Exhibit I - Claims Denial Reporting Form: Long-Term Care Insurance

Current through Register Vol. 46, No. 15, April 8, 2022

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The purpose of this format is to report all long-term care claim denials under in force long-term care insurance policies. "Denied" means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.

State Data

Nationwide Data1


Total Number of Long-Term Care Claims Reported


Total Number of Long-Term Care Claims Denied/Not Paid


Number of Claims Not Paid due to Preexisting Condition Exclusion


Number of Claims Not Paid due to Waiting (Elimination) Period Not Met


Net Number of Long-Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4)


Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1)


Number of Long-Term Care Claims Denied due to:


* Long-Term Care Services Not Covered under the Policy2


* Provider/Facility Not Qualified under the Policy3


Benefit Eligibility Criteria Not Met4


* Other

1 The nationwide data may be viewed as a more representative and credible indicator where the data for claims and denied for your state are small in number.

2 Example - home health care claim filed under a nursing home only policy.

3 Example - a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy.

4 Example - a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care.


Amended at 32 Ill. Reg. 7600, effective May 5, 2008

The following state regulations pages link to this page.

State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.