reglab/statecodes huggingface dataset:
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1503 - Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
Accelerated Benefits
covered under this
				  regulation-benefits payable under a life insurance contract:
1. to a policy owner or certificate holder, during the
				  lifetime of the insured, in anticipation of death or upon the occurrence of
				  specified life-threatening or catastrophic conditions, as defined by the policy
				  or rider; and
2. which reduce the death benefit otherwise payable under the
				  life insurance contract; and
3. which are payable upon the occurrence of a single
				  qualifying event which results in the payment of a benefit amount fixed at the
				  time of acceleration.
Qualifying Event
- includes one or more of
				  the following:
1. a medical condition which would result in a drastically
				  limited life span as specified in the contract, for example, 24 months or less;
				  or
2. a medical condition which has required or requires
				  extraordinary medical intervention, such as, but not limited to, major organ
				  transplant or continuous artificial life support, without which the insured
				  would die; or
3. any condition which usually requires continuous
				  confinement in an eligible institution, as defined in the contract, if the
				  insured is expected to remain there for the rest of his or her life; or
4. a medical condition which would, in the absence of
				  extensive or extraordinary medical treatment, result in a drastically limited
				  life span. Such conditions may include, but are not limited to, one or more of
				  he following:
a. coronary artery disease resulting in an acute infarction
				  or requiring surgery;
b. permanent neurological deficit resulting from cerebral
				  vascular accident;
c. end stage renal failure;
d. Acquired Immune Deficiency Syndrome; or
e. other medical conditions which the commissioner shall
				  approve for any particular filing; or
5. other qualifying events which the commissioner shall
				  approve for any particular filing.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1505 - Type of Product

Current through Register Vol. 50, No. 6, June 20, 2024
A. Accelerated
				benefit riders and life insurance policies with accelerated benefit provisions
				are primarily mortality risks rather than morbidity risks. They are life
				insurance benefits subject to R.S. 22:161-181; 22:191-197; and the applicable
				portions of Part XIV, (22:611-672).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1507 - Assignee/Beneficiary

Current through Register Vol. 50, No. 6, June 20, 2024
A. Prior to the
				payment of the accelerated benefit, the insurer is required to obtain from any
				assignee or irrevocable beneficiary a signed acknowledgment of concurrence for
				payout. If the insurer making the accelerated benefit is itself the assignee
				under the policy, no such acknowledgment is required.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1509 - Criteria for Payment

Current through Register Vol. 50, No. 6, June 20, 2024
A. Lump Sum
				Settlement Option Required. Contract payment options shall include the option
				to take the benefit as a lump sum. The benefit shall not be made available as
				an annuity contingent upon the life of the insured.
B. Restrictions on Use of Proceeds. No
				restrictions are permitted on the use of the proceeds.
C. Accidental Death Benefit Provision. If any
				death benefit remains after payment of an accelerated benefit, the accidental
				death benefit provision, if any, in the policy or rider shall not be affected
				by the payment of the accelerated benefit.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1511 - Disclosures

Current through Register Vol. 50, No. 6, June 20, 2024
A. Descriptive
				Title. The terminology
accelerated benefit
shall be included
				in the descriptive title. Products regulated under this regulation shall not be
				described or marketed as long-term care insurance or as providing long-term
				care benefits.
B. Tax Consequences.
				A disclosure statement is required 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 advisor. The disclosure statement shall be
				prominently displayed on the first page of the policy or rider and any other
				related documents.
C. Solicitations
1. A written disclosure including, but not
				necessarily limited to, a brief description of the accelerated benefit and
				definitions of the conditions or occurrences triggering payment of the benefits
				shall be given to the applicant. The description shall include an explanation
				of any effect of the payment of a benefit on the policy's cash value,
				accumulation account, death benefit, premium, policy loans and policy liens.
a. In the case of agent solicited insurance,
				the agent shall provide the disclosure form to the applicant prior to or
				concurrently with the application. Acknowledgment of the disclosure shall be
				signed by the applicant and writing agent.
b. In the case of a solicitation by direct
				response methods, the insurer shall provide disclosure form to the applicant at
				the time the policy is delivered, with a notice that a full premium refund
				shall be received if policy is returned to the company within the free look
				period.
c. In the case of group
				insurance policies, the disclosure form shall be contained as part of the
				certificate of coverage or any related document furnished by the insurer for
				the certificate holder.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1513 - Effective Date of the Accelerated Benefits

