Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-157 - LONG-TERM CARE INSURANCE › Section 69O-157.010 - Conversion or Continuation Privilege

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Group long-term care insurance issued in this state shall provide covered
				individuals with a basis for continuation or conversion of coverage.
(2) For the purposes of this rule, "a basis
				for continuation of coverage" means a policy provision which maintains coverage
				under the existing group policy when such coverage would otherwise terminate
				and which is subject only to the continued timely payment of premium when
				due.
(3) For the purposes of this
				rule, "a basis for conversion of coverage" means a policy provision that an
				individual whose coverage under the group policy would otherwise terminate or
				has been terminated for any reason, including discontinuance of the group
				policy in its entirety or with respect to an insured class, and who has been
				continuously insured under the group policy (and any group policy which it
				replaced), for at least six months immediately prior to termination, shall be
				entitled to the issuance of a converted policy by the insurer under whose group
				policy he or she is covered, without evidence of insurability.
(4) For the purposes of this rule, "converted
				policy" means an individual policy of long-term care insurance providing
				benefits identical to or benefits determined by the Office to be substantially
				equivalent to or in excess of those provided under the group policy from which
				conversion is made. If the policy from which conversion is made restricts
				provision of benefits and services to named providers or facilities, and the
				circumstances of termination make continued use of these providers or
				facilities impossible or impractical, the converted policy shall provide
				coverage on an indemnity or expense incurred basis with benefits equivalent to
				the reasonable cost of services provided by the named providers or facilities,
				and shall not restrict provision of benefits and services to any named
				providers or facilities.
(5)
				Written application for the converted policy shall be made and the first
				premium due, if any, shall be paid as directed by the insurer not later than 31
				days after termination of coverage under the group policy. The converted policy
				shall be issued effective on the day following the termination of coverage
				under the group policy, and shall be renewable annually.
(6)
(a)
				Unless the group policy from which conversion is made replaced previous group
				coverage, the premium for the converted policy shall be calculated on the basis
				of the insured's age and risk class at inception of coverage under the group
				policy from which conversion is made.
(b) Where the group policy from which
				conversion is made replaced previous group coverage, the premium for the
				converted policy shall be calculated on the basis of the insured's age and risk
				class used in determining the coverage issued at inception of coverage under
				the group policy replaced.