reglab/statecodes huggingface dataset:
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION Q - Guideline to Section 2010.90(a)

Current through Register Vol. 48, No. 28, July 12, 2024
An advertisement shall specifically identify the Medicare
				  supplement insurance policy to which statistics relate and, where statistics
				  are given which are applicable to a different policy, it must be stated clearly
				  that the data does not relate to the policy being advertised.
An advertisement which states the dollar amount of claims
				  paid must also indicate the period over which such claims have been
				  paid.
If the term "loss ratio" is used, it shall be properly
				  explained in the context of the advertisement and, unless the state has issued
				  a regulation otherwise defining the term, it shall be calculated on the basis
				  of premium earned to losses incurred and shall not be on a yearly run-off
				  basis.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION R - Guideline to Section 2010.90(c)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section does not require the statistics for this State
				  be used since such statistics as hospital charges and average stays may vary
				  from state to state. When nationwide statistics are used, such fact should be
				  noted, unless the statistics on the particular point are substantially the same
				  in a state to which the advertisement is directed. Statistics may only be used
				  if they are current and credible.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION S - Guideline to Section 2010.100

Current through Register Vol. 48, No. 28, July 12, 2024
This Section prohibits disparaging, unfair or incomplete
				  comparisons of policies or benefits which would have a tendency to deceive or
				  mislead the public. The Section does not preclude the use of comparisons by
				  health maintenance organizations, prepaid health plans and other direct service
				  organizations which describe the difference between their prepaid health
				  benefits coverage and indemnity insurance coverage.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION T - Guideline to Section 2010.110(a)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section prohibits advertisements which imply that an
				  insurer is licensed beyond the limits of those jurisdictions where it is
				  actually licensed. An advertisement which contains testimonials from persons
				  who reside in a state in which the insurer is not licensed or which refers to
				  claims of persons residing in states in which the insurer is not licensed
				  implies licensing in those states; and, therefore, is in violation of this
				  Section unless the advertisement states that the insurer is not licensed in
				  those states.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION U - Guideline to Section 2010.110(b)

Current through Register Vol. 48, No. 28, July 12, 2024
Although this Section permits a reference to an insurer being
				  licensed in a state where the advertisement appears, it does not allow
				  exaggeration of the fact of such licensing nor does it permit the suggestion
				  that competing insurers may not be so licensed because, in most states, an
				  insurer must be licensed in the state to which it directs its
				  advertising.
Terms such as "official", or words of similar import, used to
				  describe any policy or application form are not permissible because of the
				  potential for deceiving or misleading the public. This guideline also applies
				  to Section
				  2010.110(c).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION V - Guideline to Section 2010.140(a)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section prohibits advertising representing that a
				  product is offered on an introductory, initial or special offer basis or
				  otherwise which will not be available later; or is available only to certain
				  individuals, unless such is the fact. This Section prohibits the repetitive use
				  of such advertisements. Where an insurer uses enrollment periods as the usual
				  method of advertising these policies, this Section prohibits describing an
				  enrollment period as a special opportunity or offer for the
				  applicant.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION W - Guideline to Section 2010.140(b)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section restricts the repetitive use of enrollment
				  periods. The requirement of reasonable closing dates and waiting periods
				  between enrollment periods was adopted to eliminate the abuses which formerly
				  existed. This Section does not limit just the use of enrollment periods. It
				  requires that a particular insurance product offered in an enrollment period
				  through any advertising media, including the prepared presentations of agents,
				  cannot be offered again in the State until 6 months from the close of the
				  enrollment period. Thus, an insurer must choose whether to use enrollment
				  periods or open enrollment for a product. (See Section
				  2010.140(d)
				  for the definition of "a particular insurance product".)
This Section does not prohibit multiple advertising during an
				  enrollment period through any and all media published or transmitted within
				  this State as long as the enrollment periods for all such advertisements have
				  the same expiration date.
This Section does not prohibit the solicitation of members of
				  a group or association for the same product even though there has not been a
				  lapse of 6 months since the close of a preceding enrollment period which was
				  open to the general public for the same product.
This Section does not require separation by 6 months of
				  enrollment periods for the same insurance product in this State if the
				  advertising material is directed by an admitted insurer to persons by direct
				  mail on the basis that a common relationship exists with an entity. Examples of
				  such would be a bank and its depositors, a department store to its charge
				  account customers, or an oil company to its credit card holders, and more than
				  one of such insurance product at different times if providing such insurance
				  under such a method is not otherwise prohibited by law. However, the 6 month
				  rule does apply to one specific sponsor to the same persons in this State on
				  the basis of their status as customers of that one specific entity
				  only.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION X - Guideline to Section 2010.140(d)

