reglab/statecodes huggingface dataset:
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.6 - Policy Practices and Provisions

Current through Register Vol. 48, No. 6, June 28, 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 Section 9 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
			 this Subsection, a qualified long term care insurance contract shall be
			 guaranteed renewable, within the meaning of Section 7702B (b)(1)(C) of the
			 Internal Revenue Code of 1986, as amended.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.8 - Required Disclosure Provisions

Current through Register Vol. 48, No. 6, June 28, 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 that 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.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.9 - Required Disclosure of Rating Practices to Consumers

Current through Register Vol. 48, No. 6, June 28, 2024
A. This Section shall apply as follows:
(1) Except as provided in Paragraph (2) of
			 this Subsection, this Section applies to any long term care policy or
			 certificate issued in this state on or after 6 months from the effective date
			 of this Regulation.
(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 Section
			 4E(1) of this Regulation which policy
			 was in force at the time this amended regulation became effective, the
			 provisions of this Section shall apply on the policy anniversary following one
			 year from the effective date of this Regulation.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.10 - Initial Filing Requirements

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 This Section applies to any long term care policy issued in this state on or
			 after six months from the effective date of this Regulation.
B. An insurer shall provide the information
			 listed in this Subsection to the Director thirty (30) days prior to making a
			 long term care insurance form available for sale.
(1) A copy of the disclosure documents
			 required in Section
			 9 of this Regulation; and
(2) An actuarial certification consisting of
			 at least the following:
(a) A statement that
			 the initial premium rate schedule is sufficient to cover anticipated costs
			 under moderately adverse experience and that the premium rate schedule is
			 reasonably expected to be sustainable over the life of the form with no future
			 premium increases anticipated;
(b)
			 A statement that the policy design and coverage provided have been reviewed and
			 taken into consideration;
(c) A
			 statement that the underwriting and claims adjudication processes have been
			 reviewed and taken into consideration;
(d) A complete description of the basis for
			 contract reserves that are anticipated to be held under the form, to include:
(i) Sufficient detail or sample calculations
			 provided so as to have a complete depiction of the reserve amounts to be
			 held;
(ii) A statement that the
			 assumptions used for reserves contain reasonable margins for adverse
			 experience;
(iii) A statement that
			 the net valuation premium for renewal years does not increase (except for
			 attained-age rating where permitted); and
(iv) A statement that the difference between
			 the gross premium and the net valuation premium for renewal years is sufficient
			 to cover expected renewal expenses; or if such a statement cannot be made, a
			 complete description of the situations where this does not occur;
(I) An aggregate distribution of anticipated
			 issues may be used as long as the underlying gross premiums maintain a
			 reasonably consistent relationship;
(II) If the gross premiums for certain age
			 groups appear to be inconsistent with this requirement, the Director may
			 request a demonstration under Subsection C based on a standard age
			 distribution; and
(e)
(i) A
			 statement that the premium rate schedule is not less than the premium rate
			 schedule for existing similar policy forms also available from the insurer
			 except for reasonable differences attributable to benefits; or
(ii) A comparison of the premium schedules
			 for similar policy forms that are currently available from the insurer with an
			 explanation of the differences.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.11 - Prohibition Against Post-Claims Underwriting

Current through Register Vol. 48, No. 6, June 28, 2024
A. All applications for long term care
			 insurance policies or certificates except those that 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 that 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 the
			 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.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.12 - Minimum Standards for Home Health and Community Care Benefits in Long Term Care Insurance Policies

Current through Register Vol. 48, No. 6, June 28, 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; or
(9) By excluding coverage for adult day care
			 services.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.13 - Requirement to Offer Inflation Protection

Current through Register Vol. 48, No. 6, June 28, 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 five percent (5%);
(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 five percent (5%) for the period beginning with
			 the purchase of the existing benefit and extending until the year in which the
			 offer is made;
(3) Covers a
			 specified percentage of actual or reasonable charges and does not include a
			 maximum specified indemnity amount or limit.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.14 - Requirements for Application Forms and Replacement Coverage

