No long-term care insurance policy or certificate may be
advertised, solicited, or issued for delivery in this state as a qualified
long-term care insurance policy or certificate which does not meet the minimum
benefit standards in this rule, and which has not been approved by the division
of insurance as a qualified long-term care insurance policy or certificate.
These minimum standards do not preclude the inclusion of other provisions or
benefits which are not inconsistent with these standards. These standards are
in addition to all other requirements for long-term care insurance policies or
certificates. In order to qualify for participation in the Iowa long-term care
asset preservation program, a long-term care insurance policy or certificate
shall meet the following:
(1) Contain
a "benefit amount maximum" equivalent to at least 365 times the minimum daily
nursing facility benefit defined in 72.6(6)"a."
(2) Offer a maximum benefit amount option
equivalent to 365 times the minimum daily nursing facility benefit defined in
72.6(6)"a." Issuers may offer other benefit amount options in
addition to this minimum benefit amount option.
(3) Provide that maximum benefits be
available in dollars and not in days of care.
(4) Include a provision of inflation
protection which satisfies at least one of the following criteria:
a. The policy or certificate covers at least
80 percent but not more than 110 percent of the average daily private pay
rate.
b. The policy or certificate
provides for automatic increases in the per diem dollar level in accordance
with either the consumer price index or at 5 percent each year over the
previous year for each year that the contract is in force.
c. The policy or
certificate provides the
following:
(1) Annual per diem upgrades on a
guaranteed issue basis at premiums based on the age of the policyholder or
certificate holder at the time of the issuance of the qualified policy or
certificate.
(2) Unless the insured
takes positive action to decline them, these upgrades automatically increase
the level of daily coverage to meet or exceed the minimum inflation adjusted
daily benefit. The minimum inflation adjusted daily benefit is defined as the
amount or amounts derived by taking the minimum daily benefit for nursing
facility care at the time of purchase as specified in
72.6(6)"a" and inflating it by the consumer price index or by
at least 5 percent each year over the previous year for each year that the
contract is in force. The schedule of minimum per diem dollar amount increases
shall be updated and maintained at the division of insurance.
(3) The issuer shall notify those
policyholders or certificate holders choosing the upgrade option when the
upgrades are automatically effective and what the increased premium, if any,
will be. The issuer shall also provide to the policyholder or certificate
holder, at the time of the upgrade, the opportunity to decline the
upgrade.
(4) The issuer shall
notify the policyholder or certificate holder when the insurance policy or
certificate will lose its qualification status if the annual per diem benefit
upgrade is declined. A qualified policy or certificate containing this
inflation protection provision will remain qualified as long as the insured's
daily benefit amount equals or exceeds the minimum inflation adjusted daily
benefit.
(5)
Provide that the unused maximum benefit amount of the policy or certificate
increase proportionately with the inflation protection requirements of
72.6(4).
(6) At a minimum, upon the
initial effective date, provide the following:
a. A daily nursing facility benefit of at
least 80 percent of the average daily private pay rate in nursing facilities
rounded to the next highest $5 increment. No policy or certificate need pay
benefits in excess of the actual charges.
b. A daily home- and community-based benefit
of at least 50 percent of the daily nursing facility benefit contained in the
policy or certificate. No policy or certificate need pay benefits in excess of
the actual charges.
c. The daily
home- and commimity-based benefit shall not exceed the daily nursing facility
benefit.
(7) If issued
on an expense incurred basis, provide benefits which are equal to at least 80
percent of the per diem cost incurred by the insured.
