reglab/statecodes huggingface dataset:
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 6 - TYPES OF INSURANCE CONTRACTS › Section R20-6-604.07 - Experience Reports

Current through Register Vol. 30, No. 28, July 12, 2024
A. By April 1
				of each year, an insurer that transacts credit insurance in this state shall
				file with the Director an experience report, on a form specified by the
				Director, for each class of business that the insurer transacts as provided in
				this Section.
1. In this Section, a "class of
				business" means:
a. Credit unions;
b. Banks, savings and loan institutions, and
				mortgage companies;
c. Finance
				companies, small loan companies, and consumer lenders defined in A.R.S. §
											6-601(5);
d. Dealers, including auto, truck, and boat
				dealers, retail stores, and other persons selling financed goods; and
e. All other persons selling credit insurance
				not specifically listed in subsection (A)(1)(a) through (d).
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 6 - TYPES OF INSURANCE CONTRACTS › Section R20-6-604.08 - Use of Prima Facie Rates; Rate Deviations

Current through Register Vol. 30, No. 28, July 12, 2024
A. Use of rates greater than prima facie
				rates. An insurer may file for approval and use of any deviated rates that are
				higher than the prima facie rates referred to in
				R20-6-604.04
				and
				R20-6-604.05
				as prescribed in A.R.S. §
									20-1610.
1. The deviated rates shall meet the minimum
				loss ratio standards and other requirements prescribed by
				R20-6-604.02.
2. The filing shall specify the accounts to
				which the rates apply.
3. The rates
				may be:
a. Applied uniformly to all accounts
				of the insurer; or
b. Applied on an
				equitable basis approved by the Director to accounts of the insurer for which
				the insurer's experience has been less favorable than expected.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 6 - TYPES OF INSURANCE CONTRACTS › Section R20-6-604.09 - Supervision of Consumer Credit Insurance Operations

Current through Register Vol. 30, No. 28, July 12, 2024
A. At least once every three years, an
				insurer transacting credit insurance in Arizona shall review the credit
				insurance operations of each creditor with whom the insurer does business to
				ensure that each creditor is complying with applicable credit insurance laws.
				The insurer shall review the following:
1.
				The creditor does not charge rates in excess of the prima facie rates or any
				deviated rates for which the insurer obtains approval;
2. The creditor makes benefit payments as
				prescribed in the policy; and
3.
				The creditor refunds unearned premiums as prescribed in
				R20-6-604.06.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 6 - TYPES OF INSURANCE CONTRACTS › Section R20-6-604.10 - Prohibited Transactions

Current through Register Vol. 30, No. 28, July 12, 2024
A. The
				practices listed in this Section are deemed unfair trade practices under A.R.S.
				§
									20-442.
				An insurer that commits any of the following practices is subject to penalties
				as prescribed in A.R.S. §
									20-456:
1. Offering or providing a creditor with any
				special advantage or any service not set out in either the group insurance
				contract or in the agency contract, other than payment of
				commissions;
2. Agreeing to deposit
				with a bank or financial institution, the insurer's money or securities as a
				substitute for a deposit of money or securities that the financial institution
				would otherwise require from the creditor as a compensating balance or deposit
				offset for a loan or other advancement; or
3. Depositing money or securities without
				interest or at a lesser rate of interest than the creditor, bank, or financial
				institution is currently paying on other similar deposits.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 6 - TYPES OF INSURANCE CONTRACTS › Section R20-6-607 - Reasonableness of Benefits in Relation to Premium Charged