Current through Register Vol. 48, No. 28, July 12, 2024
This Section defines the meaning of "a particular insurance
				  product" in Section
				  2010.140(b)
				  and prohibits advertising of products having minor variances such as different
				  periods or different amounts of daily hospital indemnity benefits, in a
				  succession of enrollment periods.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2010 - ADVERTISEMENTS OF MEDICARE SUPPLEMENT INSURANCE › Appendix A - Interpretive Guidelines › ILLUSTRATION Y - Guideline to Section 2010.150

Current through Register Vol. 48, No. 28, July 12, 2024
This Section is closely related to the requirements of
				  Section
				  2010.90
				  concerning the use of statistics. This Section prohibits insurers which have
				  been organized for only a brief period of time advertising that they are "old"
				  and also prohibits emphasizing the size and magnitude of the insurer. Also, the
				  occupations of the persons comprising the insurer's board of directors or the
				  public's familiarity with their names or reputations is irrelevant and must not
				  be emphasized. The preponderance of a particular occupation or profession among
				  the board of directors of an insurer does not justify the advertisement of a
				  plan of insurance offered to the general public as insurance designed or
				  recommended by members of that occupation or profession. For example, it is
				  unacceptable for an insurance company to advertise a policy offered to the
				  general public as "the physicians' policy" or "the doctors' plan" simply
				  because there is a preponderance of physicians or doctors on the board of
				  directors of the insurer. This Section prohibits the use of recommendation of a
				  commercial rating system unless the purpose, meaning and limitations of the
				  recommendation are clearly indicated.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.10 - Purpose

Current through Register Vol. 48, No. 28, July 12, 2024
The purpose of this Part is to implement Article XIXA of the
				Illinois Insurance Code, to promote the public interest, to promote the
				availability of long-term care insurance coverage, to protect applicants for
				long-term care insurance from unfair or deceptive sales or enrollment
				practices, to facilitate public understanding and comparison of long-term care
				insurance coverages and to facilitate flexibility and innovation in the
				development of long-term care insurance.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.20 - Applicability and Scope

Current through Register Vol. 48, No. 28, July 12, 2024
a) Except
			 as otherwise specifically provided, this Part applies to all long-term care
			 insurance policies including qualified long-term care insurance contracts and
			 life insurance policies that accelerate benefits for long-term care insurance
			 delivered or issued for delivery in this State by any insurer on or after June
			 15, 1990. Certain provisions of this Part apply only to qualified long-term
			 care insurance contracts as noted.
b) Additionally, this Part is intended to
			 apply to policies having indemnity benefits that are triggered by activities of
			 daily living and sold as disability income insurance, if:
1) The benefits of the disability income
			 policy are dependent upon or vary in amount based on the receipt of long-term
			 care services;
2) The disability
			 income policy is advertised, marketed or offered as insurance for long-term
			 care services; or
3) Benefits under
			 the policy may commence after the policyholder has reached Social Security's
			 normal retirement age unless benefits are designed to replace lost income or
			 pay for specific expenses other than long-term care services.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.50 - Policy Practices and Provisions

Current through Register Vol. 48, No. 28, July 12, 2024
a) Renewability. The terms "guaranteed
			 renewable" and "noncancellable" shall not be used in any individual long-term
			 care insurance policy or certificate without explanatory language in accordance
			 with the disclosure requirements of Section
			 2012.62.
1) A policy issued to an individual shall not
			 contain renewal provisions other than "guaranteed renewable" or
			 "noncancellable".
2) The term
			 "guaranteed renewable" may be used only when the insured has the right to
			 continue the long-term care insurance in force by the timely payment of
			 premiums and when the insurer has no unilateral right to make any change in any
			 provision of the policy or rider while the insurance is in force, and cannot
			 decline to renew, except that rates may be revised by the insurer on a class
			 basis.
3) The term "noncancellable"
			 may be used only when the insured has the right to continue the long-term care
			 insurance in force by the timely payment of premiums during which period the
			 insurer has no right to unilaterally make any change in any provision of the
			 insurance or in the premium rate.
4) The term "level premium" may only be used
			 when the insurer does not have the right to change the premium.
5) In addition to the other requirements of
			 subsection (a), a qualified long-term care insurance contract shall be
			 guaranteed renewable, within the meaning of Section 7702B(b)(1)(C) of the
			 Internal Revenue Code of 1986, as amended.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.55 - Unintentional Lapse

