| disorders (single episode
or recurrent); and schizo-affective disorders (bipolar or depressive).
Specifically describe each benefit screen or other policy provision
which provides preconditions to the availability of policy benefits
for such an insured.)
(11) PREMIUM.
(A) (State the total annual premium for the policy.
In the event the total premium for the policy is different from the
annual premium, then the total premium also must be stated. Initial
policy fees must be stated separately.)
(B) (If the premium varies with an applicant's choice
among benefit options, indicate the portion of annual premium which
corresponds to each benefit option.)
(C) (This paragraph also must include a statement of
the policy grace period.)
(12) TEXAS DEPARTMENT OF INSURANCE'S CONSUMER HELP
LINE. An insurer must include notification that the prospective insured
may call the Texas Department of Insurance's Consumer Help Line at
1-800-252-3439 for agent, company, and any other insurance information,
and 1-800-599-SHOP to order publications related to long-term care
coverage, and the Texas Health and Human Services Commission at (1-800-252-9240
or current number if different) to receive counseling regarding the
purchase of long-term care or other health care coverage.
(13) DENIAL OF APPLICATION. A long-term care insurer
must state that within 30 days of denial of an application, it will
refund any premiums paid by a long-term care applicant.
(14) OFFER OF INFLATION PROTECTION. Insurers must include
the information set out in subparagraphs (A) and (B) of this paragraph
regarding the offer of inflation protection.
(A) A graphic comparison of the benefit levels of a
policy and certificate, if applicable, that increases benefits due
over the policy interval with a policy that does not increase benefits,
depicting benefit levels over at least a 20-year period, must be provided.
(B) A disclosure of any expected premium increases
or additional premiums to pay for automatic or optional benefit increases
must be made. If premium increases or additional premiums will be
based on the attained age of the applicant at the time of the increase,
the insurer must also disclose the magnitude of the potential premiums
the applicant would need to pay at ages 75 and 85 for benefit increases.
An insurer may use a reasonable hypothetical or a graphic demonstration
for the purposes of this disclosure.
(15) OFFER OF NONFORFEITURE BENEFITS. Insurers must
include the information set out in subparagraphs (A), (B), and (C)
of this paragraph regarding the offer of nonforfeiture benefits.
(A) A complete and clear explanation of each nonforfeiture
option being offered, including an actual numerical example.
Attached Graphic
(B) Disclosure of the premium and percentage increase
in premium associated with each of the nonforfeiture benefits offered.
(C) Disclosure that if the nonforfeiture offer is rejected
that a contingent benefit upon lapse will be provided and a description
of such benefit.
(16) DISCLOSURE REGARDING FEDERAL TAX TREATMENT OF
LONG-TERM CARE INSURANCE POLICY.
(A) Policies intended to be qualified long-term care
insurance policies. Include disclosure language substantially similar
to the following: "This policy is intended to be a qualified long-term
care contract as defined by the Internal Revenue Code of 1986, §7702B(b).
There may be tax consequences associated with the purchase of a qualified
long-term care insurance contract, such as the tax deductibility of
premiums and the exclusion from taxable income of benefits. The prospective
insured is urged to consult with a qualified tax advisor."
(B) Policies which are not intended to be a qualified
long-term care insurance contract. Include disclosure language substantially
similar to the following: "This policy is not intended to be a qualified
long-term care insurance contract as defined by the Internal Revenue
Code of 1986, §7702B(b). This policy will not qualify the insured
for the favorable tax treatment provided for in the Internal Revenue
Code of 1986, §7702B. The prospective insured is urged to consult
with a qualified tax advisor." Additionally, the insurer must disclose
the criteria which result in the policy or certificate not being classified
as a qualified long-term care insurance contract.
(17) ADDITIONAL FEATURES.
(A) (Indicate if medical underwriting is used.)
(B) (Describe other important features such as unintentional
lapse as provided by §3.3841 of this title (relating to Unintentional
Lapse and Reinstatement).
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| Source Note: The provisions of this §3.3832 adopted to be effective February 15, 1990, 15 TexReg 544; amended 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; amended to be effective May 11, 2022, 47 TexReg 2758 |