Current through Register Vol. 30, No. 28, July 12, 2024
A. Applicability. This rule shall apply to
				individual disability insurance (as defined in A.R.S. §
									20-253
				) policy forms and rates.
B. When
				rate filing is required. Every individual policy form, rider or endorsement
				form affecting benefits which is submitted for approval shall be accompanied by
				a rate filing unless such rider or endorsement form does not require a change
				in the rate. Any subsequent addition to or change in rates applicable to such
				policy, rider or endorsement form shall also be filed.
C. General contents of all rate filings. Each
				rate submission shall include an actuarial memorandum describing the basis on
				which rates were determined and shall indicate and describe the calculation of
				the ratio, hereinafter called "anticipated loss ratio," of the present value of
				the expected benefits to the present value of the expected premiums over the
				entire period for which rates are computed to provide coverage. Each rate
				submission must also include a certification by a qualified actuary that to the
				best of the actuary's knowledge and judgment, the rate filing is in compliance
				with applicable laws and regulations of this state and that the benefits are
				reasonable in relation to the premiums.
D. Previously approved forms. Filings of rate
				revisions for a previously approved policy, rider or endorsement form shall
				also include the following:
1. A statement of
				the scope and reason for the revision, and an estimate of the expected average
				effect on premiums including the anticipated loss ratio for the form.
2. A statement as to whether the filing
				applies only to new business, only to in-force business, or both, and the
				reasons.
3. A history of the
				experience under existing rates, including at least the data indicated in
				subsection (E). The history may also include, if available and appropriate, the
				ratios of actual claims to the claims expected according to the assumptions
				underlying the existing rates. All additional data must be reconciled, as
				appropriate, to the required data. Additional data might include:
a. Substitution of actual claim run-offs for
				claim reserves and liabilities,
b.
				Determination of loss ratios with the increase in policy reserves (other than
				unearned premium reserves) added to benefits rather than subtracted from
				premiums,
c. Substitution of net
				level policy reserves for preliminary term policy reserves,
d. Adjustment of premiums to an annual mode
				basis, or
e. Other adjustments or
				schedules suited to the form and to the records of the company.
4. The date and magnitude of each
				previous rate change, if any.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 7 - LICENSING PROVISIONS AND PROCEDURES › Section R20-6-708 - Licensing Time-frames

Current through Register Vol. 30, No. 28, July 12, 2024
A. Definitions. The
				definitions in A.R.S. §
									41-1072 and the following
				definitions apply to this Article.
1.
				"Department" means the Insurance Division of the Department of Insurance and
				Financial Institutions.
2.
				"License" has the meaning prescribed in A.R.S. §
										41-1001(13).
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 7 - LICENSING PROVISIONS AND PROCEDURES › Table A - Licensing Time-frames Table

Current through Register Vol. 30, No. 28, July 12, 2024
License
Relevant
							 A.R.S.
Administrative
							 Completeness
Substantive
							 Review
Overall
							 Time-frame
Insurance
Captive Insurer
§
													20-1098.01
150
30*
180
Certificate of Authority
§
													20-216
210
90*
300
Certificate of Exemption
§
													20-401.05
92
30
122
Health Care Services Organization
§
													20-1052
210
90
300
Hospital, Medical, Dental, and Optometric Service
							 Corporation
§
													20-825
210
90
300
Life Care Provider Permit
§
													20-1803
60*
30*
90
Life Settlement Provider
§
													20-3202
60
60
120
Mechanical Reimbursement Reinsurer
§
													20-1096.04
210
90
300
Prepaid Dental Plan Organization
§
													20-1004
210
90
300
Prepaid Legal Insurer*
§
													20-1097.02
45
15
60*
Qualifying Surplus Lines Insurer
§
													20-413
45
30
75
Reinsurance Intermediary
§
													20-486.01
120
60
180
Insurance Professional
Adjuster
§
													20-321.01
60
60
120
Bail Bond Agent
§
													20-340.01
60
60
120
Certified Application Counselor
§
													20-336.04
60
60
120
Life Settlement Broker
§
													20-3202
60
60
120
Limited Travel Agent
§
													20-3553
60
60
120
Navigator
§
													20-336.03
60
60
120
Nonresident Insurance Producer
							 (Agent/Broker)
§
													20-287
60
60
120
Portable Electronics Insurance
							 Adjuster
§
													20-321.01
60
60
120
Portable Electronics Insurance
							 Vendor
§
													20-1693.01
60
60
120
Rental Car Agent
§
													20-331
60
60
120
Resident Insurance Producer
							 (Agent/Broker)
§
													20-285
60
60
120
Risk Management Consultant
§
													20-331.01
60
60
120
Self-service Storage Agents
§
													20-332
60
60
120
Surplus Lines Broker
§
													20-411
60
60
120
Temporary License
§
													20-294
60
60
120
Title Insurance Agent
§
													20-1580
60
60
120
Variable Contract Agent
§
													20-2662
60
60
120
Other
Rating Organization*
§
													20-361
30
30
60*
Rate Service Organization
§
													20-389
60
60
120
Third Party Administrator
§
													20-485.12
45
45
90
Senior Residential Entrance Fee Contracts: Provider
							 Registration
§
													44-6952
60
60
120
Service Company
§
													20-1095.01
30
30
60
Utilization Review Agent
§
													20-2505
30
90
120
Risk Retention Groups
Risk Retention Group (Foreign)
§
													20-2403
60
0
60
Risk Purchasing Groups
§
													20-2407
30
30
60
* Statutory time-frames
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 8 - PROHIBITED PRACTICES, PENALTIES › Section R20-6-801 - Unfair Claims Settlement Practices