Current through Register Vol. 48, No. 28, July 12, 2024
Each insurer offering long-term care insurance shall, as a
				protection against unintentional lapse, comply with the following:
a) Notice before lapse or termination.
1) No individual long-term care policy or
			 certificate shall be issued until the insurer has received from the applicant a
			 written designation of at least one person, in addition to the applicant, who
			 is to receive notice of lapse or termination of the policy or certificate for
			 nonpayment of premium; or a written waiver dated and signed by the applicant
			 electing not to designate additional persons to receive notice. The applicant
			 has the right to designate at least one person who is to receive the notice of
			 termination, in addition to the insured. Designation shall not constitute
			 acceptance of any liability on the third party for services provided to the
			 insured. The form used for the written designation must provide space clearly
			 designated for listing at least one person. The designation shall include each
			 person's full name and home address. In the case of an applicant who elects not
			 to designate an additional person, the waiver shall state: "Protection against
			 unintended lapse. I understand that I have the right to designate at least one
			 person other than myself to receive notice of lapse or termination of this
			 long-term care insurance policy for nonpayment of premium. I understand that
			 notice will not be given until 30 days after a premium is due and unpaid. I
			 elect NOT to designate any person to receive such notice." The insurer shall
			 also notify the insured of the right to change this written designation, no
			 less often than once every 2 years.
2) When the policyholder or certificateholder
			 pays premium for a long-term care insurance policy or certificate through a
			 payroll or pension deduction plan, the requirements contained in subsection
			 (a)(1) need not be met until 60 days after the policyholder or
			 certificateholder is no longer on such a payment plan. The application or
			 enrollment form for such policies or certificates shall clearly indicate the
			 payment plan selected by the applicant.
3) Lapse or termination for nonpayment of
			 premium. No individual long-term care policy or certificate shall lapse or be
			 terminated for nonpayment of premium unless the insurer, at least 30 days
			 before the effective date of the lapse or termination, has given notice to the
			 insured and to those persons designated pursuant to subsection (a)(1), at the
			 address provided by the insured for purposes of receiving notice of lapse or
			 termination. Notice shall be given by first class United States mail, postage
			 prepaid; and notice shall not be given until 30 days after a premium is due and
			 unpaid. Notice shall be deemed to have been given as of 5 days after the date
			 of mailing.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.62 - Required Disclosure of Rating Practices to Consumers

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Section shall apply as follows:
1) Except as provided in subsection (a)(2),
			 this Section applies to any long-term care policy issued in this State on or
			 after January 1, 2003.
2) For
			 certificates issued on or after July 1, 2002, under a group long-term care
			 insurance policy as defined in Section 351A-1(e)(1) of the Code that was in
			 force prior to July 1, 2002, the provisions of this Section shall apply on the
			 policy anniversary following July 1, 2003.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.65 - Prohibition Against Post Claims Underwriting

Current through Register Vol. 48, No. 28, July 12, 2024
a) All applications for long-term care
			 insurance policies or certificates except those which are guaranteed issue
			 shall contain unambiguous questions designed to ascertain the health condition
			 of the applicant.
1) If an application for
			 long-term care insurance contains a question which asks whether the applicant
			 has had medication prescribed by a physician, it must also ask the applicant to
			 list the medication that has been prescribed.
2) If the medications listed in the
			 application were known by the insurer, or should be known at the time of
			 application, to be directly related to a medical condition for which coverage
			 would otherwise be denied, then the policy or certificate shall not be
			 rescinded for that condition.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.70 - Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 A long-term care insurance policy or certificate may not, if it provides
			 benefits for home health care or community care services, limit or exclude
			 benefits:
1) By requiring that the
			 insured/claimant would need skilled care in a skilled nursing facility if home
			 health care services were not provided;
2) By requiring that the insured/claimant
			 first or simultaneously receive nursing and/or therapeutic services in a home
			 or community or institutional setting before home health care services are
			 covered;
3) By limiting eligible
			 services to services provided by registered nurses or licensed practical
			 nurses;
4) By requiring that a
			 nurse or therapist provide services covered by the policy that can be provided
			 by a home health aide, or other licensed or certified home care worker acting
			 within the scope of his or her licensure or certification;
5) By requiring that the insured/claimant
			 have an acute condition before home health care services are covered;
6) By excluding coverage for personal care
			 services provided by a home health aide;
7) By requiring that the provision of home
			 health care services be at a level of certification or licensure greater than
			 that required by the eligible service;
8) By limiting benefits to services provided
			 by Medicare-certified agencies or providers;
9) By excluding coverage for adult day care
			 services.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.80 - Requirement to Offer Inflation Protection

