| (a) Standards.
(1) General requirements. In addition to the required
filing and approval pursuant to §3.3873 of this title (relating
to Filing Requirements for Long-Term Care Partnership Policies), any
policy or certificate marketed or represented to qualify as a long-term
care partnership policy or certificate must comply with the following
requirements:
(A) the insured individual was a resident of Texas
when coverage first became effective under the policy. If the policy
or certificate is later exchanged for a different long-term care policy
or certificate, the individual was a resident of Texas when coverage
under the first policy became effective;
(B) the policy is intended to be a qualified long-term
care insurance policy under the provisions of §3.3847 of this
title (relating to Qualified Long-Term Care Insurance Contracts: Prohibited
Representations);
(C) the policy or certificate is issued with and retains
inflation coverage that meets the inflation standards specified in §3.3872
of this title (relating to Inflation Protection Requirements for Long-Term
Care Partnership Policies and Certificates) based on the insured's
then attained age;
(D) the effective date of the newly issued partnership
policy, which is shown on the policy schedule page, must be either
the date that the partnership policy is issued or the date the application
for the partnership policy was signed. The insurer has the option
of using either date, but the insurer must use the same option in
all partnership policies issued by that insurer.
(2) Required disclosure notice.
(A) A policy or certificate represented or marketed
as a long-term care partnership policy or certificate must be accompanied
by a disclosure notice that explains the benefits associated with
the policy or certificate. The required disclosure notice is set forth
in Form Number LHL569(LTC) Partnership Status Disclosure Notice for
Long-Term Care Partnership Policies/Certificates as specified in Figure:
28 TAC §3.3871(a)(2)(B)(vii).
(B) The following requirements and procedures apply
to Form Number LHL569(LTC).
(i) The text in the notice must be in at least 12-point
type and must follow the order of the information presented in Figure:
28 TAC §3.3871(a)(2)(B)(vii).
(ii) The text in the notice as specified in Figure:
28 TAC §3.3871(a)(2)(B)(vii) is mandated; the format for the
form is a recommended format. An insurer may format the mandated text
in a different format from that specified in Figure: 28 TAC §3.3871(a)(2)(B)(vii)
if the insurer files the form for review and approval by the commissioner.
(iii) Any form filed pursuant to clause (ii) of this
subparagraph must be filed no later than 60 days prior to use and
is subject to the requirements and procedures set forth in Subchapter
A of this chapter (relating to Submission Requirements for Filings
and Departmental Actions Related to Such Filings).
(iv) An insurer may add a company name and identifying
form number to Form Number LHL569(LTC) as specified in Figure: 28
TAC §3.3871(a)(2)(B)(vii) without obtaining commissioner approval.
(v) The Instructions to Company that are included in
Figure: 28 TAC §3.3871(a)(2)(B)(vii) are to aid the insurer in
drafting the form and should not be included in the disclosure notice
provided by the insurer.
(vi) Any form filed pursuant to clause (ii) of this
subparagraph should be filed with the Texas Department of Insurance,
Life and Health Division, Filings Intake, MC-LH-LHL, P.O. Box 12030,
Austin, Texas 78711-2030.
(vii) A representation of Form Number LHL569(LTC) Partnership
Status Disclosure Notice for Long-Term Care Partnership Policies/Certificates
is as follows:
Attached Graphic
(viii) Any policyholder that exchanges their policy
for a partnership policy must be provided with the required Form Number
LHL569(LTC) Partnership Status Disclosure Notice for Long-Term Care
Partnership Policies/Certificates as specified in Figure: 28 TAC §3.3871(a)(2)(B)(vii).
(ix) When an insurer is made aware that a policyholder
or certificate holder has initiated action that will result in the
loss of partnership status, the insurer must provide an explanation
of how such action impacts the insured in writing. The insurer must
also advise the policyholder or certificate holder on how to retain
partnership status if possible.
(x) If a partnership plan subsequently loses partnership
status, the insurer must explain to the policyholders or certificate
holders in writing the reason for the loss of status.
(3) Commissioner certification. Under §1917(b)(5)(B)(iii)
of the Social Security Act (42 U.S.C. §1396p(b)(5)(B)(iii)),
the Commissioner of Insurance, in implementing the Texas Long-Term
Care Partnership Insurance Program (Partnership Program), may certify
that long-term care insurance policies and certificates covered under
the Partnership Program meet certain consumer protection requirements,
and policies so certified are deemed to satisfy such requirements.
These consumer protection requirements are set forth in §1917(b)(5)(A)
of the Social Security Act and principally include certain specified
provisions of the NAIC Long-Term Care Model Act and Model Regulations
(adopted as of October 2000). In providing this certification, the
commissioner may reasonably rely upon the certification by insurers
of the policy forms that is made in accordance Form Number LHL570(LTC)
Long-Term Care Partnership Program Insurer Certification Form as specified
in Figure: 28 TAC §3.3873(a)(2)(F).
(b) Reporting requirements. In accordance with §1917(b)(1)(C)(iii)(VI)
and (v) of the Social Security Act, all issuers of partnership policies
or certificates must provide regular reports to the Secretary of the
Department of Health and Human Services (Secretary) in accordance
with regulations to be developed by the Secretary. Such information
must include but not be limited to the following:
(1) notification regarding when insurance benefits
provided under partnership policies or certificates have been paid
and the amount of such benefits paid;
(2) notification regarding when such policies or certificates
otherwise terminate; and
(3) any other information the Secretary determines
is appropriate.
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