recognizing past insured status by granting premium
credits toward the premiums for the new policy or certificate. The premium
credits shall be based on premiums paid or reserves held for the prior policy
or certificate;
(c) By exchanging
the existing policy or certificate for a new policy or certificate in which
consideration for past insured status shall be recognized by setting the
premium for the new policy or certificate at the issue age of the policy or
certificate being exchanged. The cost for the new policy or certificate may
recognize the difference in reserves between the new policy or certificate and
the original policy or certificate; or
(d) By an alternative program developed by
the insurer that meets the intent of this section if the program is filed with
and approved by the Commissioner.
(4) An insurer is not required to notify
policyholders of a new proprietary policy series created and filed for use in a
limited distribution channel. For purposes of this subsection, "limited
distribution channel" means through a discrete entity, such as a financial
institution or brokerage, for which specialized products are available that are
not available for sale to the general public. Policyholders that purchased such
a new proprietary policy shall be notified when a new long-term care policy
series that provides coverage for new long-term care services or providers
material in nature is made available to that limited distribution
channel.
(5) Policies issued
pursuant to this section shall be considered exchanges and not replacements.
These exchanges shall not be subject to Sections
120-2-16-.14 and 120-2-16-24, and
the reporting requirements of Section
120-2-16-.15(1) through
(5) of this Regulation.
(6) Where the policy is offered through an
employer, labor organization, professional, trade or occupational association,
the required notification in subsection (1) above shall be made to the offering
entity. However, if the policy is issued to a group defined in O.C.G.A. Section
33-42-4, the notification shall be
made to each certificateholder.
(7)
Nothing in this section shall prohibit an insurer from offering any policy,
rider, certificate or coverage change to any policyholder or certificateholder.
However, upon request any policyholder may apply for currently available
coverage that includes the new services or providers. The insurer may require
that policyholders meet all eligibility requirements, including underwriting
and payment of the required premium to add such new services or
providers.
(8) This section does
not apply to life insurance policies or riders containing accelerated long-term
care benefits.
(9) This section
shall become effective on or after April 1, 2008.
Notes
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