Connecticut Administrative Code › Title 38a - Insurance Department › 475 - Connecticut Partnership For Long Term Care › Section 38a-475-4 - Conditions for partnership-approval

Current through July 10, 2024
(a) No long-term
			 care insurance policy shall be advertised, solicited, or issued for delivery in
			 this state as a partnership-approved long-term care policy which does not meet
			 the following minimum standards. These are minimum standards and do not
			 preclude the inclusion of other provisions or benefits which are not
			 inconsistent with these standards.
(b) The following standards apply to
			 partnership-approved long-term care policies as defined herein and are in
			 addition to all other requirements of sections
			 38a-475-1
			 to
			 38a-475-6,
			 inclusive, of the Regulations of Connecticut State Agencies.
(c) Each company seeking partnership-approval
			 for a long-term care insurance product shall:
(1) Notify the Insurance Department in
			 writing that it will provide to the consumer, prior to any application for a
			 partnership-approved policy, a complete description of the Connecticut
			 Partnership for Long-Term Care as prepared by the Office of Policy and
			 Management, including the Connecticut partnership's toll free phone number, and
			 an outline of coverage.
(2) Offer
			 the option of or include a provision for Home and Community-Based Services,
			 with a minimum benefit of one (1) year at issue, in addition to nursing home
			 care.
All home care plans shall include case management services
				delivered by an access agency.
Case management services shall include, but need not be limited
				to, the development of a comprehensive individualized assessment and plan of
				care and, as needed, coordination of appropriate services and the monitoring of
				the delivery of such services.
(3) Provide a provision for inflation
			 protection which satisfies at least one of the following criteria:
(A) The policy covers at least seventy (70)
			 percent of the actual charges or at least seventy (70) percent of the average
			 Connecticut private pay rate, without increases in premium, for that service
			 based on a listing of average private pay rates that will be inflated or
			 updated annually by the Office of Policy and Management and does not include a
			 maximum specified daily indemnity amount or daily limit. The policy shall also
			 provide for increases in lifetime benefit levels, without related increases in
			 premium, at a rate not less than three (3.0) percent each year over the
			 previous year for each year the contract is in force except that, at the option
			 of the insurer, policyholders and applicants sixty-five (65) years of age and
			 older may be given the option not to inflate their lifetime benefit levels.
			 Premiums shall be based on the age of the policyholder at the time of the
			 issuance of the partnership-approved policy; or
(B) The policy provides for automatic
			 increases in the per diem dollar level, without related increases in premiums,
			 at a rate not less than three (3.0) percent each year over the previous year
			 for each year the contract is in force. The policy shall also provide for
			 increases in lifetime benefit levels, without related increases in premium, at
			 a rate not less than three (3.0) percent each year over the previous year for
			 each year the contract is in force except that, at the option of the insurer,
			 policyholders and applicants sixty-five (65) years of age and older may be
			 given the option not to inflate their lifetime benefit levels. Premiums shall
			 be based on the age of the policyholder at the time of the issuance of the
			 partnership-approved policy.
(4) At a minimum, provide a nursing home
			 benefit of at least $265.00 per day for policies applied for in 2017. For each
			 year after 2017, the minimum daily nursing home benefit shall be three (3.0)
			 percent greater than the previous year's minimum, rounded down to the nearest
			 dollar amount. No policy shall pay for care in excess of the actual charges.
In addition, those policies issued with home and
				community-based services shall provide a daily home and community-based benefit
				that, at a minimum, equals at least fifty (50) percent of the minimum daily
				nursing home benefit in effect for any given year. No policy shall pay for care
				in excess of the actual charges.
Policies that pay benefits based on a percentage of costs, and
				not a daily benefit amount, shall provide benefits which are equal to at least
				seventy (70) percent of the actual charges incurred by the insured or at least
				seventy (70) percent of the average private pay rate provided by the Office of
				Policy and Management for each service.
(5) Use applications to be signed by the
			 applicant acknowledging:
(A) That the agent
			 delivered to the applicant, at time of application, a copy of "Before You Buy,"
			 the state's toll-free number for consumer assistance, a graphic comparison of
			 inflating vs. fixed benefits and premiums, and a "Notice to Applicants
			 Regarding Mandatory Inflation Protection." The following disclosure statement
			 shall be used (or substantially similar language).
