Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 72 - Long-term Care Asset Preservation Program › Rule 191-72.5 - Standards for Marketing

Current through Register Vol. 47, No. 3, July 24, 2024
No long-term care insurance policy or certificate which does
				  not meet the requirements of this chapter and has not been approved by the
				  division of insurance as a certified long-term care insurance policy or
				  certificate may be advertised, solicited, or issued for delivery in this state
				  as a certified long-term care insurance policy or certificate. Each issuer
				  seeking to qualify a long-term care policy or certificate for participation in
				  the Iowa long-term care asset preservation program must do the
				  following:
(1) Provide the consumer,
				prior to presentation of an application for long-term care insurance,
				information regarding the availability of consumer information and public
				education provided by the Senior Health Insurance Information Program using the
				form developed by the division.
(2)
				Use applications to be signed by the applicant which indicate, as described as
				follows, that the applicant:
a. Received a
				complete description of the Iowa long-term care asset preservation program in a
				format prescribed by the commissioner, including an explanation of asset
				protection provided by the program and how it is achieved and the insurance
				division's Senior Health Insurance Information Program consumer information
				telephone number
b. Received a
				description of the issuer's certified long-term care policy or certificate
				benefit option meeting the requirements of subrule 72.6(2).
c. Received a statement regarding Medicaid
				eligibility and benefits that shall be in the following format:
NOTICE TO APPLICANT REGARDING MEDICAID ELIGIBILITY
I understand that eligibility for Medicaid is not automatic;
				  an application is necessary. My insurance company will send me quarterly
				  statements showing how much asset protection I have earned. This permanent
				  asset protection is in addition to any asset exemptions available to any lowan
				  applying for Medicaid. I understand that should I wish to apply for public
				  assistance it is my responsibility to apply for Medicaid. I further understand
				  that before receiving Medicaid I will first have to use any additional assets I
				  have not protected. I will also need to meet Medicaid's criteria for medical
				  necessity which may be different from the eligibility criteria used by my
				  private insurance. Once I become a Medicaid recipient, I understand that I may
				  have to apply a portion of my income toward the cost of my care, and that
				  Medicaid services at that time may not be the same services I was receiving
				  under my private long-term care insurance.
_________________________
(Signature of Applicant(s))
d. Agrees to the release of information by
				the issuer to the state as may be needed to evaluate the Iowa long-term care
				asset preservation program and document a claim for Medicaid asset protection,
				in the following format:
CONSENT AND AUTHORIZATION TO RELEASE INFORMATION
I hereby agree to the release of all records and information
				  pertaining to this long-term care policy or certificate by the [insert issuer
				  name] to the Iowa department of human services for the purposes of documenting
				  a claim for asset protection under the state Medicaid program, evaluating the
				  Iowa long-term care asset preservation program, and meeting Medicaid audit
				  requirements.
I understand that the information contained in these records
				  will be used for no purpose other than those stated above, and will be kept
				  strictly confidential by the state of Iowa.
__________________________
(Signature of Applicant(s))
e. Received 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 certified by the state of Iowa and qualify to provide asset protection
				  for the state Medicaid program, daily coverage benefits must meet or exceed
				  standards established by the state of Iowa. Depending on the option you choose
				  to automatically inflate daily coverage benefits, premiums may rise over the
				  life of the policy [certificate]. [Insert issuer name] will provide you with a
				  graphic comparison showing the differences in premiums and benefits, over at
				  least a 20-year period, between a policy that increases benefits over the
				  policy period and a policy that does not increase benefits. Failure to maintain
				  the required daily coverage benefits will result in the policy [certificate]
				  losing its certified status and no longer being allowed to provide asset
				  protection. It is [insert issuer name]'s responsibility to automatically
				  inflate coverage benefit levels in order to maintain certified status; it is
				  your responsibility to make premium payments in order to maintain certified
				  status.
f. Received a
				graphic comparison showing the differences in premiums and benefits, over at
				least a 20-year period, between a policy or certificate that increases benefits
				over the policy or certificate period and a policy or certificate that does not
				increase benefits.