Current through Register Vol. 48, No. 6, June 28, 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 agent, except where
			 the coverage is sold without an agent, containing the questions may be used.
			 With regard to a replacement policy issued to a group as defined in Section
			 4E(1) of this Regulation, 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
			 certificate holder 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 twelve (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]?
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.15 - Reporting Requirements

Current through Register Vol. 48, No. 6, June 28, 2024
A. Every
			 insurer shall maintain records for each agent of that agent's amount of
			 replacement sales as a percent of the agent's total annual sales and the amount
			 of lapses of long term care insurance policies sold by the agent as a percent
			 of the agent's total annual sales.
B. Every insurer shall report annually by
			 June 30 the ten percent (10%) of its agents with the greatest percentages of
			 lapses and replacements as measured by Subsection A above. (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 agent 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 percent of its
			 total annual sales and as a percent of its total number of policies in force as
			 of the end of the preceding calendar year. (Appendix G)
E. Every insurer shall report annually by
			 June 30 the number of replacement policies sold as a percent of its total
			 annual sales and as a percent of its total number of policies in force as of
			 the preceding calendar year. (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.
			 (Appendix E).
G. For purposes of
			 this Section:
(1) "Policy" means only long
			 term care insurance;
(2) Subject to
			 Paragraph (3) in this Subsection, "claim" means a request for 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.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.16 - Licensing

Current through Register Vol. 48, No. 6, June 28, 2024
A producer is not authorized to sell, solicit or negotiate with
				respect to long term care insurance except as authorized by S.C. Code Section
				38-43-10
				et seq.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.17 - Powers of Director

Current through Register Vol. 48, No. 6, June 28, 2024
The Director may, upon written request, waive or grant an
				exemption to a specific provision or provisions of this regulation with respect
				to a specific long term care insurance policy or certificate upon a finding
				that:
A. The modification or
			 suspension would be in the best interest of the insureds;
B. The purposes to be achieved could not be
			 effectively or efficiently achieved without the modification or suspension;
			 and
C.
(1) The modification or suspension is
			 necessary to the development of an innovative and reasonable approach for
			 insuring long term care; or
(2) 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
(3) 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.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.18 - Reserve Standards

Current through Register Vol. 48, No. 6, June 28, 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 S.C. Code Section
			 38-9-180.
			 Claim reserves shall also be established in the case when the policy or rider
			 is in claim status. Reserves for policies and riders subject to this Subsection
			 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. In the development and calculation of
			 reserves for policies and riders subject to this Subsection, 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:
(1) Definition of insured events;
(2) Covered long term care
			 facilities;
(3) Existence of home
			 convalescence care coverage;
(4)
			 Definition of facilities;
(5)
			 Existence or absence of barriers to eligibility;
(6) Premium waiver provision;
(7) Renewability;
(8) Ability to raise premiums;
(9) Marketing method;
(10) Underwriting procedures;
(11) Claims adjustment procedures;
(12) Waiting period;
(13) Maximum benefit;
(14) Availability of eligible
			 facilities;
(15) Margins in claim
			 costs;
(16) Optional nature of
			 benefit;
(17) Delay in eligibility
			 for benefit;
(18) Inflation
			 protection provisions; and
(19)
			 Guaranteed insurability option.
Any applicable valuation morbidity table shall be certified as
				appropriate as a statutory valuation table by a member of the American Academy
				of Actuaries.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.19 - Loss Ratio

Current through Register Vol. 48, No. 6, June 28, 2024
A. This Section
			 shall apply to all long term care insurance policies or certificates except
			 those covered under Sections
			 10 and 20.
B. Benefits under long term care insurance
			 policies shall be deemed reasonable in relation to premiums provided the
			 expected loss ratio is at least sixty percent (60%), 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.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.20 - Premium Rate Schedule Increases