Current through Register Vol. 30, No. 28, July 12, 2024
A. Applicability.
				This rule applies to all persons and to all insurance policies, insurance
				contracts and subscription contracts except policies of Worker's Compensation
				and title insurance. This rule is not exclusive, and other acts not herein
				specified, may also be deemed to be a violation of A.R.S. §
									20-461, The Unfair Claims
				Settlement Practices Act.
B.
				Definitions
1. "Agent" means any individual,
				corporation, association, partnership or other legal entity authorized to
				represent an insurer with respect to a claim. "Agent" has the same meaning as
				"Insurance producer" as defined at A.R.S. §
										20-281(5).
2. "Claimant" means either a first party
				claimant, a third party claimant, or both and includes the claimant's
				designated legal representative and includes a member of the claimant's
				immediate family designated by the claimant.
3. "Department" means the Arizona Department
				of Insurance and Financial Institutions - Insurance Division.
4. "Director" has the meaning of A.R.S.
				§
										20-102.
5. "First party claimant" means an
				individual, corporation, association, partnership or other legal entity
				asserting a right to payment under an insurance policy or insurance contract
				arising out of the occurrence of the contingency of loss covered by the policy
				or contract.
6. "Insurance policy
				or insurance contract" has the meaning of A.R.S. §
										20-103.
7. "Insurer" has the meaning of A.R.S. §
										20-106(C).
8. "Investigation" means all activities of an
				insurer directly or indirectly related to the determination of liabilities
				under coverages afforded by an insurance policy or insurance
				contract.
9. "Notification of
				claim" means any notification, whether in writing or other means, acceptable
				under the terms of any insurance policy or insurance contract, to an insurer or
				its agent, by a claimant, which reasonably apprises the insurer of the facts
				pertinent to a claim.
10. "Person"
				has the meaning of A.R.S. §
										20-105.
11. "Third party claimant" means any
				individual, corporation, association, partnership or other legal entity
				asserting a claim against any individual, corporation, association, partnership
				or other legal entity insured under an insurance policy or insurance contract
				of an insurer.
12. "Worker's
				compensation" includes, but is not limited to, Longshoremen's and Harbor
				Worker's Compensation.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1001 - Applicability and Scope

Current through Register Vol. 30, No. 28, July 12, 2024
Except as otherwise specifically provided, this Article
				  applies to all long-term care insurance policies, including qualified long-term
				  care contracts and life insurance policies that accelerate benefits for
				  long-term care, delivered or issued for delivery in this state by insurers;
				  fraternal benefit societies; nonprofit health, hospital and medical service
				  corporations; prepaid health plans; health care service organizations and all
				  similar organizations.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1002 - Definitions

Current through Register Vol. 30, No. 28, July 12, 2024
The definitions in A.R.S. §
									20-1691
				  and the following definitions apply in this Article.
A. "Benefit trigger," for purposes of a
				tax-qualified long-term care insurance contract, as defined in Section 7702B(b)
				of the Internal Revenue Code of 1968, as amended, "benefit trigger" shall
				include a determination by a licensed health care practitioner that an insured
				is a chronically ill individual.
B.
				"Exceptional increase" means only those rate increases that an insurer has
				filed as exceptional and that the Director determines the need for the premium
				rate increase is justified due to changes in laws or regulations applicable to
				long-term care coverage in this state; or due to increased and unexpected
				utilization that affects the majority of insurers of similar products.
1. Except as provided in Sections
				R20-6-1014
				and
				R20-6-1015,
				exceptional increases are subject to the same requirements as other premium
				rate schedule increases.
2. The
				Director may request independent actuarial review on the issue of whether an
				increase should be deemed an exceptional increase.
3. The Director may also determine whether
				there are any potential offsets to higher claims costs.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1004 - Required Policy Provisions