Current through Register Vol. 50, No. 6, June 20, 2024
A. The accelerated benefit provision shall be
				effective for accidents on the effective date of the policy or rider. The
				accelerated benefit provision shall be effective for illness no more than 30
				days following the effective date of the policy or rider.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1515 - Waiver of Premiums

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				insurer may offer a waiver of premium for the accelerated benefit provision in
				the absence of a regular waiver of premium provision being in effect. At the
				time the benefit is claimed, the insurer shall explain any continuing premium
				requirement to keep the policy in force.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1517 - Discrimination

Current through Register Vol. 50, No. 6, June 20, 2024
A. Insurers shall
				not unfairly discriminate among insureds with differing qualifying events
				covered under the policy or among insureds with similar qualifying events
				covered under the policy. Insurers shall not apply further conditions on the
				payment of the accelerated benefits other than those conditions specified in
				the policy or rider.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1519 - Actuarial Standards

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				Financing Options
1. The insurer may require a
				premium charge or cost of insurance charge for the accelerated benefit. These
				charges shall be based on sound actuarial principles. In the case of group
				insurance, the additional cost may also be reflected in the experience
				rating.
2. The insurer may pay a
				present value of the face amount. The calculation shall be based on any
				applicable actuarial discount appropriate to the policy design. The interest
				rate or interest rate methodology used in the calculation shall be based on
				sound actuarial principles and disclosed in the contract or actuarial
				memorandum. The maximum interest rate used shall be no greater than the greater
				of:
a. the current yield on 90 day treasury
				bills; or
b. the current maximum
				statutory adjustable policy loan interest rate.
3. The insurer may accrue an interest charge
				on the amount of the accelerated benefits. The interest rate or interest rate
				methodology used in the calculation shall be based on sound actuarial
				principles and disclosed in the contract or actuarial memorandum. The maximum
				interest rate used shall be no greater than the greater of:
a. the current yield on 90 day treasury
				bills; or
b. the current maximum
				statutory adjustable policy loan interest rate. The interest rate accrued on
				the portion of the lien which is equal in amount to the cash value of the
				contract at the time of the benefit acceleration shall be no more than the
				policy loan interest rate stated in the contract.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1521 - Actuarial Disclosure and Reserves

Current through Register Vol. 50, No. 6, June 20, 2024
A. Actuarial Memorandum. A qualified actuary
				should describe the accelerated benefits, the risks, the expected costs and the
				calculation of statutory reserves in an actuarial memorandum accompanying each
				state filing. The insurer shall maintain in its files descriptions of the bases
				and procedures used to calculate benefits payable under these provisions. These
				descriptions shall be made available for examination by the commissioner upon
				request.
B. Reserves
1. When benefits are provided through the
				acceleration of benefits under group or individual life policies or riders to
				such policies, policy reserves shall be determined in accordance with the
				Standard Valuation Law. All valuation assumptions used in constructing the
				reserves shall be determined as appropriate for statutory valuation purposes by
				a member in good standing of the American Academy of Actuaries. Mortality
				tables and interest currently recognized for life insurance reserves by the
				NAIC may be used as well as appropriate assumptions for the other provisions
				incorporated in the policy form. The actuary must follow both actuarial
				standards and certification for good and sufficient reserves. Reserves in the
				aggregate should be sufficient to cover:
a.
				policies upon which no claim has yet arisen;
b. policies upon which an accelerated claim
				has arisen.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 15 - Regulation 44- Accelerated Benefits › Section XIII-1523 - Filing Requirement

