Fla. Admin. Code Ann. R. 69O-157.023 - Reporting
(1) Every insurer shall maintain records for
each agent of that agent's amount of replacement sales as a percentage of the
agent's total annual sales in this state and the amount of lapses of long-term
care insurance policies sold by the agent as a percentage of the agent's total
annual sales in this state.
(2)
Every insurer shall report annually by June 30 the 10 percent of its agents
with the greatest percentages of lapses and replacements as measured by
subsection 69O-157.023(1),
F.A.C., in the format prescribed by Appendix J, "Long-Term Care Insurance
Replacement and Lapse Reporting Form OIR-B2-1555," which is incorporated by
reference in Rule 69O-157.111, F.A.C.
(3) 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 in this
state.
(4) Every insurer shall
report annually by June 30 the number of lapsed policies as a percentage of its
total annual sales and as a percentage of its total number of policies in force
as of the end of the preceding calendar year in this state in the format
prescribed in Appendix J.
(5) Every
insurer shall report annually by June 30 the number of replacement policies
sold as a percentage of its total annual sales and as a percentage of its total
number of policies in force as of the preceding calendar year in this state in
the format as prescribed in Appendix J.
(6) Every insurer shall report annually by
June 30, for qualified long-term care insurance contracts, the number of claims
denied for each class of business, expressed as a percentage of claims denied
in this state, in the format as prescribed in Appendix E, "Annual Long-Term
Care Claims Denial Reporting Form" OIR-B2-1553, which is incorporated by
reference in Rule 69O-157.111, F.A.C.
(7) For purposes of this section:
(a) "Policy" means only long-term care
insurance;
(b) "Claim" means,
subject to paragraph 69O-157.023(8)(c),
F.A.C., a request for payment of benefits under an in force policy regardless
of whether the benefit claimed is covered under the policy or any terms or
conditions of the policy have been met;
(c) "Denied" means the insurer refuses to pay
a claim for any reason other than claims not paid for failure to meet the
elimination period or because of an applicable preexisting condition;
and
(d) "Report" means on a
statewide basis.
(8)
Every insurer or other entity selling or issuing long-term care insurance
benefits shall maintain a record of all policy or certificate rescissions, both
state and countrywide, except those that the insured voluntarily effectuated,
and shall annually furnish this information to the Office by March 1 of each
year in the format prescribed in Appendix A, "Long-Term Care Rescission Report"
OIR-B2-1552, which is incorporated by reference in Rule
69O-157.111, F.A.C.
(9) Reports required under this Rule
69O-157.023, F.A.C., are
available from and shall be filed with the Division of Market Investigations,
Office of Insurance Regulation.
Notes
Rulemaking Authority 624.308(1), 627.9407(1), 627.9408 FS. Law Implemented 624.307(1), 627.9402, 627.9407(1), 627.410(7) FS.
New 1-13-03, Formerly 4-157.023, Amended 1-4-24.
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