Current through Register Vol. 30, No. 28, July 12, 2024
A.
				Renewability
1. An individual long-term care
				insurance policy shall contain a renewability provision which shall be either
				"guaranteed renewable" or "noncancellable." The renewability provision shall be
				appropriately captioned, shall appear on the first page of the policy, and
				shall state that the coverage is guaranteed renewable or noncancellable. This
				requirement does not apply to a long-term care insurance policy that is part of
				or combined with a life insurance policy that does not contain a renewability
				provision and that reserves the right not to renew solely to the
				policyholder.
2. An insurer shall
				not use the terms "guaranteed renewable" and "noncancellable" in any individual
				long-term care insurance policy without further explanatory language according
				to the disclosure requirements of this Article.
3. A qualified long-term care insurance
				policy shall have the guaranteed renewability provisions specified in Section
				7702B(b)(1)(C) of the Internal Revenue Code of 1986, as amended, in the
				policy.
4. A long-term care
				insurance policy or certificate shall include a statement that premium rates
				are subject to change, unless the policy does not afford the insurer the right
				to raise premiums.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1006 - Inflation Protection

Current through Register Vol. 30, No. 28, July 12, 2024
A. An
				insurer shall not offer a long-term care insurance policy unless the insurer
				offers to the policyholder, at the time of purchase, in addition to any other
				inflation protection, the option to purchase a policy with an inflation
				protection provision 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. The terms of the required provision shall be no less favorable than one
				of the following:
1. A provision that
				provides for annual increases in benefit levels compounding annually at a rate
				of not less than 5%;
2. A provision
				that guarantees an insured the right to periodically increase benefit levels
				without providing evidence of insurability or health status, if the insured did
				not decline the option for the previous period. The increased 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
				from the purchase of the existing benefit and extending until the year in which
				the offer is made; or 3. A provision for coverage of a specified percentage of
				actual or reasonable charges that is not subject to a maximum specified
				indemnity amount or limit.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1007 - Required Disclosure Provisions

Current through Register Vol. 30, No. 28, July 12, 2024
A. Riders and endorsements. Except for riders
				or endorsements by which an insurer effectuates a request made in writing by
				the insured under an individual long-term care insurance policy, if an insurer
				adds a rider or endorsement to an individual long-term care insurance policy
				after date of issue or at reinstatement or renewal that reduces or eliminates
				benefits or coverage in the policy, the insurer shall require signed acceptance
				by the individual insured. After the date of policy issue, any rider or
				endorsement that increases benefits or coverage with a concomitant increase in
				premium during the policy term shall require the signed written agreement of
				the insured unless the increased benefits or coverage are required by law. If
				the insurer charges a separate additional premium for benefits provided in
				connection with riders or endorsements, the premium charge shall be set forth
				in the policy, rider, or endorsement.
B. Payment of Benefits. A long-term care
				insurance policy that provides for the payment of benefits based on standards
				described as "usual and customary," "reasonable and customary" or words of
				similar import shall define the terms and explain them in its accompanying
				outline of coverage.
C. Disclosure
				of tax consequences. For life insurance policies that provide an accelerated
				benefit for long-term care, an insurer shall provide a disclosure statement at
				the time of application for the policy or rider and at the time the accelerated
				benefit payment request is submitted, that receipt of these accelerated
				benefits may be taxable, and that assistance should be sought from a personal
				tax adviser. The disclosure statement shall be prominently displayed on the
				first page of the policy or rider and any other related documents. This
				subsection shall not apply to qualified long-term care insurance
				contracts.
D. Benefit triggers. A
				long-term care insurance policy shall use activities of daily living and
				cognitive impairment to measure an insured's need for long-term care. The
				long-term care insurance policy shall describe these terms and provisions in a
				separate paragraph in the policy labeled "Eligibility for the Payment of
				Benefits" that includes and explains:
1. Any
				additional benefit triggers,
2.
				Benefit triggers that result in payment of different benefit levels,
				and
3. Any requirement that an
				attending physician or other specified person certify a certain level of
				functional dependency for the insured to be eligible for benefits.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1008 - Required Disclosure of Rating Practices to Consumers

Current through Register Vol. 30, No. 28, July 12, 2024
A. This Section applies 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 May 10, 2005.
2.
				For certificates issued under an in-force, long-term care insurance policy
				issued to a group as defined in A.R.S. §
										20-1691(5)(a),
				the provisions of this Section apply on the first policy anniversary that
				occurs on or after November 10, 2005.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1010 - Requirements for Application Forms and Replacement Coverage, Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates; Reporting Requirements

