California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58053 - Conversion of Policies or Certificates

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Conversion of Non-Partnership Policies or
					 Certificates to Partnership Policies.
Each participating Issuer which has previously sold
						non-Partnership long-term care insurance policies or certificates shall make
						the following provisions for its policy or certificate holders who are not in
						benefit status or in the process of satisfying the policy or certificate
						elimination period;
(1) Individual
					 policy holders who hold non-Partnership policies on the date when the
					 participating Issuer's Policy is first available for purchase shall have a
					 right to convert to a Partnership Policy at any time during the period the
					 Issuer is a participating Issuer. However, the policy holder's right to convert
					 may be limited to one-time only if the Issuer elects to provide written
					 notification to each individual policy holder of the right to convert to a
					 Partnership Policy within twelve months (12) of the date the participating
					 Issuer is approved and allows the policy holder a minimum window of at least
					 sixty (60) days to convert to a Partnership Policy.
(2) Each holder of a non-Partnership
					 certificate shall be afforded the right to convert to a Partnership Certificate
					 if the employer or entity who holds the group policy elects to make available a
					 Partnership Certificate to any of its employees or members. If the employer or
					 entity so elects, the holders of non-Partnership certificates shall be provided
					 written notification and allowed, at minimum, a window of at least sixty (60)
					 days to convert to a Partnership Certificate.
(3) Except as provided in (4) below,
					 participating Issuers shall allow current policy or certificate holders to
					 convert to a Partnership Policy or Certificate based upon full underwriting
					 criteria no more stringent than if the policy or certificate holder were
					 applying for coverage under a certified Policy or Certificate.
(4) Participating Issuers shall allow current
					 policy or certificate holders with policies or certificates in effect for less
					 than twenty-four (24) months to convert to a Partnership Policy or Certificate
					 based on underwriting criteria no more stringent than specified in (5) below if
					 either of the following conditions are met:
(A) the current policy or certificate
					 converts nursing home care only and the policy or certificate holder is
					 converting to a Partnership Nursing Facility and Residential Care Facility Only
					 Policy or Certificate with a lifetime maximum benefit that is no greater than
					 the lifetime maximum benefit of the current policy or certificate; or
(B) the current policy or certificate covers
					 home and community-based care and nursing home benefits and the policy or
					 certificate holder is converting to a Partnership Comprehensive Policy or
					 Certificate with a lifetime maximum benefit no greater than the lifetime
					 maximum benefit of the current policy or certificate.
(5) Participating Issuers shall allow current
					 policy or certificate holders who meet the conditions of (4) above to convert
					 to a Partnership Policy or Certificate based on either no underwriting or
					 underwriting that only disqualifies the policy or certificate holder from
					 converting to a Partnership Policy or Certificate if he or she is:
(A) currently in benefit status or satisfying
					 an elimination period; and/or
(B)
					 currently receiving Formal or Informal Long-Term Care Services which would
					 reasonably indicate that the policy or certificate holder would meet or shortly
					 meet (within 1 year) the Insured Event criteria were the policy or certificate
					 holder to be assessed; and/or
(C)
					 currently using ambulation devices or medical equipment that would reasonably
					 indicate that the policy or certificate holder would meet or shortly meet
					 (within 1 year) the Insured Event criteria were he or she to be
					 assessed.
(6) When a
					 participating Issuer replaces the current policy or certificate of its policy
					 or certificate holder with a Partnership Policy or Certificate, the Issuer
					 shall acknowledge the prior coverage by granting a premium credit for each full
					 year the original policy or certificate was in force toward all subsequent
					 premium payments for the replacement Policy or Certificate as specified in
					 Section 58066(b).