02-031 C.M.R. ch. 425, § 16 - Annual Reports to Superintendent: Lapsed and Replaced Policies

Current through 2022-14, April 6, 2022

A. Every insurer shall maintain records for each agent of that agent's amount of 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.
B. Every insurer shall report annually by June 30, on a form prescribed by the superintendent, the ten percent (10%) of its agents with the greatest percentages of lapses and replacements as measured by Subsection A above.
C. 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.
D. Every insurer shall report annually by June 30, on a form prescribed by the superintendent,the number of lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year.
E. Every insurer shall report annually by June 30, on a form prescribed by the superintendent, the number of replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the preceding calendar year.
F. Every insurer shall report annually by June 30, on a form prescribed by the superintendent, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied.
G. For purposes of this section:
(1) "Policy" means only long-term care insurance;
(2) Subject to Subsection (3), "claim" means a request for payment of benefits under an in force policy, including a request for a determination that an insured is eligible for benefits,regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;
(3) "Denied" means the insurer refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition; and
(4) "Report" means on a statewide basis.
H. Reports required under this section shall be filed with the superintendent.

Notes

02-031 C.M.R. ch. 425, § 16

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