Current through Register Vol. 30, No. 28, July 12, 2024
A. An insurer's application form for a
				long-term care insurance policy shall include the questions listed in this
				Section 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 health or long-term care policy or certificate presently in force. An
				insurer may include the questions in 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. For a replacement policy issued to a
				group as defined in A.R.S. §
									20-1691(5)(a),
				the insurer may modify the questions only to the extent necessary to elicit
				information about health or long-term care insurance policies other than the
				group policy being replaced if 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 or certificate?
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1011 - Prohibition Against Post-claims Underwriting

Current through Register Vol. 30, No. 28, July 12, 2024
A. An application for a long-term care
				insurance policy or certificate that is not guaranteed issue shall meet the
				requirements of this Section.
1. The
				application shall contain clear and unambiguous questions designed to ascertain
				the applicant's health condition.
a. If the
				application has a question asking whether the applicant has had medication
				prescribed by a physician, the application shall also ask the applicant to list
				the prescribed medication.
b. If
				the insurer knew or reasonably should have known that the medications listed in
				the application are related to a medical condition for which coverage would
				otherwise be denied, the insurer shall not rescind the policy or certificate
				for that condition.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1012 - Reserve Standards

Current through Register Vol. 30, No. 28, July 12, 2024
A. If
				long-term care benefits are provided through the acceleration of benefits under
				group or individual life policies or riders, an insurer shall determine policy
				reserves for long-time care benefits under A.R.S. §
									20-510.
				An insurer shall also establish claim reserves for a policy or rider in claim
				status.
B. An insurer shall base
				reserves for policies and riders under subsection (A) on the multiple decrement
				model using all relevant decrements except for voluntary termination rates. An
				insurer may use single decrement approximations if the calculation produces
				essentially similar reserves, if the reserve is clearly more conservative, or
				if the reserve is immaterial. The insurer, when calculating reserves, may take
				into account the reduction in life insurance benefits due to the payment of
				long-term care benefits. The insurer shall not set the reserves for the
				long-term care benefit and the life insurance benefit to be less than the
				reserves for the life insurance benefit assuming no long-term care
				benefit.
C. In the development and
				calculation of reserves for policies and riders subject to this Section, an
				insurer shall give due regard to the applicable policy provisions, marketing
				methods, administrative procedures and all other considerations which impact
				projected claim costs including 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, and
20. Other similar or comparable factors
				affecting risk.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1013 - Loss Ratio

Current through Register Vol. 30, No. 28, July 12, 2024
A. This Section
				applies to policies and certificates issued any time prior to May 10,
				2005.
B. Benefits under an
				individual long-term care insurance policy are deemed reasonable in relation to
				premiums if the expected loss ratio is at least 60% calculated in a manner that
				provides for adequate reserving of the long-term care insurance risk. In
				evaluating the expected loss ratio, the director shall consider all relevant
				factors, including:
1. Statistical
				credibility of incurred claims experience and earned premiums;
2. The period for which rates are computed to
				provide coverage;
3. Experienced
				and projected trends;
4.
				Concentration of experience within early policy duration;
5. Expected claim fluctuation;
6. Experience refunds, adjustments, or
				dividends;
7. Renewability
				features;
8. All appropriate
				expense factors;
9.
				Interest;
10. Experimental nature
				of the coverage;
11. Policy
				reserves;
12. Mix of business by
				risk classification; and
13.
				Product features such as long elimination periods, high deductibles, and high
				maximum limits.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1016 - Filing Requirements for Group Policies

Current through Register Vol. 30, No. 28, July 12, 2024
A. Out-of-State Policies. Before an insurer
				or similar organization may offer group long-term care insurance to a resident
				of this state under A.R.S. §
									20-1691.02(D),
				the insurer or organization shall file with the Director evidence that a state
				with statutory or regulatory long-term care insurance requirements
				substantially similar to those of this state has approved the group policy or
				certificate for use in that state.
B. Associations. For long-term policies
				marketed or issued to associations, the insurer or organization shall file with
				the insurance department the policy, certificate, and corresponding outline of
				coverage.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1017 - Standards for Marketing

