Exhibit K - Replacement and Lapse Reporting Form

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

Long-Term Care Insurance

Replacement and Lapse Reporting Form

For the State of ______________________________

Reporting Year of ____________________________

Company Name: ___________________________________Due: June 30 annually

Company Address: _____________________________________________________

Company NAIC Number: _________________________________________________

Contact Person: _______________________________________________________

Phone Number: ________________________________________________________

Instructions

The purpose of this form is to report on a statewide basis information regarding long-term care insurance policy replacements and lapses. Specifically, every insurer shall maintain records for each agent on that agent's amount of long-term care insurance replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales. The tables below should be used to report the 10% of the insurer's agents with the greatest percentages of replacements and lapses.

Listing of the 10% of Agents with the Greatest Percentage of Replacements

Agent's Name

Number of Policies Sold By This Agent

Number of Policies Replaced By This Agent

Number of Replacements As % of Number Sold By This Agent

Listing of the 10% of Agents with the Greatest Percentage of Lapses

Agent's Name

Number of Policies Sold By This Agent

Number of Policies Lapsed By This Agent

Number of Lapses As % of Number Sold By This Agent

Company Totals:

Percentage of Replacement Policies Sold to Total Annual Sales

_______%

Percentage of Replacement Policies Sold to Policies in Force (as of the end of the preceding calendar year)

_______%

Percentage of Lapsed Policies to Total Annual Sales

_______%

Percentage of Lapsed Policies to Policies in Force (as of the end of the preceding calendar year)

_______%

Notes

Added 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.