Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1905 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. For the purpose of this regulation, the terms
applicant
,
certificate
,
commissioner
,
group long-term care insurance
,
long-term care insurance
,
policy
, and
qualified long-term care insurance
shall have the meanings set
				  forth in
				  R.S.
				  22:1184. In addition, the following
				  definitions will apply.
Benefit Trigger
-for the purposes of
				  independent review, a contractual provision in the insureds policy of long-term
				  care insurance conditioning the payment of benefits on a determination of the
				  insureds ability to perform activities of daily living and on cognitive
				  impairment. For purposes of a tax-qualified long-term care insurance contract,
				  as defined in section 7702B of the
Internal Revenue Code
of
				  1986, as amended, "benefit trigger" shall include a determination by a licensed
				  health care practitioner that an insured is a chronically ill
				  individual.
Exceptional Increase
-
a. only those increases filed by an insurer as exceptional
				  for which the commissioner determines the need for the premium rate increase is
				  justified:
i. due to changes in laws or regulations applicable to
				  long-term care coverage in this state; or
ii. due to increased and unexpected utilization that affects
				  the majority of insurers of similar products;
b. except as provided in §1937, exceptional increases are
				  subject to the same requirements as other premium rate schedule
				  increases;
c. the commissioner may request a review by an independent
				  actuary or a professional actuarial body of the basis for a request that an
				  increase be considered an exceptional increase;
d. the commissioner, in determining that the necessary basis
				  for an exceptional increase exists, shall also determine any potential offsets
				  to higher claims costs.
Incidental
(as used in §1937 J)-that the
				  value of the long-term care benefits provided is less than 10 percent of the
				  total value of the benefits provided over the life of the policy. These values
				  shall be measured as of the date of issue.
Independent Review Organization
-an
				  organization that conducts independent reviews of long-term care benefit
				  trigger decisions.
Licensed Health Care Professional
-an
				  individual qualified by education and experience in an appropriate field, to
				  determine, by record review, an insureds actual functional or cognitive
				  impairment.
Qualified Actuary
- a member in good standing
				  of the American Academy of Actuaries.
Similar Policy Forms
-all of the long-term
				  care insurance policies and certificates issued by an insurer in the same
				  long-term care benefit classification as the policy form being considered.
				  Certificates of groups that meet the definition in
				  R.S.
				  22:1184(4)(a) are not
				  considered similar to certificates or policies otherwise issued as long-term
				  care insurance, but are similar to other comparable certificates with the same
				  long-term care benefit classifications. For purposes of determining similar
				  policy forms, long-term care benefit classifications are defined as follows:
				  institutional long-term care benefits only, non-institutional long-term care
				  benefits only, or comprehensive long-term care benefits.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.