Rhode Island Code of Regulations › Title 230 - Department of Business Regulation › Chapter 20 - Insurance › Subchapter 35 - Long Term Care Insurance › Part 1 - Long Term Care Insurance (formerly Insurance Regulation 44) › Section 230-RICR-20-35-1.4 - Definitions

Current through June 14, 2024
A. For the purpose of this Part, the terms
				  "long-term care insurance," "qualified long-term care insurance," "group long
				  term care insurance," "applicant," "policy" and "certificate" shall have the
				  meanings set forth in R.I. Gen. Laws §
										27-34.2-4. In addition, the
				  following definitions shall apply:
1.
				  "Benefit trigger," for the purposes of independent review, means a contractual
				  provision in the insured's policy of long-term care insurance conditioning the
				  payment of benefits on a determination of the insured's 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 (26 U.S.C. §
												7702B), as
				  amended, "benefit trigger" shall include a determination by a licensed health
				  care practitioner that an insured is a chronically ill individual.
2. "Director" means the Director of the
				  Department of Business Regulation or his or her designee.
3. "Exceptional increase" means
a. only those increases filed by an issuer as
				  exceptional for which the Director determines the need for the premium rate
				  increase is justified:
(1) Due to changes in
				  laws or regulations applicable to long-term care coverage in this state;
				  or
(2) Due to increased and
				  unexpected utilization that affects the majority of issuers of similar
				  products.
b. Except as
				  provided in §§
												1.20  and  1.20.1   of this Part, exceptional increases are
				  subject to the same requirements as other premium rate schedule
				  increase
c. The Director 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 Director, in
				  determining that the necessary basis for an exceptional increase exists, shall
				  also determine any potential offsets to higher claims costs.
4. "Incidental," as used in
				  §§
											1.20(J)  and  1.20.1(J)   of this Part, means that the value of the
				  long-term care benefits provided is less than ten percent (10%) 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.
5. "Licensed health care professional" means
				  an individual qualified by education and experience in an appropriate field, to
				  determine, by record review, an insured's actual functional or cognitive
				  impairment.
6. "Qualified actuary"
				  means a member in good standing of the American Academy of Actuaries.
7. "Similar policy forms" means all of the
				  long-term care insurance policies and certificates issued by an issuer in the
				  same long-term care benefit classification as the policy form being considered.
				  Certificates of groups that meet the definition in R.I. Gen. Laws §
											27-34.2-4(4)(i)
				  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.