(a) Every insurer shall maintain records, for each agent, of
that agent's number and dollar amount of replacement sales as a percentage
of the agent's total number and amount of annual sales attributable to long-term
care products, as well as the number and dollar amount of lapses of long-term
care insurance policies sold by the agent and expressed as a percentage of
the agent's total annual sales attributable to long-term care products.
(1) Each insurer shall report by June 30 of every year the
10% of its agents with the greatest percentages of lapses and replacements
as measured by this subsection; provided, however, that any agent with 20
or fewer sales of long-term care policies for any reporting period shall not
be included in such report, even if such agent's replacement-and-lapse percentage
rates would otherwise result in inclusion in such report.
(2) Reported replacement and lapse rates do not alone constitute
a violation of insurance laws or necessarily imply wrongdoing. The reports
are for the purpose of reviewing more closely agent activities regarding the
sale of long-term care insurance.
(3) Every insurer shall report by June 30 of every year the
number of lapsed long-term care policies as a percentage of its total annual
sales of such policies and as a percentage of its total number of long-term
care policies in force as of the end of the preceding calendar year.
(4) Every insurer shall report by June 30 of every year the
number of replacement long-term care policies sold as a percentage of its
total annual sales of such products, and as a percentage of its total number
of such policies in force as of the preceding calendar year.
(5) Every insurer by June 30 of each year shall file the annual
rate filing required by Insurance Code Article 3.70-12, §4(b).
(b) Every insurer issuing long-term care insurance benefits
shall maintain a record of all policy, contract, or certificate rescissions
relating to such long-term care insurance benefits, both for coverage in this
state and nationwide, except for those which the insured voluntarily effectuated,
and shall report to the commissioner by June 30th of every year this information
utilizing Form LTC RESCIND as referenced in §3.3848 of this title (relating
to Adoption by Reference of Department Form Utilized in Reporting).
(c) Every insurer issuing long-term care insurance benefits
shall maintain a record by class of business the number of long-term care
claims for long-term care services denied during the preceding calendar year.
The insurer shall report this information expressed as a percentage of claims
denied (other than claims denied for failure to meet the waiting period or
because of any applicable preexisting conditions or because the service for
which the claim was submitted is not the type of service covered by a long-term
care policy) to the commissioner by June 30th of every year.
(d) For purposes of this section, reporting requirements relate
only to long-term care insurance and coverages that are delivered or issued
for delivery in this state.
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Source Note: The provisions of this §3.3837 adopted to be effective July 20, 1992, 17 TexReg 4769; amended to be effective May 8, 1997, 22 TexReg 3786; amended to be effective January 6, 2002, 26 TexReg 10886 |