20 CSR 400-4.110 - Qualified Long-Term Care Partnership Program
(1)
Requirements. For the purposes of this section, "Qualified Long-Term Care
Partnership coverage" shall mean any long-term care coverage that is intended
to be marketed as part of a long-term care partnership program, as outlined in
sections 208.690 to
208.698, known as the "Missouri
Long-Term Care Partnership Program Act."
(A)
Coverage Requirements. Coverage will be considered meeting the requirements of
the Missouri Long-Term Care Partnership Program if the following requirements
are met:
1. The insured was a resident of
this state when coverage first became effective;
2. The coverage is a qualified long-term care
insurance policy (as defined in section 7702B(b) of the Internal
Revenue Code of 1986);
3.
The coverage meets the requirements of the Deficit Reduction Act of 2005,
except for Subchapter B, Section 6021(a)(1)(iii)(IV) as stated in section
208.696.1(2), RSMo; and
4. The
coverage includes inflation protection no less favorable than the following:
A. For a person who is less than sixty-one
(61) years of age as of the date of purchase, the coverage provides compound
annual inflation protection; and
B.
For a person who is at least sixty-one (61) years of age but less than
seventy-six (76) years of age, the policy provides some level of inflation
protection; and
C. For any person
who has attained the age of seventy-six (76), inflation protection may be
provided but is not required.
D. In
order for coverage to meet the requirements of subparagraph (1)(A)4.A., if the
required inflation protection offer of five percent (5%) compound annual
inflation protection referenced in
20 CSR
400-4.100(11) is rejected, the
inflation protection included shall:
(I)
Provide automatic annual compounded inflation increases at a rate not less than
three percent (3%); or
(II) Provide
automatic annual compound inflation increases at a rate based on changes in the
consumer price index. "Consumer price index" means consumer price index for all
urban consumers, U.S. city average, all items, as determined by the Bureau of
Labor Statistics of the United States Department of Labor; or
(III) The director may approve an alternative
inflation protection method so long as such method is submitted to the director
with an explanation and demonstration as to how the alternative method provides
for meaningful benefits which are in the best interest of the consumer and
provides assurances that the policy or certificate will remain a partnership
plan.
(B) Offers of Exchange. In addition to
complying with the requirements of
20 CSR
400-4.100(25), where applicable-
1. Within one hundred eighty (180) days of
the date that an insurer begins to advertise, market, offer, sell or issue
policies that qualify under the state long-term care partnership program, the
insurer shall offer, on a one (1)-time basis, in writing, to all existing
policyholders and certificate holders that were issued long-term care coverage
by the insurer on or after February 8, 2006, the option to exchange their
existing long-term care coverage for coverage that is intended to qualify under
the Missouri Long-Term Care Partnership Program (Partnership Plan). The written
offer of exchange shall include the LongTerm Care Partnership Program Exchange
Notification letter (Form LTC-4);
2. An exchange occurs when an insurer offers
a policyholder or certificate holder (hereinafter "insured") the option to
replace an existing long-term care insurance policy with a policy that
qualifies as a Partnership Plan, and the insured accepts the offer to terminate
the existing policy and accepts the new policy. In making an offer to exchange,
an insurer shall comply with all of the following requirements:
A. The offer shall be made on a
nondiscriminatory basis without regard to the age or health status of the
insured;
B. The offer shall remain
open for a minimum of one hundred eighty (180) days from the date of mailing by
the insurer to the insured's last known address; and
C. At the time the offer is made, the insurer
shall provide the insured a copy of Form LTC-4;
3. Notwithstanding paragraphs (1)(B)1. and
2., above:
A. An offer to exchange may be
deferred for any insured who is currently eligible for benefits under an
existing policy or who is subject to an elimination period on a claim, but such
deferral shall continue only as long as such eligibility or elimination period
exists, or the insured is no longer in claims status;
B. An offer to exchange does not have to be
made if the insured would be required to purchase additional benefits to
qualify for the state long-term care partnership program and the insured is not
eligible to purchase the additional benefits under the insurer's new business,
long-term care, underwriting guidelines;
4. If the new policy has an actuarial value
of benefits equal to or lesser than the actuarial value of benefits of the
existing policy, then all of the following apply:
A. The new policy shall not be underwritten;
and
B. The rate charged for the new
policy shall be determined using the original issue age and risk class of the
insured that was used to determine the rate of the existing policy;
5. If the new policy has an
actuarial value of benefits exceeding the actuarial value of the benefits of
the existing policy, then all of the following apply:
A. The insurer shall apply its new business,
long-term care, underwriting guidelines to the increased benefits only;
and
B. The rate charged for the new
policy shall be determined using the method set forth in subparagraph
(1)(B)4.B., above, for the existing benefits, increased by the rate for the
increased benefits using the then current attained age and risk class of the
insured for the increased benefits only;
6. The new policy offered in an exchange
shall be on a form that is currently offered for sale by the insurer in the
general market and the effective date of the Partnership Plan policy shall be
the same as the new policy;
7. In
the event of an exchange, the insured shall not lose any rights, benefits or
built-up value that has accrued under the original policy with respect to the
benefits provided under the original policy, including, but not limited to,
rights established because of the lapse of time related to pre-existing
condition exclusions, elimination periods, or incontestability
clauses;
8. Insurers may complete
an exchange by issuing a new policy with an effective date no earlier than the
effective date of Missouri's State Plan Amendment;
9. For those insureds with long-term care
policies issued before February 8, 2006, any insurer may offer any insured an
option to exchange an existing policy for a policy that qualifies as a
Partnership Plan. The requirements set forth in paragraphs (1)(B)2. through 9.