I acknowledge that I have received a copy of "Before You Buy,"
				a complete description of the Connecticut Partnership for Long-Term Care,
				prepared by the State of Connecticut, including the state's toll-free number,
				1-800-547-3443. I have also been advised that I can request individual consumer
				information assistance from the State of Connecticut. I have also received a
				graphic comparison of inflating vs. fixed benefits and premiums and the "Notice
				To Applicant Regarding Mandatory Inflation Protection."
___________________ _____
Signature of Applicant(s) Date
(B) That the applicant agrees to the release
			 of information by the insurer to the State of Connecticut as may be needed to
			 evaluate the Connecticut Partnership for Long-Term Care, document a claim for
			 Medicaid asset protection and meet Medicaid audit requirements. Said release
			 shall be in the following format and require a separate signature by the
			 applicant(s):
I hereby agree to the release of my insurance records
				pertaining to this long-term care insurance policy (certificate) by the (insert
				insurance company name) to the State of Connecticut for the purpose of
				documenting a claim for Asset Protection under the Connecticut Medicaid
				program, evaluating the Connecticut Partnership for Long-Term Care, and meeting
				Medicaid audit requirements. I understand that my records will be used for no
				purpose other than those stated above, and will be kept strictly confidential
				by the State of Connecticut.
_________________________ _____
Signature of Applicant(s) Date
(C) That the agent delivered to the applicant
			 at the time of application a description regarding mandatory inflation
			 protection that shall be in the following format:
NOTICE TO APPLICANT REGARDING MANDATORY INFLATION PROTECTION In
				order for this long-term care policy (certificate) to remain
				partnership-approved by the State of Connecticut and qualify to provide Asset
				Protection for the State Medicaid program in Connecticut, daily coverage
				benefits shall meet or exceed standards established by the State of
				Connecticut. The insurance company will provide you with a graphic comparison
				showing the differences in premiums and benefits, over at least a twenty (20)
				year period, between a policy that increases benefits and a policy that does
				not increase benefits. Failure to maintain the required daily coverage benefits
				will result in the policy losing its partnership-approved status and no longer
				being allowed to provide Asset Protection. It is the insurance company's
				responsibility to automatically inflate daily coverage benefit levels in order
				to maintain partnership-approval; it is your responsibility to make premium
				payments in order to maintain coverage and eligibility for Asset
				Protection.
(D) That the
			 agent delivered to the applicant at the time of application a graphic
			 comparison showing the differences in premiums and benefits, over at least a
			 twenty (20) year period, between a policy that increases benefits and a policy
			 that does not increase benefits.
(6) Report all sales involving replacement to
			 the Commissioner within thirty (30) days of the effective date of the newly
			 issued policy or certificate. The report shall include the name and address of
			 the insured, the name of the company whose policy is being replaced and the
			 name of the agent replacing the coverage. For sales involving replacement by an
			 insurer other than a direct response insurer, this report shall also include a
			 comparison of the coverage issued with that being replaced, including a
			 comparison of the premiums and an explanation of how said replacement was
			 beneficial to the insured.
(7)
			 Issue a policy which shall include a provision which allows for a thirty (30)
			 day period within which coverage may be cancelled by the applicant by
			 delivering or mailing the evidence of coverage to the insurer or the agent
			 through whom it was effected for a full refund of any premium that was paid.
			 The policy shall have a notice prominently printed on the first page of the
			 policy or certificate or attached thereto stating in substance that the
			 policyholder or certificate holder shall have the right to return the policy or
			 certificate to the insurer or its agent for cancellation within thirty (30)
			 days of its delivery and to have the premium refunded if, after examination of
			 the policy or certificate, the insured is not satisfied for any
			 reason.
(8) Agree to provide to
			 each individual who is denied a partnership-approved long term care insurance
			 policy, a survey produced by the Office of Policy and Management which the
			 individual would, at his or her option, complete and return to the Office of
			 Policy and Management.
