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(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.
This agency hereby certifies that the adoption
has been reviewed by legal counsel and found to be a valid exercise of the
agency's legal authority.
Filed with the Office of
the Secretary of State on December 17, 2001
TRD-200107967 Lynda
Nesenholtz
General Counsel and Chief Clerk
Texas Department of Insurance
Effective date: January 6, 2002
Proposal publication date: November 9, 2001
For further information, please call: (512) 475-6327
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