Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-157 - LONG-TERM CARE INSURANCE › Section 69O-157.111 - Reporting Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1) Every insurer
				shall maintain records for each agent of that agent's amount of replacement
				sales as a percentage of the agent's total annual sales in this state and the
				amount of lapses of long-term care insurance policies sold by the agent as a
				percentage of the agent's total annual sales in this state.
(2) Every insurer shall report annually by
				June 30 the 10 percent of its agents with the greatest percentages of lapses
				and replacements as measured by subsection
				69O-157.111(1),
				F.A.C., in the format as prescribed in Appendix J, "Long-Term Care Insurance
				Replacement and Lapse Reporting Form OIR-B2-1555," effective 07/23 hereby
				incorporated by reference and available at
www.flrules.org/Gateway/reference.asp?No=Ref-16244
.
(3) 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 in this
				state.
(4) Every insurer shall
				report annually by June 30 the number of lapsed policies as a percentage of its
				total annual sales and as a percentage of its total number of policies in force
				as of the end of the preceding calendar year in this state in the format as
				prescribed in Appendix J, "Long-Term Care Insurance Replacement and Lapse
				Reporting Form OIR-B2-1555" (06/2017), which is incorporated herein by
				reference.
(5) Every insurer shall
				report annually by June 30 the number of replacement policies sold as a
				percentage of its total annual sales and as a percentage of its total number of
				policies in force as of the preceding calendar year in this state in the format
				as prescribed in Appendix J, "Long-Term Care Insurance Replacement and Lapse
				Reporting Form OIR-B2-1555" (06/2017), which is incorporated herein by
				reference.
(6) Every insurer shall
				report annually by June 30, for qualified long-term care insurance contracts,
				the number of claims denied for each class of business, expressed as a
				percentage of claims denied in this state in the format as prescribed in
				Appendix E, "Annual Long-Term Care Claims Denial Reporting Form" OIR-B2-1553,
				effective 07/23, hereby incorporated by reference and available at
www.flrules.org/Gateway/reference.asp?No=Ref-16245
.
(7) For purposes of this section:
(a) "Policy" means only long-term care
				insurance;
(b) "Claim" means,
				subject to paragraph 69O-157.111(7)(c),
				F.A.C., 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;
(c) "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
(d) "Report" means on a statewide
				basis.