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				filing and prior approval of forms containing an accelerated benefit is
				required.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:644.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 17 - Regulation Number 45-Filing of Affirmative Action Plans › Section XIII-1701 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to implement
				R.S.
				22:33(A)(1), which requires
				an insurer to file an affirmative action plan upon the violation of a cease and
				desist order issued by the commissioner after hearing.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:32 and
				  22:33 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 17 - Regulation Number 45-Filing of Affirmative Action Plans › Section XIII-1703 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation applies to any insurer that is called for hearing before the
				commissioner for violating Chapter 1, Part I, Subpart C of the Insurance Code
				(Equal Opportunity in Insurance) and found to be in violation of a cease and
				desist order issued in accordance with the provisions of
				R.S.
				22:33(A). It sets forth the
				minimum content and procedures for the filing of an affirmative action plan by
				an insurer who violates Chapter 1, Part I, Subpart C of the Insurance Code, and
				who then violates a cease and desist order issued by the commissioner after
				hearing.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:32 and
				  22:33 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 17 - Regulation Number 45-Filing of Affirmative Action Plans › Section XIII-1705 - Content and Procedure

Current through Register Vol. 50, No. 6, June 20, 2024
A. The
				commissioner shall notify an insurer of its violation of a cease and desist
				order issued pursuant to Chapter 1, Part I, Subpart C of the Insurance Code by
				certified U.S. mail, return receipt requested. Said notification shall also
				direct the insurer to file an affirmative action plan.
B. The notice shall require the insurer to
				file its plan within 20 days of receipt of the notice.
C. The insurer shall file its plan by means
				of the U.S. mail, and it shall contain the minimum requirements stated in
				R.S. 22:33(C)(4)(a) and
				(b).
D. The insurer shall address the plan to the
				attention of the Division of Diversity and Opportunity.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:32 and
				  22:33 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 17 - Regulation Number 45-Filing of Affirmative Action Plans › Section XIII-1707 - Effective Date

Current through Register Vol. 50, No. 6, June 20, 2024
A. This
				regulation shall become effective upon final promulgation in the
Louisiana Register.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:11,
				  22:32 and
				  22:33 and
				  the Administrative Procedure Act,
				  R.S.
				  49:950 et
				  seq.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1901 - Purpose

Current through Register Vol. 50, No. 6, June 20, 2024
A. The purpose of
				this regulation is to implement R.S. 22:1181-1191, Long-Term Care Insurance
				Act, to promote the public interest; to promote the availability of long-term
				care insurance coverage; to protect applicants for long-term care insurance, as
				defined, from unfair or deceptive sales or enrollment practices; to facilitate
				public understanding and comparison of long-term care insurance coverages; and
				to facilitate flexibility and innovation in the development of long-term care
				insurance.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1903 - Applicability and Scope

Current through Register Vol. 50, No. 6, June 20, 2024
A. Except
				as otherwise specifically provided, this regulation 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 on or after February 20, 2005, by insurers;
				fraternal benefit societies; nonprofit health, hospital and medical service
				corporations; prepaid health plans; health maintenance organizations; and all
				similar organizations to the extent they are authorized to issue life or health
				insurance. Certain provisions of this regulation apply only to qualified
				long-term care insurance contracts as noted. Renewal policies shall comply with
				this regulation as amended.
B.
				Additionally, this regulation is intended to apply to policies having indemnity
				benefits that are triggered by activities of daily living and sold as
				disability income insurance, if:
1. the
				benefits of the disability income policy are dependent upon or vary in amount
				based on the receipt of long-term care services;
2. the disability income policy is
				advertised, marketed or offered as insurance for long-term care services;
				or
3. benefits under the policy may
				commence after the policyholder has reached Social Security's normal retirement
				age unless benefits are designed to replace lost income or pay for specific
				expenses other than long-term care services.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1909 - Policy Practices and Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Renewability. The terms
guaranteed renewable
and
noncancellable
shall not be used in any individual long-term care insurance policy without further explanatory language in accordance with the disclosure requirements of §1913 of this regulation.
1. A policy issued to an individual shall not contain renewal provisions other than guaranteed renewable or noncancellable.
2. The term
guaranteed renewable
may be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums and when the insurer has no unilateral right to make any change in any provision of the policy or rider while the insurance is in force, and cannot decline to renew, except that rates may be revised by the insurer on a class basis.
3. The term
noncancellable
may be used only when the insured has the right to continue the long-term care insurance in force by the timely payment of premiums, during which period the insurer has no right to unilaterally make any change in any provision of the insurance or in the premium rate.
4. The term
level premium
may only be used when the insurer does not have the right to change the premium.
5. In addition to the other requirements of §1909 A, a qualified long-term insurance contract shall be guaranteed renewable, within the meaning of Section  7702B(b)(1)(C) of the Internal Revenue Code of 1986, as amended.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1911 - Unintentional Lapse