Current through Register Vol. 48, No. 28, July 12, 2024
a) No insurer may offer a long-term care
			 insurance policy unless the insurer also offers to the policyholder in addition
			 to any other inflation protection the option to purchase a policy that provides
			 for benefit levels to increase with benefit maximums or reasonable durations
			 which are meaningful to account for reasonably anticipated increases in the
			 costs of long-term care services covered by the policy. Insurers must offer to
			 each policyholder, at the time of purchase, the option to purchase a policy
			 with an inflation protection feature no less favorable than one of the
			 following:
1) Increases benefit levels
			 annually in a manner so that the increases are compounded annually at a rate
			 not less than 5%;
2) Guarantees the
			 insured individual the right to periodically increase benefit levels without
			 providing evidence of insurability or health status so long as the option for
			 the previous period has not been declined. The amount of the additional benefit
			 shall be no less than the difference between the existing policy benefit and
			 that benefit compounded annually at a rate of at least 5% for the period
			 beginning with the purchase of the existing benefit and extending until the
			 year in which the offer is made; or
3) Covers a specified percentage of actual or
			 reasonable charges and does not include a maximum specified indemnity amount or
			 limit.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.83 - Incontestability Period

Current through Register Vol. 48, No. 28, July 12, 2024
a) For a policy
			 or certificate that has been in force for less than 6 months, an insurer may
			 rescind a long-term care insurance policy or certificate or deny an otherwise
			 valid long-term care insurance claim upon a showing of misrepresentation that
			 is material to the acceptance for coverage.
b) For a policy or certificate that has been
			 in force for at least 6 months but less than 2 years, an insurer may rescind a
			 long-term care insurance policy or certificate or deny an otherwise valid
			 long-term care insurance claim upon a showing of misrepresentation that is both
			 material to the acceptance for coverage and that pertains to the condition for
			 which benefits are sought.
c) After
			 a policy or certificate has been in force for 2 years, it is not contestable
			 upon the grounds of misrepresentation alone; the policy or certificate may be
			 contested only upon a showing that the insured knowingly and intentionally
			 misrepresented relevant facts relating to the insured's health.
d) A long-term care insurance policy or
			 certificate may be field issued based on medical or health status if the
			 compensation to the field issuer is not based on the number of policies or
			 certificates issued. For purposes of this Section, "field issued" means a
			 policy or certificate issued by a producer or an agent or a third-party
			 administrator pursuant to the underwriting authority granted to the producer,
			 agent or third party administrator by an insurer and using the insurer's
			 underwriting guidelines.
e) If an
			 insurer has paid benefits under the long-term care insurance policy or
			 certificate, the benefit payments may not be recovered by the insurer in the
			 event that the policy or certificate is rescinded.
f) In the event of the death of the insured,
			 this Section shall not apply to the remaining death benefit of a life insurance
			 policy that accelerates benefits for long-term care. In this situation, the
			 remaining death benefits under these policies shall be governed by Section
			 224(1)(c) of the Code. In all other situations, this Section shall apply to
			 life insurance policies that accelerate benefits for long-term care.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.86 - Nonforfeiture Benefits

