Utah Admin. Code R590-148-25 - Reporting Requirements
(1)
(a) An insurer shall maintain records for
each producer detailing the:
(i) producer's
number of replacement sales as a percent of the agent's total annual sales;
and
(ii) amount of lapses of
long-term care insurance policies sold by the producer as a percent of the
producer's total annual sales.
(b) An insurer shall report the 10% of its
producers with the greatest percentage of lapses and replacements under
Subsection (1)(a).
(c) An insurer
shall report the number of:
(i) lapsed
policies as a percent of its total annual sales and as a percent of its total
number of policies in force as of the end of the preceding calendar year;
and
(ii) replacement policies sold
as a percent of its total annual sales and as a percent of its total number of
policies in force as of the end of the preceding calendar year.
(d) The reports required by this
subsection shall be reported on the Replacement and Lapse Reporting
Form.
(e) Reported replacement and
lapse rates do not, by themselves, constitute a violation of Utah laws nor do
they necessarily imply wrongdoing. The reports are for reviewing producer
activities regarding the sale of long-term care insurance.
(2)
(a) An
insurer shall report, for qualified long-term care insurance contracts, the
number of claims denied for each class of business, expressed as a percentage
of claims denied.
(b) The report
shall include, at a minimum, the information contained in the Claims Denial
Reporting Form Long-Term Care Insurance.
(3) An insurer shall maintain a record of
each policy or certificate rescission, both state and nationwide, except those
the insured voluntarily effectuated, and shall annually report this information
on the Rescission Reporting Form.
(4)
(a) An
insurer shall report the total number of applications received from Utah
residents, the number of those who declined to provide information on the
personal worksheet, the number of applicants who did not meet the suitability
standards, and the number of those who chose to confirm after receiving a
suitability letter.
(b) The report
shall be submitted on the Suitability Reporting Form.
(5) For purposes of this section:
(a) "claim" means a request for payment of
benefits under an in force policy, regardless of whether the benefit claimed is
covered under the policy or any terms or conditions of the policy have been
met;
(b) "denied" means that an
insurer refused to pay a claim for any reason other than for claims not paid
for failure to meet a waiting period or due to a preexisting condition;
and
(c) "report" means a report
filed on a statewide basis.
(6) A report required under this section
shall be filed with the commissioner annually on or before June 30 and in
compliance with Rule R590-220.
Notes
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