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 This Section shall apply as follows:
(1)
			 Except as provided in Paragraph (2), this Section applies to any long term care
			 policy or certificate issued in this state on or after July 1, 2010.
(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 Section
			 4E(1) of this Regulation, which policy
			 was in force at the time this amended regulation became effective, the
			 provisions of this Section shall apply on the policy anniversary following
			 January 1, 2011.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.21 - Filing Requirement

Current through Register Vol. 48, No. 6, June 28, 2024
Prior to an insurer or similar organization offering group long
				term care insurance to a resident of this state pursuant to S.C. Code Section
				38-72-50,
				it shall file with the Director evidence that the group policy or certificate
				thereunder has been approved by a state having statutory or regulatory long
				term care insurance requirements substantially similar to those adopted in this
				state.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.22 - Filing Requirements for Advertising

Current through Register Vol. 48, No. 6, June 28, 2024
A. Every insurer, health care service plan or
			 other entity providing long term care insurance or benefits in this state shall
			 file a copy of any long term care insurance advertisement intended for use in
			 this state whether through written, radio or television medium to the Director
			 of Insurance of this state for review and approval by the Director 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 (3) years from the date the advertisement was first
			 used.
B. The Director may exempt
			 from these requirements any advertising form or material when, in the
			 Director's opinion, this requirement may not be reasonably applied.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.23 - Standards for Marketing

Current through Register Vol. 48, No. 6, June 28, 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 agent
			 training requirements to assure that:
(a) Any
			 marketing activities, including any comparison of policies, by its agents or
			 other producers will be fair and accurate; and
(b) Excessive insurance is not sold or
			 issued.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.24 - Suitability

Current through Register Vol. 48, No. 6, June 28, 2024
A. This Section
			 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 agents 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 Director.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.25 - Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates

Current through Register Vol. 48, No. 6, June 28, 2024
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 preexisting 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.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.26 - Availability of New Services or Providers

Current through Register Vol. 48, No. 6, June 28, 2024
A. An insurer shall notify policyholders of
			 the availability of a new long term 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 twelve (12) months of the date that the new policy series is
			 made available for sale in this state.
B. Notwithstanding Subsection A above,
			 notification is not required for any policy issued prior to the effective date
			 of this Regulation or to any policyholder or certificate holder 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 insured's
			 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 this Section if the program is filed with
			 and approved by the Director.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.27 - Right to Reduce Coverage and Lower Premiums

Current through Register Vol. 48, No. 6, June 28, 2024
A.
(1)
			 Every long term care insurance policy and certificate shall include a provision
			 that allows the policyholder or certificate holder to reduce coverage and lower
			 the policy or certificate premium in at least one of the following ways:
(a) Reducing the maximum benefit;
			 or
(b) Reducing the daily, weekly
			 or monthly benefit amount.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.28 - Nonforfeiture Benefit Requirement

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 This Section does not apply to life insurance policies or riders containing
			 accelerated long term care benefits.
B. To comply with the requirement to offer a
			 nonforfeiture benefit pursuant to the provisions of S.C. Code Section
			 38-72-67:
(1) A policy or certificate offered with
			 nonforfeiture benefits shall have coverage elements, eligibility, benefit
			 triggers and benefit length that are the same as coverage to be issued without
			 nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
			 be the benefit described in Subsection E; and
(2) The offer shall be in writing if the
			 nonforfeiture benefit is not otherwise described in the Outline of Coverage or
			 other materials given to the prospective policyholder.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.29 - Standards for Benefit Triggers

Current through Register Vol. 48, No. 6, June 28, 2024
A.
			 A long term care insurance policy shall condition the payment of benefits on a
			 determination of the insured's ability to perform activities of daily living
			 and on cognitive impairment. Eligibility for the payment of benefits shall not
			 be more restrictive than requiring either a deficiency in the ability to
			 perform not more than three (3) of the activities of daily living or the
			 presence of cognitive impairment.
B.
(1)
			 Activities of daily living shall include at least the following as defined in
			 Section
			 5 and in the policy:
(a) Bathing;
(b) Continence;
(c) Dressing;
(d) Eating;
(e) Toileting; and
(f) Transferring;
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.30 - Additional Standards for Benefit Triggers for Qualified Long Term Care Insurance Contracts