Current through Register Vol. 48, No. 28, July 12, 2024
a) Except as
			 provided in subsection (b), a long-term care insurance policy may not be
			 delivered or issued for delivery in this State unless the policyholder or
			 certificateholder has been offered the option of purchasing a policy or
			 certificate including a nonforfeiture benefit as specified in Section
			 2012.127
			 of this Part. The offer of a nonforfeiture benefit may be in the form of a
			 rider that is attached to the policy. In the event the policyholder or
			 certificateholder declines the nonforfeiture benefit, the insurer shall provide
			 a contingent benefit upon lapse that shall be available for a specified period
			 of time following a substantial increase in premium rates.
b) When a group long-term care insurance
			 policy is issued, the offer required in subsection (a) shall be made to the
			 group policyholder. However, if the policy is issued as group long-term care
			 insurance as defined in Section 351A-1(e)(4) of the Code, other than to a
			 continuing care retirement community or other similar entity, the offering
			 shall be made to each proposed certificateholder.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.90 - Requirements for Application Forms and Replacement Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
a) Application forms shall include the
			 following questions designed to elicit information as to whether, as of the
			 date of the application, the applicant has another long-term care insurance
			 policy or certificate in force or whether a long-term care policy or
			 certificate is intended to replace any other accident and sickness or long-term
			 care policy or certificate presently in force. A supplementary application or
			 other form to be signed by the applicant and insurance producer, except where
			 the coverage is sold without an insurance producer, containing such questions
			 may be used. With regard to a replacement policy issued to a group defined by
			 Section 351A-1(e)(1) of the Code the following questions may be modified only
			 to the extent necessary to elicit information about health or long-term care
			 insurance policies other than the group policy being replaced; provided,
			 however, that the certificateholder has been notified of the replacement.
1) Do you have another long-term care
			 insurance policy or certificate in force (including health care service
			 contract, health maintenance organization contract)?
2) Did you have another long-term care
			 insurance policy or certificate in force during the last 12 months?
A) If so, with which company?
B) If that policy lapsed, when did it
			 lapse?
3) Are you
			 covered by Medicaid?
4) Do you
			 intend to replace any of your medical or health insurance coverage with this
			 policy (certificate)?
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.95 - Reporting Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
All insurers shall:
a)
			 Maintain records for each insurance producer of that producer's amount of
			 replacement sales as a percent of the producer's total annual sales and the
			 amount of lapses of long-term care insurance policies sold by the insurance
			 producer as a percent of the producer's total sales.
b) Report annually by June 30 the 10% of its
			 insurance producers with the greatest percentages of lapses and replacements as
			 measured by subsection (a) as provided in Exhibit K.
c) Report annually by June 30 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
			 as provided in Exhibit K.
d) Report
			 annually by June 30 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 as provided in Exhibit K.
e) 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, as provided by Exhibit
			 I.
f) For purposes of this Section:
1) "Policy" means only long-term care
			 insurance;
2) Subject to subsection
			 (f)(3), "claim" means 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;
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.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.97 - Annual Rate Certification Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Section applies to any long-term care
			 policy issued in this State on or after July 1, 2018.
b) The annual rate certifications required by
			 subsection (c) and the memorandum required by subsection (d), shall be filed in
			 accordance with the filing requirements in Section
			 2012.95.
c) An annual actuarial certification
			 prepared, dated and signed by a member of the American Academy of Actuaries who
			 provides the information shall be included and shall provide at least the
			 following information:
1) A statement of the
			 sufficiency of the current premium rate schedule including:
A) For the rate schedules currently marketed,
i) The premium rate schedule continues to be
			 sufficient to cover anticipated costs under moderately adverse experience and
			 that the premium rate schedule is reasonably expected to be sustainable over
			 the life of the form with no future premium increases anticipated; or
ii) If the above statement cannot be made, a
			 statement that margins for moderately adverse experience may no longer be
			 sufficient. In this situation, the insurer shall provide to the Director,
			 within 60 days of the date the actuarial certification is submitted to the
			 Director, a plan of action, including a time frame, for the re-establishment of
			 adequate margins for moderately adverse experience so that the ultimate premium
			 rate schedule would be reasonably expected to be sustainable over the future
			 life of the form with no future premium increases anticipated. Failure to
			 submit a plan of action to the Director within 60 days or to comply with the
			 time frame stated in the plan of action constitutes grounds for the Director to
			 withdraw or modify its approval of the form for future sales pursuant to
			 Section 143 of the Illinois Insurance Code.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.100 - Filing Requirement