Current through Register Vol. 50, No. 6, June 20, 2024
A. Each insurer
				offering long-term care insurance shall, as a protection against unintentional
				lapse, comply with the following.
1. Notice
				before Lapse or Termination
a. No individual
				long-term care policy or certificate shall be issued until the insurer has
				received from the applicant either a written designation of at least one
				person, in addition to the applicant, who is to receive notice of lapse or
				termination of the policy or certificate for nonpayment of premium or a written
				waiver, dated and signed by the applicant, electing not to designate additional
				persons to receive notice. The applicant has the right to designate at least
				one person who is to receive the notice of termination, in addition to the
				insured. Designation shall not constitute acceptance of any liability on the
				third party for services provided to the insured. The form used for the written
				designation must provide space clearly designated for listing at least one
				person. The designation shall include each person's full name and home address.
				In the case of an applicant who elects not to designate an additional person,
				the waiver shall state:
"Protection against unintended lapse. I understand that I
				  have the right to designate at least one person other than myself to receive
				  notice of lapse or termination of this long-term care insurance policy for
				  nonpayment of premium. I understand that notice will not be given until 30 days
				  after a premium is due and unpaid. I elect NOT to designate a person to receive
				  this notice."
b. The
				insurer shall notify the insured of the right to change this written
				designation, no less often than once every two years.
c. When the policyholder or certificateholder
				pays premium for a long-term care insurance policy or certificate through a
				payroll or pension deduction plan, the requirements contained in §1911. A.1.a need not be met until 60 days after the policyholder or certificateholder is no
				longer on such a payment plan. The application or enrollment form for such
				policies or certificates shall clearly indicate the payment plan selected by
				the applicant.
d. Lapse or
				Termination for Nonpayment of Premium. No individual long-term care policy or
				certificate shall lapse or be terminated for nonpayment of premium unless the
				insurer, at least 30 days before the effective date of the lapse or
				termination, has given notice to the insured and to those persons designated
				pursuant to §1911. A.1 a, at the address provided by the insured for purposes
				of receiving notice of lapse or termination. Notice shall be given by first
				class United States mail, postage prepaid; and notice may not be given until 30
				days after a premium is due and unpaid. Notice shall be deemed to have been
				given as of five days after the date of mailing.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1913 - Required Disclosure Provisions

Current through Register Vol. 50, No. 6, June 20, 2024
A. Renewability. Individual long-term care
				insurance policies shall contain a renewability provision.
1. The provision shall be appropriately
				captioned, shall appear on the first page of the policy, and shall clearly
				state that the coverage is guaranteed renewable or noncancellable. This
				provision shall not apply to policies which do not contain a renewability
				provision, and under which the right to nonrenew is reserved solely to the
				policyholder.
2. A long-term care
				insurance policy or certificate, other than one where the insurer does not have
				the right to change the premium, shall include a statement that premium rates
				may change.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1915 - Required Disclosure of Rating Practices to Consumers

Current through Register Vol. 50, No. 6, June 20, 2024
A. This Section shall apply as follows.
1. Except as provided in §1915. A 2,
				§1915 applies to any long-term care
				policy or certificate issued in this state on or after August 19,
				2005.
2. For certificates issued on
				or after the effective date of this amended regulation under a
group
				long-term care insurance policy
as defined in
				R.S.
				22:1184(4), which policy was
				in force at the time this amended regulation became effective, the provisions
				of §1915 shall apply
				on the policy anniversary following February 19, 2006.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1919 - Requirements to Offer Inflation Protection

Current through Register Vol. 50, No. 6, June 20, 2024
A. No insurer may offer a long-term care
				insurance policy unless the insurer also offers to the policyholder, in
				addition to any other inflation protection, the option to purchase a policy
				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.
				Insurers must offer to each policyholder, at the time of purchase, the option
				to purchase a policy with an inflation protection feature no less favorable
				than one of the following:
1. increases
				benefit levels annually in a manner so that the increases are compounded
				annually at a rate not less than 5 percent;
2. guarantees the insured individual the
				right to periodically increase benefit levels without providing evidence of
				insurability or health status, so long as the option for the previous period
				has not been declined. The amount of the additional 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 percent for the period beginning
				with the purchase of the existing benefit and extending until the year in which
				the offer is made; or
3. covers a
				specified percentage of actual or reasonable charges and does not include a
				maximum specified indemnity amount or limit.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1921 - Prohibition against Post-Claim Underwriting (Formerly section 1915)

