Tenn. Comp. R. & Regs. 0780-01-61-.31 - LONG-TERM CARE INSURANCE PARTNERSHIP PROGRAM

(1) In accordance with Section 6021 of the Deficit Reduction Act of 2005 ( Pub.L. 109-171) and in addition to the applicable provisions of this Chapter, the provisions of this Rule shall apply to any Qualified State Long-Term Care Insurance Partnership Policy.

(2) As used in this Rule, "Qualified State Long-Term Care Insurance Partnership Policy" or "Partnership Policy" means an insurance policy that:

(a) Covers an insured who was a resident of Tennessee, or another state that has a Partnership Program, when coverage first became effective under the policy;

(b) Is a qualified long-term care insurance policy as defined in Section 7702B(b) of the Internal Revenue Code of 1986 and was issued no earlier than February 8, 2006;

(c) Meets all the applicable requirements of this Chapter and the requirements of the National Association of Insurance Commissioners' Long-Term Care Insurance Model Act and Model Regulation as those requirements are set forth in Section 1917(b)(5)(A) of the Social Security Act ( 42 U.S.C. 1396p(b)(5)(A)); and

(d) Provides the following inflation protections:

1. For a person who is less than sixty-one (61) years of age as of the date of purchase of the policy, the policy provides compound annual inflation protection;

2. For a person who is at least sixty-one (61) years of age but less than seventy-six (76) years of age as of the date of purchase of the policy, the policy provides some level of inflation protection; and

3. For a person who is at least seventy-six (76) years of age as of the date of purchase of the policy, the policy may provide inflation protection, but is not required.

(3)

(a) An insurer or its agent, soliciting or offering to sell a policy that is intended to qualify as a Partnership Policy, shall provide to each prospective applicant a Long-Term Care Insurance Partnership Program Notice in a form identical to or substantially similar to Appendix K, outlining the requirements and benefits of a partnership policy. A similar notice may be used for this purpose if filed and approved by the commissioner. The Partnership Program Notice shall be provided with the required Outline of Coverage.

(b) An insurer or its agent, soliciting or offering to sell a policy that is intended to qualify as a Partnership Policy, shall provide to each prospective applicant a pamphlet approved by the Commissioner that explains rules regarding Medicaid eligibility. Copies of the pamphlet can be accessed through request to the Department or on the Department's web site.

(c) A Partnership Policy issued or issued for delivery in Tennessee shall be accompanied by a Long-Term Care Insurance Partnership Disclosure Notice in a form identical to or substantially similar to Appendix L explaining the benefits associated with a Partnership Policy and indicating that at the time issued, the policy is a Qualified State Long-Term Care Insurance Partnership Policy. A similar notice may be used if filed and approved by the Commissioner. The Partnership Disclosure Notice shall also include a statement indicating that by purchasing this Partnership Policy, the insured does not automatically qualify for Medicaid.

(4)

(a) A Partnership Policy shall not be issued or issued for delivery in Tennessee unless filed with and approved by the Commissioner. Any policy submitted for certification as a Partnership Policy shall be accompanied by an Issuer Certification Form identical to Appendix M, or a similar form filed and approved by the Commissioner.

(b) A policy which was issued on or after February 8, 2006 and which otherwise satisfied all the terms and requirements to be a Partnership Policy shall be eligible for an exchange to a Partnership Policy on or after October 1, 2008. The insurer that issued such a policy shall be required to either issue a Partnership Rider amending the existing policy or exchange the existing policy for a Partnership Policy. Such rider may be issued or such exchange made only after the policy to which it pertains has been filed and approved by the Commissioner as a Partnership Policy under the process set forth in Subparagraph (4)(a) of this Rule. The insurer shall provide the insured with the same materials as those issued to the purchaser of a new policy, as provided in Paragraph (3) above.

(c) Insurers requesting to make use of a previously approved policy form as a Qualified State Long-Term Care Partnership Policy shall submit to the Commissioner an Issuer Certification Form signed by an officer of the company.

(5)

(a) An individual may not sell, solicit or negotiate long-term care insurance unless the individual is licensed as an insurance producer who is currently licensed to sell long term care insurance and has completed a one-time training course by or before July 1, 2009. An individual who is not licensed to sell long-term care insurance by July 1, 2008, must take the one-time training course before beginning to sell long-term care products. Individuals who are not already exempt from continuing education requirements under T.C.A. § 56-6-107(c), must also complete continuing education courses every twenty-four (24) months. The training must meet the requirements set forth in subsection (b) of this Paragraph.

(b)

1. The one-time training required by this Rule shall be no less than eight (8) hours and the ongoing training required by this Rule shall be no less than four (4) hours.

2. The training required under subdivision Paragraph (5)(b)1. shall consist of topics related to long-term care insurance, long-term care services and, if applicable, qualified state long-term care insurance partnership programs, including, but not limited to:

(i) State and federal regulations and requirements and the relationship between qualified state long-term care insurance partnership programs and other public and private coverage of long-term care services, including Medicaid;

(ii) Available long-term services and providers;

(iii) Changes or improvements in long-term care services or providers;

(iv) Alternatives to the purchase of private long-term care insurance;

(v) The effect of inflation on benefits and the importance of inflation protection; and

(vi) Consumer suitability standards and guidelines.

3. The training required by this Rule shall not include training that is insurer or company product specific or that includes any sales or marketing information, materials, or training, other than those required by state or federal law.

4. Non-resident insurance producers who meet the education and training requirements of their home state will be deemed to meet the requirements for education and training in this state.

(c)

1. Insurers subject to this Chapter shall obtain verification that a producer has received training required by this Rule before a producer is permitted to sell, solicit or negotiate the insurer's long-term care insurance products, maintain records subject to the state's record retention requirements, and make that verification available to the commissioner upon request.

2. Insurers subject to this Chapter shall maintain records with respect to the training of its producers concerning the distribution of its partnership policies that will allow the Commissioner to provide assurance to the state Medicaid agency that producers have received the training contained in this Rule and that producers have demonstrated an understanding of Partnership Policies and their relationship to public and private coverage of long-term care, including Medicaid, in this state. These records shall be made available to the Commissioner upon request.

Notes

Tenn. Comp. R. & Regs. 0780-01-61-.31

Original rule filed November 24, 2008; effective February 7, 2009.

Authority: Pub.L. 109-171, § 6021 (a)(1), 42 U.S.C. § 1396p(b), T.C.A. §§ 56-6-107, 56-8-101 et seq,56-8-104, 56-42-101, et seq, 56-42-105, 56-42-109, 56-42-110, The TN Medicaid State Plan, TN 08-001, eff. 10/1/08, and 2008 Tenn. Pub. Act Ch. 1058.