Iowa Administrative Code › Agency 191 - Insurance Division › Health Benefit Plans › Chapter 72 - Long-term Care Asset Preservation Program › Rule 191-72.6 - Minimum Benefit Standards for Qualifying Policies and Certificates

Current through Register Vol. 47, No. 3, July 24, 2024
No long-term care insurance policy or certificate may be
				  advertised, solicited, or issued for delivery in this state as a qualified
				  long-term care insurance policy or certificate which does not meet the minimum
				  benefit standards in this rule, and which has not been approved by the division
				  of insurance as a qualified long-term care insurance policy or certificate.
				  These minimum standards do not preclude the inclusion of other provisions or
				  benefits which are not inconsistent with these standards. These standards are
				  in addition to all other requirements for long-term care insurance policies or
				  certificates. In order to qualify for participation in the Iowa long-term care
				  asset preservation program, a long-term care insurance policy or certificate
				  shall meet the following:
(1) Contain
				a "benefit amount maximum" equivalent to at least 365 times the minimum daily
				nursing facility benefit defined in 72.6(6)
"a."
(2) Offer a maximum benefit amount option
				equivalent to 365 times the minimum daily nursing facility benefit defined in
				72.6(6)
"a."
Issuers may offer other benefit amount options in
				addition to this minimum benefit amount option.
(3) Provide that maximum benefits be
				available in dollars and not in days of care.
(4) Include a provision of inflation
				protection which satisfies at least one of the following criteria:
a. The policy or certificate covers at least
				80 percent but not more than 110 percent of the average daily private pay
				rate.
b. The policy or certificate
				provides for automatic increases in the per diem dollar level in accordance
				with either the consumer price index or at 5 percent each year over the
				previous year for each year that the contract is in force.
c. The policy or certificate provides the
				following:
(1) Annual per diem upgrades on a
				guaranteed issue basis at premiums based on the age of the policyholder or
				certificate holder at the time of the issuance of the qualified policy or
				certificate.
(2) Unless the insured
				takes positive action to decline them, these upgrades automatically increase
				the level of daily coverage to meet or exceed the minimum inflation adjusted
				daily benefit. The minimum inflation adjusted daily benefit is defined as the
				amount or amounts derived by taking the minimum daily benefit for nursing
				facility care at the time of purchase as specified in
				72.6(6)
"a"
and inflating it by the consumer price index or by
				at least 5 percent each year over the previous year for each year that the
				contract is in force. The schedule of minimum per diem dollar amount increases
				shall be updated and maintained at the division of insurance.
(3) The issuer shall notify those
				policyholders or certificate holders choosing the upgrade option when the
				upgrades are automatically effective and what the increased premium, if any,
				will be. The issuer shall also provide to the policyholder or certificate
				holder, at the time of the upgrade, the opportunity to decline the
				upgrade.
(4) The issuer shall
				notify the policyholder or certificate holder when the insurance policy or
				certificate will lose its qualification status if the annual per diem benefit
				upgrade is declined. A qualified policy or certificate containing this
				inflation protection provision will remain qualified as long as the insured's
				daily benefit amount equals or exceeds the minimum inflation adjusted daily
				benefit.