(a)Policy or certificate replacements [Certificate
Replacements] and lapses [Lapses]. The
purpose of this subsection is to specify requirements for insurers
issuing long-term care insurance benefits in this state to report
to the commissioner information on a statewide basis regarding long-term
care insurance policy or certificate replacements and lapses.
(1)Agent records.
(A)Each insurer must [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.
(B)(No change.)
(2)Reporting of 10 percent of agents. Each insurer must
[shall] report by June 30 of every year the information
indicated in the parts of Form Number LHL562(LTC) Long-Term Care Insurance
Replacement and Lapse Reporting Form on the listing of the 10 percent
of agents data as specified in Figure: 28 TAC §3.3837(a)(2) for
the 10 percent of its agents with the greatest percentages of policy
or certificate lapses and replacements during the preceding calendar
year. Each insurer must [shall] submit the required
information electronically in a format prescribed by the department
on the department's website.
Figure: 28 TAC §3.3837(a)(2) (No change.)
(3)Reporting number of lapsed long-term care policies.
Each insurer must [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 during the preceding
calendar year as indicated in the Company Totals part of Form Number
LHL562(LTC) Long-Term Care Insurance Replacement and Lapse Reporting
Form as specified in Figure: 28 TAC §3.3837(a)(2). Each insurer
must [shall] submit the required information electronically
in a format prescribed by the department on the department's website.
(4)Reporting number of replacement long-term care
policies. Each insurer must [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 during
the preceding calendar year as indicated in the Company Totals part
of Form Number LHL562(LTC) Long-Term Care Insurance Replacement and
Lapse Reporting Form as specified in Figure: 28 TAC §3.3837(a)(2).
Each insurer must [shall] submit the required
information electronically in a format prescribed by the department
on the department's website.
(b)Rescissions. Each insurer issuing long-term care
insurance benefits in this state must [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 must [shall] report this data
for the preceding calendar year to the commissioner by June 30 of
every year as indicated on Form Number LHL563(LTC) Rescission Reporting
Form for Long-Term Care Policies as specified in Figure: 28 TAC §3.3837(b).
Each insurer must [shall] submit the required
information electronically in a format prescribed by the department
on the department's website.
Figure: 28 TAC §3.3837(b) (No change.)
(c)Claims denied [Denied] by class
of business [Class of Business].
(1)Definitions. For purposes of this subsection, the
following terms [shall] have the following meanings.
(A) - (B)(No change.)
(2)Report of claims denied [Claims
Denied]. Each insurer issuing long-term care insurance benefits
in this state must [shall] maintain a record
by class of business of the number of long-term care claims for long-term
care services denied during the preceding calendar year in this state.
The insurer must [shall] report the number of
claims denied for each class of business expressed as a percentage
of claims denied to the commissioner by June 30 of every year as indicated
on Form Number LHL564(LTC) Long-Term Care Insurance Claim Denials
Reporting Form as specified in Figure: 28 TAC §3.3837(c)(2).
Each insurer must [shall] submit the required
information electronically in a format prescribed by the department
on the department's website.
Figure: 28 TAC §3.3837(c)(2) (No change.)
(d)Long-Term Care Partnership Program. Each insurer
that markets partnership policies in this state must [shall
] report to the department by June 30 of each year the information
required in §32.107 of the Human Resources Code, specifying the
number of approved partnership plans sold in this state during the
preceding calendar year and the average age of individuals purchasing
approved partnership plans during the preceding calendar year in this
state. The information required in this subsection must [
shall] be reported in accordance with Form Number LHL565(LTC)
Long-Term Care Policies Sold Reporting Form as specified in Figure:
28 TAC §3.3837(e). Each insurer must [shall]
submit the required information electronically in a format prescribed
by the department on the department's website.
(e)Data report [Report] for non-partnership
plans [Non-Partnership Plans]. Each insurer that
markets long-term care insurance in this state must [shall
] report to the department by June 30 of each year the number
of non-partnership plans sold in this state during the preceding calendar
year and the average age of individuals purchasing such non-partnership
plans. The information required in this subsection must [
shall] be reported in accordance with Form Number LHL565(LTC)
Long-Term Care Policies Sold Reporting Form as specified in Figure:
28 TAC §3.3837(e). Each insurer must [shall]
submit the required information electronically in a format prescribed
by the department on the department's website.
Figure: 28 TAC §3.3837(e) (No change.)
(f)Suitability data [Data].
Each insurer issuing long-term care benefits in this state must [
shall] report suitability data for this state for the preceding
calendar year to the commissioner by June 30 of each year as indicated
on Form Number LHL566(LTC) Long-Term Care Suitability Reporting Form
as specified in Figure: 28 TAC §3.3837(f)(1). Each insurer must
[shall] submit the required information electronically
in a format prescribed by the department on the department's website.
(1)Reporting form [Form]. A
representation of Form Number LHL566(LTC) Long-Term Care Suitability
Reporting Form is as follows:
Figure: 28 TAC §3.3837(f)(1) (No change.)
(2)Applicability.
(A)This subsection applies [shall
apply] to riders for group and individual annuities and life
insurance policies that provide long-term care insurance.
(B)This subsection does [shall]
not apply to life insurance policies:
(i) - (iii)(No change.)
(g)Demonstration of compliance with applicable loss
ratio standards. Each insurer must [shall] file
by June 30 of each year the annual rate filing required by [the]
Insurance Code §1651.053(c) to demonstrate compliance with the
applicable loss ratios of this state and any other filing requirement
adopted by the commissioner relating to loss ratios. The filing must
be submitted to the Texas Department of Insurance, Life and Health
Division, Filings Intake, MC-LH-LHL, P.O. Box 12030, Austin, Texas
78711-2030 [Filings Intake Division, Mail Code 106-1E,
Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104
or 333 Guadalupe, Austin, Texas 78701]. Such demonstration must
[shall] be in addition to any demonstration required
under §3.3831(c)(2)(B) - (D) of this title [subchapter
] (relating to Standards and Rates) and must [shall
] include the following information by calendar duration, separately
by form number:
(1) - (7)(No change.)
The agency certifies that legal counsel has
reviewed the proposal and found it to be within the state agency's
legal authority to adopt.
Filed
with the Office of the Secretary of State on October 19, 2021
TRD-202104185 Allison Eberhart
Deputy General Counsel
Texas Department of Insurance
Earliest possible date of adoption: December 5, 2021
For further information, please call: (512) 676-6584
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