(9) Issue a
			 policy which does not require prior hospitalization or a prior stay in a
			 nursing home as a condition of providing benefits.
(10) Provide assurances to the Commissioner
			 that no agent will be authorized to market, sell, solicit or otherwise contact
			 any person for the purpose of marketing a partnership-approved long-term care
			 insurance policy unless the agent has completed seven (7) hours of training on
			 long term care insurance in general and the Connecticut Partnership for
			 Long-Term Care specifically. Such assurances shall be in the form of a document
			 signed by a representative of the company attesting to the completion of the
			 required training by the agent and submitted to the Commissioner. All training
			 programs designed to meet the requirements of this subdivision shall receive
			 prior approval from the Office of Policy and Management.
(11) Issue a policy which, in the event the
			 policy is about to lapse, proactively offers, as defined in this subdivision,
			 the insured the option to switch their coverage to a lower lifetime maximum
			 benefit. The offering shall provide the policyholder the option of reducing
			 their lifetime maximum benefit to any lifetime maximum benefit available from
			 the insurer. The offering shall include, at a minimum, an option covering a
			 period of care less than or equal to two (2) years. After the policy has been
			 in force for at least one (1) year, this option need only be offered one time.
			 Premiums shall be based on the age of the policyholder at the time of the
			 issuance of the original partnership-approved policy and shall be less than the
			 premium the policyholder had been charged prior to electing the lower lifetime
			 maximum benefit. Except for the premium and lifetime maximum benefit, all other
			 provisions and benefits that were part of the policy at the time the lifetime
			 maximum benefit was changed shall remain in force. For purposes of this
			 subdivision, proactively offering the lower lifetime maximum benefit means, at
			 a minimum, sending a letter to the policyholder explaining the option to switch
			 coverage to a lower amount, while providing no less than fifteen (15) days for
			 the policyholder to switch their coverage before their policy lapses, except in
			 a case where:
(A) The balance of the original
			 policy's available benefits (after any claims have been paid) would provide for
			 the equivalent of one (1) year of coverage or less; or
(B) The original policy was issued with the
			 equivalent of one (1) year of coverage.
(12) Issue a policy which in the event a
			 policyholder lapses a partnership-approved policy and retains a non-forfeiture
			 benefit, the policy will maintain its partnership-approval status only so long
			 as the partnership-approved policy's non-forfeiture benefit will pay benefits.
			 A non-forfeiture benefit that returns premium to the policyholder will result
			 in the policy losing its partnership-approval once the return of premium
			 non-forfeiture benefit is accessed.
(13) Issue a policy which defines "One period
			 of confinement" as meaning consecutive days of confinement: it shall be deemed
			 to include successive periods of confinement which are due to the same or
			 related cause and are not separated by at least ninety (90) days during which
			 the insured is not confined for either skilled nursing care, custodial,
			 intermediate care, or home and community-based care.
(14) Issue a policy that makes maximum
			 benefits available in dollars and not in days of care. Nothing in this
			 subsection shall prevent an insurance company from expressing its maximum
			 benefits as days of care when marketing their partnership-approved policies as
			 long as the actual payment of benefits is based on dollars and not days of
			 care.
(15) Issue a policy that
			 provides for one pool of benefit dollars when home and community-based services
			 are chosen in addition to nursing home benefits. The one pool of benefit
			 dollars will be available to the insured to cover any of the benefits covered
			 under the policy.
(16) Issue a
			 policy that does not limit payments to the room and board charges in an
			 institution, such as a nursing home, as long as the payments do not exceed the
			 daily maximum benefit or the actual charges.
(17) Issue a policy that includes a
			 description of Medicaid asset protection and Connecticut Partnership for
			 Long-Term Care residency requirements in the policy and outline of coverage.
			 The plan of action requirements will include the format and language to be used
			 for the description.
(18) Issue a
			 policy that includes licensed homemaker-home health aide agencies as an
			 eligible provider in the policy and certificate.
(19) Offer a policy that provides for
			 automatic increases in the per diem dollar and lifetime benefit levels, without
			 related increases in premiums, at a rate of five (5) percent each year over the
			 previous year for each year the policy is in force.