Current through Register Vol. 50, No. 6, June 20, 2024
A. All applications
				for long-term care insurance policies or certificates, except those which are
				guaranteed issue, shall contain clear and unambiguous questions designed to
				ascertain the health condition of the applicant.
B.
1. If an
				application for long-term care insurance contains a question which asks whether
				the applicant has had medication prescribed by a physician, it must also ask
				the applicant to list the medication that has been prescribed.
2. If the medications listed in such
				application were known by the insurer, or should have been known at the time of
				application, to be directly related to a medical condition for which coverage
				would otherwise be denied, then the policy or certificate shall not be
				rescinded for that condition.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1923 - Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies (Formerly section 1917)

Current through Register Vol. 50, No. 6, June 20, 2024
A. A long-term care insurance policy or
				certificate shall not, if it provides benefits for home health care or
				community care services, limit or exclude benefits:
1. by requiring that the insured or claimant
				would need care in a skilled nursing facility if home health care services were
				not provided;
2. by requiring that
				the insured or claimant first, or simultaneously, receive nursing or
				therapeutic services, or both, in a home, community, or institutional setting
				before home health care services are covered;
3. by limiting eligible services to services
				provided by registered nurses or licensed practical nurses;
4. by requiring that a nurse or therapist
				provide services covered by the policy that can be provided by a home health
				aide, or other licensed or certified home care worker acting within the scope
				of his or her licensure or certification;
5. by excluding coverage for personal care
				services provided by a home health aide;
6. by requiring that the provision of home
				health care services be at a level of certification or licensure greater than
				that required by the eligible service;
7. by requiring that the insured or claimant
				have an acute condition before home health care services are covered;
8. by limiting benefits to services provided
				by Medicare-certified agencies or providers;
9. by excluding coverage for adult day care
				services.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1925 - Requirements for Application Forms and Replacement Coverage (Formerly section 1921)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Application
				forms shall include the following questions designed 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 accident and
				sickness or long-term care policy or certificate presently in force. A
				supplementary application or other form to be signed by the applicant and
				producer, except where the coverage is sold without a producer, containing such
				questions may be used. With regard to a replacement policy issued to a group
				defined by
				R.S.
				22:1184(4)(a), the following
				questions may be modified only to the extent necessary to elicit information
				about health or long-term care insurance policies other than the group policy
				being replaced, provided that 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 (certificate)?
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1927 - Reporting Requirements (Formerly section 1921)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every insurer shall maintain records for
				each producer of that producer's amount of replacement sales as a percentage of
				the producer's total annual sales and the amount of lapses of long-term care
				insurance policies sold by the producer as a percentage of the producer's total
				annual sales.
B. Each insurer shall
				report annually, by June 30, the 10 percent of its producers with the greatest
				percentages of lapses and replacements, as measured by §1927. A (§1969,
				Appendix G).
C. Reported
				replacement and lapse rates do not alone constitute a violation of insurance
				laws or necessarily imply wrongdoing. The reports are for the purpose of
				reviewing more closely producer activities regarding the sale of long-term care
				insurance.
D. Every insurer shall
				report annually, by June 30, the number of lapsed policies as a percentage of
				its total annual sales and as a percentage of its total number of policies in
				force as of the end of the preceding calendar year (§1969, Appendix
				G).
E. Every insurer shall report
				annually, by June 30, the number of replacement policies sold as a percentage
				of its total annual sales and as a percentage of its total number of policies
				in force as of the preceding calendar year (§1969, Appendix G).
F. Every insurer shall report annually, by
				June 30, for qualified long-term care insurance contracts, the number of claims
				denied for each class of business, expressed as a percentage of claims denied
				(§1969, Appendix E).
G. For
				purposes of §1927:
1.
policy
means only long-term care insurance; and
2. subject to §1927. G 3,
claim
means a request for a payment of benefits under an in
				force policy regardless of whether the benefit claimed is covered under the
				policy or any terms or conditions of the policy have been met;
3.
denied
means the insurer
				refuses to pay a claim for any reason other than for claims not paid for
				failure to meet the waiting period or because of an applicable preexisting
				condition; and
4.
report
means on a statewide basis.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1929 - Licensing (Formerly section 1925)

