28 Tex. Admin. Code § 3.3837 - Reporting Requirements
(a) Policy or
certificate replacements and lapses. The purpose of this subsection is to
specify requirements for insurers issuing long-term care insurance benefits in
this state to report to the commissioner information on a statewide basis
regarding long-term care insurance policy or certificate replacements and
lapses.
(1) Agent records.
(A) Each insurer must maintain records, for
each agent, of that agent's number and dollar amount of replacement sales as a
percentage of the agent's total number and amount of annual sales attributable
to long-term care products, as well as the number and dollar amount of lapses
of long-term care insurance policies sold by the agent and expressed as a
percentage of the agent's total annual sales attributable to long-term care
products.
(B) 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.
(2) Reporting
of 10 percent of agents. Each insurer must report by June 30 of every year the
information indicated in the parts of Form Number LHL562(LTC) Long-Term Care
Insurance Replacement and Lapse Reporting Form on the listing of the 10 percent
of agents data as specified in Figure: 28 TAC §
3.3837(a)(2) for
the 10 percent of its agents with the greatest percentages of policy or
certificate lapses and replacements during the preceding calendar year. Each
insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(3)
Reporting number of lapsed long-term care policies. Each insurer must report by
June 30 of every year the number of lapsed long-term care policies as a
percentage of its total annual sales of such policies and as a percentage of
its total number of long-term care policies in force during the preceding
calendar year as indicated in the Company Totals part of Form Number
LHL562(LTC) Long-Term Care Insurance Replacement and Lapse Reporting Form as
specified in Figure: 28 TAC §
3.3837(a)(2).
Each insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(4) Reporting number of replacement long-term
care policies. Each insurer must report by June 30 of every year the number of
replacement long-term care policies sold as a percentage of its total annual
sales of such products, and as a percentage of its total number of such
policies in force during the preceding calendar year as indicated in the
Company Totals part of Form Number LHL562(LTC) Long-Term Care Insurance
Replacement and Lapse Reporting Form as specified in Figure: 28 TAC §
3.3837(a)(2).
Each insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(b) Rescissions. Each insurer issuing
long-term care insurance benefits in this state must maintain a record of all
policy, contract, or certificate rescissions relating to such long-term care
insurance benefits, both for coverage in this state and nationwide, except for
those which the insured voluntarily effectuated, and must report this data for
the preceding calendar year to the commissioner by June 30 of every year as
indicated on Form Number LHL563(LTC) Rescission Reporting Form for Long-Term
Care Policies as specified in Figure: 28 TAC §
3.3837(b). Each
insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(c)
Claims denied by class of business.
(1)
Definitions. For purposes of this subsection, the following terms have the
following meanings.
(A) Claim--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.
(B) Denied--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.
(2) Report of
claims denied. Each insurer issuing long-term care insurance benefits in this
state must maintain a record by class of business of the number of long-term
care claims for long-term care services denied during the preceding calendar
year in this state. The insurer must report the number of claims denied for
each class of business expressed as a percentage of claims denied to the
commissioner by June 30 of every year as indicated on Form Number LHL564(LTC)
Long-Term Care Insurance Claim Denials Reporting Form as specified in Figure:
28 TAC §
3.3837(c)(2).
Each insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(d) Long-Term Care Partnership Program. Each
insurer that markets partnership policies in this state must report to the
department by June 30 of each year the information required in §
32.107 of the
Human Resources Code, specifying the number of approved partnership plans sold
in this state during the preceding calendar year and the average age of
individuals purchasing approved partnership plans during the preceding calendar
year in this state. The information required in this subsection must be
reported in accordance with Form Number LHL565(LTC) Long-Term Care Policies
Sold Reporting Form as specified in Figure: 28 TAC §
3.3837(e). Each
insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(e) Data report for non-partnership plans.
Each insurer that markets long-term care insurance in this state must report to
the department by June 30 of each year the number of non-partnership plans sold
in this state during the preceding calendar year and the average age of
individuals purchasing such non-partnership plans. The information required in
this subsection must be reported in accordance with Form Number LHL565(LTC)
Long-Term Care Policies Sold Reporting Form as specified in Figure: 28 TAC §
3.3837(e). Each
insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(f)
Suitability data. Each insurer issuing long-term care benefits in this state
must report suitability data for this state for the preceding calendar year to
the commissioner by June 30 of each year as indicated on Form Number
LHL566(LTC) Long-Term Care Suitability Reporting Form as specified in Figure:
28 TAC §
3.3837(f)(1).
Each insurer must submit the required information electronically in a format
prescribed by the department on the department's website.
(1) Reporting form. A representation of Form
Number LHL566(LTC) Long-Term Care Suitability Reporting Form is as follows:
(2)
Applicability.
(A) This subsection applies to
riders for group and individual annuities and life insurance policies that
provide long-term care insurance.
(B) This subsection does not apply to life
insurance policies:
(i) that accelerate the
death benefit for one or more of the qualifying events of terminal illness,
medical conditions requiring extraordinary medical intervention or permanent
institutional confinement; and
(ii)
that provide the option of a lump-sum payment for those benefits; and
(iii) where neither the benefits nor the
eligibility for the benefits is conditioned upon the receipt of long-term
care.
(g) Demonstration of compliance with
applicable loss ratio standards. Each insurer must file by June 30 of each year
the annual rate filing required by Code §1651.053(c) to demonstrate compliance
with the applicable loss ratios of this state and any other filing requirement
adopted by the commissioner relating to loss ratios. The filing must be
submitted to the Texas Department of Insurance, Life and Health Division,
Filings Intake, MC-LH-LHL, P.O. Box 12030, Austin, Texas 78711-2030. Such
demonstration must be in addition to any demonstration required under §
3.3831(c)(2)(B) -
(D) of this title (relating to Standards and
Rates) and must include the following information by calendar duration,
separately by form number:
(1) calendar
duration;
(2) first year
issued;
(3) actual earned premium
by duration;
(4) actual incurred
claims;
(5) actual calendar
duration loss ratio;
(6)
anticipated calendar duration loss ratio; and
(7) number of insured lives.
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