shall apply to any such exchange; and
10. Policies or certificates issued pursuant
to this section shall be considered exchanges and not replacements. These
exchanges shall not be subject to
20 CSR
400-4.100(12) and the reporting
requirements of subsections (13)(B) through (F), in accordance with subsection
(25)(E) of regulation
20 CSR
400-4.100.
(C) Filing Requirements.
1. Any policy that is intended to qualify as
a Partnership Plan must be filed for approval with the director prior to use,
and such filing shall include a separate partnership certification for each
form, signed by an officer, which shall include:
A. Certification that the form includes all
consumer protection requirements set forth in section 1917(b)(5)A of the Social
Security Act (42 U.S.C.
1396p(b)(5)(A)) and that it
contains specified provisions of the Deficit Reduction Act of 2005 and the
appropriate provisions included in this regulation and sections
376.1100 through
376.1130, RSMo;
B. General information, including:
(I) Name, address and telephone number of the
issuer;
(II) Policy form(s) covered
by this certificate, including the form number and approval date; and
(III) Specimen copies of each form if they
have not been previously approved by the department;
C. Identification and location in the form of
each of the required provisions indicated in the Deficit Reduction Act of 2005
and this regulation; and
D. A
statement that the form complies with the partnership program inflation
protection requirements of paragraph (1)(A)4. of this
regulation.
2. Insurers
intending to make use of a previously filed policy as a qualifying partnership
policy shall submit to the director the Partnership Program Policy
Certification Form (Form LTC-5) signed by an officer of the company with
respect to each such policy form filed. For each policy form, the partnership
program certification shall identify the policy by the original form number and
approval date.
3. If an insurer
intends to amend a previously approved policy with an endorsement or rider in
order to bring the policy into compliance with the partnership program, the
insurer shall file the endorsement or rider for approval by the director prior
to use, and the filing shall include a partnership program certification signed
by an officer of the company for each policy to be amended by the endorsement
or rider, which shall include the original form number and filing date of the
previously filed policy.
4.
Insurers using Form LTC-4 do not have to file the form with the director before
use.
(D) Partnership
Plan Disclosure Form.
1. For policies intended
to qualify under the partnership program, the producer or insurer shall give
the consumer a partnership disclosure notice using the Long-Term Care
Partnership Program Disclosure Notice (Form LTC-6), either-
A. Along with the outline of coverage
required by regulation at the time of solicitation;
B. In the case of a policy issued to a group
where an outline of coverage is not delivered, along with the enrollment forms;
or
C. In the case of a life
insurance policy that offers long-term care insurance as a term of the policy
or in a rider, along with the policy summary at the time of
solicitation.
2. A
partnership policy or certificate issued or issued for delivery in Missouri
shall be accompanied by a Long-Term Care Partnership Delivery Notice (Form
LTC-7) explaining the benefits associated with a partnership policy and
indicating that at the time issued, the policy is intended to be a qualified
state long-term care insurance partnership policy. A similar notice may be used
if filed and approved by the director.
(E) Data Reporting.
1. Each insurer offering partnership program
policies in this state shall make regular reports to the United States
Secretary of Health and Human Services that include such information as
required by law or as the secretary determines is appropriate for the
administration of the partnership program.
2. If requested, the regular reports required
by United States Secretary of Health and Human Services shall also be submitted
to the director.
Notes
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