Current through Register Vol. 50, No. 6, June 20, 2024
A. A producer is not authorized to market,
				sell, solicit, or negotiate with respect to long-term care except as authorized
				by
				R.S.
				22:1543 and
				R.S. 22:1547(A)(1) and
				(2).
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1931 - Discretionary Powers of Commissioner (former Section 1927)

Current through Register Vol. 50, No. 6, June 20, 2024
A. The commissioner may, upon written request
				and after an administrative hearing, issue an order to modify or suspend a
				specific provision or provisions of this regulation with respect to a specific
				long-term care insurance policy or certificate upon a written finding that:
1. the modification or suspension would be in
				the best interest of the insureds;
2. the purposes to be achieved could not be
				effectively or efficiently achieved without the modification or suspension;
				and
3.
a. the modification or suspension is
				necessary to the development of an innovative and reasonable approach for
				insuring long-term care; or
b. the
				policy or certificate is to be issued to residents of a life care or continuing
				care retirement community or some other residential community for the elderly
				and the modification or suspension is reasonably related to the special needs
				or nature of such a community; or
c. the modification or suspension is
				necessary to permit long-term care insurance to be sold as part of, or in
				conjunction with, another insurance product.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1933 - Reserve Standards (Formerly section 1929)

Current through Register Vol. 50, No. 6, June 20, 2024
A. When long-term care benefits are provided
				through the acceleration of benefits under group or individual life policies or
				riders to such policies, policy reserves for the benefits shall be determined
				in accordance with
				R.S.
				22:751,
				R.S.
				22:752, and
				R.S.
				22:753. Claim reserves shall also be
				established in the case when the policy or rider is in claim status.
B. Reserves for policies and riders subject
				to §1933. B should be based on the multiple decrement model, utilizing all
				relevant decrements except for voluntary termination rates. Single decrement
				approximations are acceptable if the calculation produces essentially similar
				reserves, if the reserve is clearly more conservative, or if the reserve is
				immaterial. The calculations may take into account the reduction in life
				insurance benefits due to the payment of long-term care benefits. However, in
				no event shall the reserves for the long-term care benefit and the life
				insurance benefit be less than the reserves for the life insurance benefit,
				assuming no long-term care benefit.
C.
1. In
				the development and calculation of reserves for policies and riders subject to
				§1933 C, due regard shall be given to the applicable policy provisions,
				marketing methods, administrative procedures, and all other considerations
				which have an impact on projected claim costs including, but not limited to,
				the following:
a. definition of insured
				events;
b. covered long-term care
				facilities;
c. existence of home
				convalescence care coverage;
d.
				definition of facilities;
e.
				existence or absence of barriers to eligibility;
f. premium waiver provision;
g. renewability;
h. ability to raise premiums;
i. marketing method;
j. underwriting procedures;
k. claims adjustment procedures;
l. waiting period;
m. maximum benefit;
n. availability of eligible
				facilities;
o. margins in claim
				costs;
p. optional nature of
				benefit;
q. delay in eligibility
				for benefit;
r. inflation
				protection provisions; and
s.
				guaranteed insurability option.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1935 - Loss Ratio (Formerly section 1931)

Current through Register Vol. 50, No. 6, June 20, 2024
A. This Section shall apply to all long-term
				care insurance policies or certificates except those covered under §1917,
				§1937, and §1939
B. Benefits
				under long-term care insurance policies shall be deemed reasonable in relation
				to premiums, provided the expected loss ratio is at least 60 percent,
				calculated in a manner which provides for adequate reserving of the long-term
				care insurance risk. In evaluating the expected loss ratio, due consideration
				shall be given to 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.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1937 - Premium Rate Schedule Increases