Current through Register Vol. 48, No. 28, July 12, 2024
Prior to an insurer offering group long-term care insurance to
				a resident of this State pursuant to Section 351A-2 of the Code, it shall file
				with the Director evidence that the group policy or certificate thereunder has
				been approved by a state that has adopted the National Association of Insurance
				Commissioners' model legislation on Long-Term Care Insurance and attendant
				regulations, 2301 McGee Street, Suite 800, Kansas City, Missouri 64108 (2000)
				(no subsequent dates or editions).
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.110 - Loss Ratio

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Section
			 shall apply to all long-term care insurance policies or certificates, except
			 those covered under Sections
			 2012.64,
			 2012.112
			 and 2012.113.
b) Notice of Rate
			 Schedule Increase
1) An insurer shall provide
			 notice of a pending premium rate schedule increase, including an exceptional
			 increase, to the Director at least 30 days prior to the notice to the
			 policyholders. The notice shall include:
A) An
			 actuarial memorandum documenting that benefits under the long-term care
			 insurance policies are reasonable in relation to premiums by demonstrating that
			 the expected loss ratio meets the requirements in subsection (c), calculated in
			 a manner that provides for adequate reserving of the long-term care insurance.
			 In evaluating the expected loss ratio, due consideration shall be given to all
			 relevant factors, including:
i) Statistical
			 credibility of incurred claims experience and earned premiums;
ii) The period for which rates are computed
			 to provide coverage;
iii)
			 Experienced and projected trends;
iv) Concentration of experience within early
			 policy duration;
v) Expected claim
			 fluctuation;
vi) Experience
			 refunds, adjustments or dividends;
vii) Renewability features;
viii) Interest;
ix) Experimental nature of the
			 coverage;
x) Product features such
			 as long elimination periods (period between when the claim arises and insured
			 is eligible to receive benefits), high deductibles and high maximum
			 limits.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.112 - Premium Rate Schedule Increases

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 This Section shall apply as follows:
1)
			 Except as provided in subsection (a)(2), this Section applies to any long-term
			 care policy or certificate issued in this State on or after January 1, 2003 and
			 prior to July 1, 2018.
2) For
			 certificates issued on or after July 1, 2002 and before July 1, 2018, under a
			 group long-term care insurance policy as defined in Section 351A-1(e)(1) of the
			 Code, if the policy was in force prior to July 1, 2002, the provisions of this
			 Section shall apply on the policy anniversary following July 1,
			 2003.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.113 - Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings

Current through Register Vol. 48, No. 28, July 12, 2024
a) This
			 Section shall apply as follows:
1) Except as
			 provided in subsection (a)(2), this Section applies to any long-term care
			 policy or certificate issued in this State on or after July 1, 2018.
2) For certificates issued on or after July
			 1, 2018, under a group long-term care insurance policy as defined in Section
			 351A-1(e)(1) of the Code, which was in force prior to July 1, 2018, the
			 provisions of this Section shall apply on the policy anniversary following
			 January 1, 2019.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.115 - Filing Requirements for Advertising

Current through Register Vol. 48, No. 28, July 12, 2024
Every insurer, as defined herein, providing long-term care
				insurance or benefits in this State shall comply with 50 Ill. Adm. Code
				2002.180.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.120 - Reserve Standards

Current through Register Vol. 48, No. 28, July 12, 2024
a) When
			 long-term care benefits are provided through the acceleration of benefits under
			 group or individual life policies or riders to such policies, policy reserves
			 for such benefits shall be determined in accordance with Section 223 of the
			 Code. Claim reserves must also be established when the policy or rider is in
			 claim status (see 50 Ill. Adm. Code
			 2004.40
			 ). Reserves for policies and riders subject to this subsection should be based
			 on the multiple decrement model utilizing all relevant decrements except for
			 voluntary termination rates. Single decrement approximations are acceptable if
			 the calculation produces reserves which differ from the reserves based on the
			 multiple decrement approach by less than 5% for each combination of issue age
			 and duration, or are greater than the reserves based on the multiple decrement
			 approach, or if the reserves for this line of business are less than 5% of the
			 statutory net worth of the company. The calculations may take into account the
			 reduction in life insurance benefits due to the payment of long-term care
			 benefits. However, in no event shall the reserves for the long-term care
			 benefit and life insurance benefit be less than the reserves for the life
			 insurance benefit assuming no long-term care benefit. In the development and
			 calculation of reserves for policies and riders subject to this subsection, due
			 regard shall be given to the applicable policy provisions, marketing methods,
			 administrative procedures and all other considerations which have an impact on
			 projected claim costs, including, but not limited to, the following:
1) Definition of insured events
2) Covered long-term care
			 facilities
3) Existence of home
			 convalescence care coverage
4)
			 Definition of facilities
5)
			 Existence or absence of barriers to eligibility
6) Premium waiver provision
7) Renewability
8) Ability to raise premiums
9) Marketing method
10) Underwriting procedures
11) Claims adjustment procedures
12) Waiting period
13) Maximum benefit
14) Availability of eligible
			 facilities
15) Margins in claim
			 costs
16) Optional nature of
			 benefit
17) Delay in eligibility
			 for benefit
18) Inflation
			 protection provisions
19)
			 Guaranteed insurability option
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.121 - Producer Training Requirements