Current through Register Vol. 30, No. 28, July 12, 2024
A. Every
				insurer marketing long-term care insurance coverage in this state, directly or
				through an insurance producer shall:
1.
				Establish marketing procedures to assure that any comparison of policies by its
				insurance producers is fair and accurate, and that excessive insurance is not
				sold or issued;
2. Display
				prominently by type, stamp or other appropriate means, on the first page of the
				outline of coverage and policy, the following language: "Notice to buyer: This
				policy may not cover all of the costs associated with long-term care incurred
				by the buyer during the period of coverage. The buyer is advised to review
				carefully all policy limitations;"
3. Provide the applicant with copies of the
				disclosure forms in Appendices A and B;
4. Inquire and otherwise make every
				reasonable effort to identify whether a prospective applicant or enrollee for
				long-term care insurance already has health or long-term care insurance and the
				types and amounts of any such insurance;
5. Provide an explanation of contingent
				benefit upon lapse as provided for in R20-6-1019(D)(3);
6. Provide written notice to an applicant or
				prospective policyholder or certificateholder advising of this state's senior
				insurance counseling program (SHIP), and the name, address, and phone number
				for the SHIP, at the time of solicitation; and
7. Establish auditable procedures for
				verifying compliance with this subsection (A).
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1018 - Suitability

Current through Register Vol. 30, No. 28, July 12, 2024
A. This Section
				does not apply to life insurance policies that accelerate benefits for
				long-term care.
B. Every insurer or
				other person marketing long-term care insurance, including an insurance
				producer or managing general agent, (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 the Director's
				request.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1019 - Nonforfeiture Benefit Requirement

Current through Register Vol. 30, 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 the provisions of A.R.S. §
									20-1691.11,
				an insurer shall meet the following requirements:
1. A policy or certificate offered with
				nonforfeiture benefits shall have the same coverage elements, eligibility,
				benefit triggers and benefit length as a policy or certificate issued without
				nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
				be the benefit described in subsection (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.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1020 - Standards for Benefit Triggers

Current through Register Vol. 30, 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. Except as otherwise provided in
				R20-6-1021,
				eligibility for the payment of benefits shall not be more restrictive than
				requiring either a deficiency in the ability to perform not more than three of
				the activities of daily living or the presence of cognitive
				impairment.
B. Activities of daily
				living shall include at least the following as defined in
				R20-6-1003(A)(1)
				and in the policy:
1. Bathing,
2. Continence,
3. Dressing,
4. Eating,
5. Toileting, and
6. Transferring.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1021 - Additional Standards for Benefit Triggers for Qualified Long-term Care Insurance Contracts

Current through Register Vol. 30, 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 under
				a plan of care prescribed by a licensed health care practitioner, which is not
				subject to approval or modification by the insurer.
B. A qualified long-term care insurance
				contract shall condition the payment of benefits on a certified 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.
				Licensed health care practitioners shall perform the certified determinations
				regarding activities of daily living and cognitive impairment required under
				subsection (B).
D. Certified
				determinations required under subsection (B) may be performed 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 certified determination may not be rescinded and additional
				certified determinations may not be performed until after the expiration of the
				90-day period.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1022 - Standard Format Outline of Coverage

Current through Register Vol. 30, No. 28, July 12, 2024
A. The outline of coverage prescribed in
				A.R.S. §
									20-1691.06
				shall be a free-standing document, using no smaller than 10 point type, and
				shall contain no advertising or promotional material.
B. Text that is capitalized or underscored in
				the standard format outline of coverage may be emphasized by other means that
				give prominence equivalent to capitalization or underscoring.
C. An insurer shall use the text and sequence
				of text in the standard format outline of coverage prescribed in Appendix J,
				unless otherwise specifically indicated.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1023 - Requirement to Deliver Shopper's Guide

Current through Register Vol. 30, No. 28, July 12, 2024
A. All prospective applicants of a long-term
				care insurance policy or certificate shall receive a long-term care insurance
				shopper's guide approved by the Director. This requirement may be satisfied by
				delivery of the current edition of the long-term care insurance shopper's guide
				in the format developed by the National Association of Insurance Commissioners.
1. In the case of insurance producer
				solicitation, an insurance producer shall deliver the shopper's guide before
				presenting an application or enrollment form.
2. In the case of direct response
				solicitations, the insurer shall provide the shopper's guide with any
				application or enrollment form.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1024 - Availability of New Health Care Services or Providers