Current through Register Vol. 50, No. 6, June 20, 2024
A.
				This Section shall apply as follows.
1.
				Except as provided in §1937. A 2,
				§1937 applies to any long-term care
				policy or certificate issued in this state on or after August 19, 2005 and
				prior to January 1, 2018.
2. For
				certificates issued on or after the effective date of this amended regulation
				under a group long-term care insurance policy as defined in
				R.S.
				22:1184(4)(a), which policy
				was in force at the time this amended regulation became effective, the
				provisions of
				§1937 shall apply on the policy
				anniversary following February 19, 2006.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1939 - Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings

Current through Register Vol. 50, No. 6, June 20, 2024
A.
									Section
				1939 shall apply as follows.
1. Except as provided in §1939. A 2,
				§1939 applies to any long-term care
				policy or certificate issued in this state on or after January 1,
				2018.
2. For certificates issued on
				or after the effective date of this amended regulation under a group long-term
				care insurance policy as defined in
				R.S.
				22:1184(4)(a), which policy
				was in force at the time this amended regulation became effective, the
				provisions of
				§1939 shall apply on the policy anniversary
				following January 1, 2018.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1941 - Filing Requirement (Formerly section 1939)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Prior to a long-term care insurer or other
				similar organization offering group long-term care insurance to a resident of
				this state, pursuant to
				R.S.
				22:1185, it shall file with the commissioner
				evidence that the group meets the requirements of
				R.S.
				22:1184(4)(d); and such
				insurers shall file for approval any group policy or certificate to be offered
				to residents of this state, regardless of from where it was issued or
				delivered.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1943 - Filing Requirements for Advertising (Formerly section 1941)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every insurer,
				health care service plan, or other entity providing long-term care insurance or
				benefits in this state shall provide a copy of any long-term care insurance
				advertisement intended for use in this state, whether through written, radio,
				or television medium, to the commissioner of insurance of this state for review
				or approval by the commissioner to the extent it may be required under state
				law. In addition, all advertisements shall be retained by the insurer, health
				care service plan, or other entity for at least three years from the date the
				advertisement was first used.
B.
				The commissioner may exempt from these requirements any advertising form or
				material when, in the commissioner's opinion, this requirement may not be
				reasonably applied.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1945 - Standards for Marketing (Formerly section 1943)

Current through Register Vol. 50, No. 6, June 20, 2024
A. Every insurer, health care service plan,
				or other entity marketing long-term care insurance coverage in this state,
				directly or through its producers, shall:
1.
				establish marketing procedures and producer training requirements to assure
				that:
a. any marketing activities, including
				any comparison of policies by its producers or other producers will be fair and
				accurate; and
b. excessive
				insurance is not sold or issued;
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1947 - Suitability (Formerly section 1945)

Current through Register Vol. 50, No. 6, June 20, 2024
A.
									Section
				1947 shall not apply to life insurance
				policies that accelerate benefits for long-term care.
B. Every insurer, health care service plan,
				or other entity marketing long-term care insurance (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 producers
				in the use of its suitability standards; and
3. maintain a copy of its suitability
				standards and make them available for inspection, upon request, by the
				commissioner.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1949 - Prohibition against Pre-Existing Conditions and Probationary Periods in Replacement Policies or Certificates (Formerly section 1947)

Current through Register Vol. 50, No. 6, June 20, 2024
A. If a long-term
				care insurance policy or certificate replaces another long-term care policy or
				certificate, the replacing insurer shall waive any time periods applicable to
				pre-existing conditions and probationary periods in the new long-term care
				policy for similar benefits, to the extent that similar exclusions have been
				satisfied under the original policy.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1951 - Availability of New Services or Providers

Current through Register Vol. 50, No. 6, June 20, 2024
A. An insurer shall notify policyholders of
				the availability of a new long-term care policy series that provides coverage
				for new long-term care services or 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 that the new policy series is
				made available for sale in this state.
B. Notwithstanding §1951. A above,
				notification is not required for any policy issued prior to the effective date
				of §1951 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 insureds 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
				§1951 if the program is filed with and
				approved by the commissioner.
Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1953 - Right to Reduce Coverage and Lower Premiums

Current through Register Vol. 50, No. 6, June 20, 2024
A.
1. 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:
a. reducing the maximum benefits;
				or
b. reducing the daily, weekly or
				monthly benefit amount.