Current through Register Vol. 48, No. 28, July 12, 2024
a) Long-Term Care Training Required
1) An individual may not sell, solicit or
			 negotiate long-term care insurance unless the individual is licensed as an
			 insurance producer for accident and health and has completed a one-time
			 training course. The training shall meet the requirements set forth in
			 subsection (b).
2) An individual
			 already licensed and selling, soliciting or negotiating long-term care
			 insurance on July 1, 2008 may not continue to sell, solicit or negotiate long
			 term care insurance unless the individual has completed a one-time training
			 course, as set forth in subsection (b), by July 1, 2009.
3) In addition to the one-time training
			 course required in subsection (a)(1) and (2), an individual who sells, solicits
			 or negotiates long-term care insurance shall complete ongoing training as set
			 forth in subsection (b).
4) The
			 training requirements of subsection (b) may be approved as continuing education
			 courses under Section 500-35(b)(1) of the Code.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.122 - Standards for Marketing

Current through Register Vol. 48, No. 28, July 12, 2024
a) Every
			 insurer, as defined herein, marketing long-term care insurance coverage in this
			 State, directly or through its producers, shall:
1) Establish marketing procedures and
			 producer training requirements to assure that:
A) Any marketing activities, including any
			 comparison of policies, by its agents or other producers will be fair and
			 accurate; and
B) Excessive
			 insurance is not sold or issued.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.123 - Suitability

Current through Register Vol. 48, No. 28, July 12, 2024
a) This Section
			 shall not apply to life insurance policies that accelerate benefits for
			 long-term care.
b) Every insurer,
			 health care service plan or other entity marketing long-term care insurance
			 (the "issuer") shall:
1) Develop and use
			 suitability standards to determine whether the purchase or replacement of
			 long-term care insurance is appropriate for the needs of the
			 applicant;
2) Train its insurance
			 producers in the use of its suitability standards; and
3) Maintain a copy of its suitability
			 standards and make them available for inspection upon request by the
			 Director.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.124 - Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates

Current through Register Vol. 48, No. 28, July 12, 2024
If a long-term care insurance policy or certificate replaces
				another long-term care policy or certificate, the replacing insurer shall waive
				any time periods applicable to preexisting conditions and probationary periods
				in the new long-term care policy for similar benefits to the extent that
				similar exclusions have been satisfied under the original
				policy.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.125 - Availability of New Services or Providers

Current through Register Vol. 48, No. 28, July 12, 2024
a) An insurer shall notify policyholders of
			 the availability of a new long-term care policy series that provides coverage
			 for new long-term care services or providers that are material in nature and
			 not previously available through the insurer to the general public. The notice
			 shall be provided within 12 months after the date the new policy series is made
			 available for sale in this State. New long-term care services or providers that
			 are material in nature shall not include changes to policy structure or
			 benefits or provisions that are minor in nature. Examples of when notification
			 need not be provided include changes in elimination periods, benefit periods
			 and benefit amounts.
b)
			 Notwithstanding subsection (a), notification is not required for any policy
			 issued prior to July 2008, or to any policyholder or certificateholder who is
			 currently eligible for benefits, within an elimination period or on claim, or
			 who previously has been in claim status, or who would not be eligible to apply
			 for coverage due to issue age limitations under the new policy. The insurer may
			 require that policyholders meet all eligibility requirements, including
			 underwriting and payment of the required premium to add new services or
			 providers.
c) The insurer shall
			 make the new coverage available in one of the following ways:
1) By adding a rider to the existing policy
			 and charging a separate premium for the new rider based on the insured's
			 attained age;
2) By exchanging the
			 existing policy or certificate for one with an issue age based on the present
			 age of the insured and recognizing past insured status by granting premium
			 credits toward the premiums for the new policy or certificate. The premium
			 credits shall be based on premiums paid or reserves held for the prior policy
			 or certificate;
3) By exchanging
			 the existing policy or certificate for a new policy or certificate in which
			 consideration for past insured status shall be recognized by setting the
			 premium for the new policy or certificate at the issue age of the policy or
			 certificate being exchanged. The cost for the new policy or certificate may
			 recognize the difference in reserves between the new policy or certificate and
			 the original policy or certificate; or
4) By an alternative program (such as
			 underwriting concessions) developed by the insurer that meets the intent of
			 this Section if the program is filed with and approved by the
			 Director.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.126 - Right to Reduce Coverage and Lower Premiums