Current through Register Vol. 30, No. 28, July 12, 2024
A. An insurer shall notify policyholders of
				the availability of a new long-term policy series that provides coverage for
				new long-term care services or heath care providers material in nature and not
				previously available through the insurer to the general public. The notice
				shall be provided within 12 months of the date the new policy series is made
				available for sale in this state.
B. Notwithstanding subsection (A),
				notification is not required for any policy issued prior to the effective date
				of this Section or to any policyholder or certificateholder who is currently
				eligible for benefits, within an elimination period or on a claim, or who
				previously had 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 such 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 developed by the
				insurer that meets the intent of this Section if the program is filed with and
				approved by the Director.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1025 - Right to Reduce Coverage and Lower Premiums

Current through Register Vol. 30, No. 28, July 12, 2024
A. 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:
1. Reducing the maximum benefit; or
2. Reducing the daily, weekly or monthly
				benefit amount.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Section R20-6-1026 - Instructions for Appendices

Current through Register Vol. 30, No. 28, July 12, 2024
Information that is designated as a "Drafting Instruction" in
				  a form appended to this Article is not required to be included as part of the
				  form. Any person using the form shall abide by the instructions when drafting,
				  preparing, or completing the form.
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Appendix A - Long-term Care Insurance Personal Worksheet

Current through Register Vol. 30, No. 28, July 12, 2024
Click here to
				  view
Click here to
				  view
(Drafting Instruction:
Choose the appropriate
				  sentences depending on whether this is a direct mail or insurance producer
				  sale.)
The company may contact you to verify your
				  answers.
(Drafting Instruction:
When the Long-term Care
				  Insurance Personal Worksheet is furnished to employees and their spouses under
				  employer group policies, the text from the heading "Disclosure Statement" to
				  the end of the document may be removed.)
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Appendix E - Long-Term Care Insurance Replacement and Lapse Reporting Form

Current through Register Vol. 30, No. 28, July 12, 2024
Click here to
				  view
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Appendix F - Long-term Care Insurance Claims Denial Reporting Form

Current through Register Vol. 30, No. 28, July 12, 2024
Click here to
				  view
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Appendix G - Rescission Reporting Form for Long-term Policies

Current through Register Vol. 30, No. 28, July 12, 2024
Click here to
				  view
Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Appendix I - Long-term Care Insurance Suitability Letter

Current through Register Vol. 30, No. 28, July 12, 2024
Long-term Care Insurance Suitability
				  Letter
Dear [Applicant]:
Your recent application for long-term care insurance included
				  a "personal worksheet," which asked questions about your finances and your
				  reasons for buying long-term care insurance. For your protection, state law
				  requires us to consider this information when we review your application, to
				  avoid selling a policy to those who may not need coverage.
[Your answers indicate that long-term care insurance may not
				  meet your financial needs. We suggest that you review the information provided
				  along with your application, including the booklet "Shopper's Guide to
				  Long-Term Care Insurance" and the page titled "Things You Should Know Before
				  Buying Long-Term Care Insurance." Your state insurance department also has
				  information about long-term care insurance and may be able to refer you to a
				  counselor free of charge who can help you decide whether to buy this
				  policy.]
[You chose not to provide any financial information for us to
				  review.]
(
Drafting Instruction:
Choose the paragraph that
				  applies.)
We have suspended our final review of your application. If,
				  after careful consideration, you still believe this policy is what you want,
				  check the appropriate box below and return this letter to us within the next 60
				  days. We will then continue reviewing your application and issue a policy if
				  you meet our medical standards.
If we do not hear from you within the next 60 days, we will
				  close your file and not issue you a policy. You should understand that you will
				  not have any coverage until we hear back from you, approve your application and
				  issue you a policy.
Please check one box and return in the enclosed
				  envelope.
[]
Yes
, [although my worksheet indicates that
				  long-term care insurance may not be a suitable purchase,] I wish to purchase
				  this coverage. Please resume review of my application.
Drafting Instruction:
Delete the phrase in
				  brackets if the applicant did not answer the questions about income.
[]
No.
I have decided not to buy a policy at
				  this time.
_____________________________________ ____________
APPLICANT'S SIGNATURE DATE
Please return to [issuer] at [address] by
				  [date].