Current through Register Vol. 48, No. 28, July 12, 2024
a) Coverage Reduction Options
1) Every long-term care insurance policy and
			 certificate shall include a provision that allows the policyholder or
			 certificateholder to reduce coverage and lower the policy or certificate
			 premium in at least one of the following ways:
A) Reducing the maximum benefit; or
B) Reducing the daily, weekly or monthly
			 benefit amount.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.127 - Nonforfeiture Benefit Requirement

Current through Register Vol. 48, No. 28, July 12, 2024
a)
			 This Section does not apply to life insurance policies or riders containing
			 accelerated long-term care benefits.
b) To comply with the requirement to offer a
			 nonforfeiture benefit pursuant to Section
			 2012.86 of
			 this Part:
1) A policy or certificate offered
			 with nonforfeiture benefits shall have coverage elements, eligibility, benefit
			 triggers and benefit length that are the same as coverage to be issued without
			 nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
			 be the benefit described in Section 2012.127(e); and
2) The offer shall be in writing if the
			 nonforfeiture benefit is not otherwise described in the Outline of Coverage or
			 other materials given to the prospective policyholder.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.128 - Standards for Benefit Triggers

Current through Register Vol. 48, No. 28, July 12, 2024
a) A
			 long-term care insurance policy shall condition the payment of benefits on a
			 determination of the insured's ability to perform activities of daily living
			 and on cognitive impairment. Eligibility for the payment of benefits shall not
			 be more restrictive than requiring either a deficiency in the ability to
			 perform not more than 3 of the activities of daily living or the presence of
			 cognitive impairment.
b) Insurers
			 may use activities of daily living to trigger covered benefits as long as they
			 are defined in the policy. Activities of daily living shall include but not be
			 limited to the following, as defined in Section
			 2012.40 of
			 this Part and in the policy:
1)
			 Bathing;
2) Continence;
3) Dressing;
4) Eating;
5) Toileting; and
6) Transferring.
Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Section 2012.129 - Additional Standards for Benefit Triggers for Qualified Long-Term Care

Current through Register Vol. 48, No. 28, July 12, 2024
a) A qualified
			 long-term care insurance contract shall pay only for qualified long-term care
			 services received by a chronically ill individual provided pursuant to a plan
			 of care prescribed by a licensed health care practitioner.
b) A qualified long-term care insurance
			 contract shall condition the payment of benefits on a determination of the
			 insured's inability to perform activities of daily living for an expected
			 period of at least 90 days due to a loss of functional capacity or to severe
			 cognitive impairment.
c)
			 Certifications regarding activities of daily living and cognitive impairment
			 required pursuant to subsection (b) of this Section shall be performed by the
			 following licensed or certified professionals: physicians, registered
			 professional nurses, licensed social workers, or other individuals who meet
			 requirements prescribed by the Secretary of the Treasury under the authority of
			 Section 7702B of the IRS Code (
			 26 USC
			 7702 B ).
d) Certifications required pursuant to
			 subsection (b) of this Section may be performed by a licensed health care
			 practitioner at the direction of the carrier as is reasonably necessary with
			 respect to a specific claim, except that when a licensed health care
			 practitioner has certified that an insured is unable to perform activities of
			 daily living for an expected period of at least 90 days due to a loss of
			 functional capacity and the insured is in claim status, the certification may
			 not be rescinded and additional certifications may not be performed until after
			 the expiration of the 90 day period.
e) Qualified long-term care insurance
			 contracts shall include a clear description of the process for appealing and
			 resolving disputes with respect to benefit determinations.