Current through Register Vol. 48, No. 6, June 28, 2024
A. For
			 purposes of this Section the following definitions apply:
(1) "Qualified long term care services" means
			 services that meet the requirements of Section 7702(c)(1) of the Internal
			 Revenue Code of 1986, as amended, as follows: necessary diagnostic, preventive,
			 therapeutic, curative, treatment, mitigation and rehabilitative services, and
			 maintenance or personal care services which are required by a chronically ill
			 individual, and are provided pursuant to a plan of care prescribed by a
			 licensed health care practitioner.
(2)
(a)
			 "Chronically ill individual" has the meaning prescribed for this term by
			 Section 7702B(c)(2) of the Internal Revenue Code of 1986, as amended. Under
			 this provision, a chronically ill individual means any individual who has been
			 certified by a licensed health care practitioner as:
(i) Being unable to perform (without
			 substantial assistance from another individual) at least two (2) activities of
			 daily living for a period of at least ninety (90) days due to a loss of
			 functional capacity; or
(ii)
			 Requiring substantial supervision to protect the individual from threats to
			 health and safety due to severe cognitive impairment.
(b) The term "chronically ill individual"
			 shall not include an individual otherwise meeting these requirements unless
			 within the preceding twelve-month period a licensed health care practitioner
			 has certified that the individual meets these requirements.
(3) "Licensed health care
			 practitioner" means a physician, as defined in Section 1861(r)(1) of the Social
			 Security Act, a registered professional nurse, licensed social worker or other
			 individual who meets requirements prescribed by the Secretary of the
			 Treasury.
(4) "Maintenance or
			 personal care services" means any care the primary purpose of which is the
			 provision of needed assistance with any of the disabilities as a result of
			 which the individual is a chronically ill individual (including the protection
			 from threats to health and safety due to severe cognitive
			 impairment).
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.32 - Requirement to Deliver Shopper's Guide

Current through Register Vol. 48, No. 6, June 28, 2024
A. A long term care insurance shopper's guide
			 in the format developed by the National Association of Insurance Commissioners,
			 or a guide developed or approved by the Director, shall be provided to all
			 prospective applicants of a long term care insurance policy or certificate.
(1) In the case of agent solicitations, an
			 agent must deliver the shopper's guide prior to the presentation of an
			 application or enrollment form.
(2)
			 In the case of direct response solicitations, the shopper's guide must be
			 presented in conjunction with any application or enrollment form.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Section 69-44.33 - Penalties

Current through Register Vol. 48, No. 6, June 28, 2024
In addition to any other penalties provided by the laws of this
				state any insurer and any agent found to have violated any requirement of this
				state relating to the regulation of long term care insurance or the marketing
				of such insurance shall be subject to a fine of up to three (3) times the
				amount of any commissions paid for each policy involved in the violation or up
				to $10,000, whichever is greater.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Appendix A

Current through Register Vol. 48, No. 6, June 28, 2024
RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE
				STATE OF __________ FOR THE REPORTING YEAR 20[ ]
Company Name:___
Address:___ ___
Phone Number:___
Due: March 1 annually
Instructions:
The purpose of this form is to report all rescissions of long
				term care insurance policies or certificates. Those rescissions voluntarily
				effectuated by an insured are not required to be included in this report.
				Please furnish one form per rescission.
Policy Policy and Name of Date of Date/s Date of
Form # Certificate Insured Policy Claim/s Rescission
# Issuance Submitted
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Detailed reason for rescission:___ ___ ___ ___
__________
Signature
__________
Name and Title (please type)
__________
Date
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Appendix D - Long Term Care Insurance Suitability Letter

Current through Register Vol. 48, No. 6, June 28, 2024
Dear [Applicant]:
Your recent application for long term care insurance included a
				"personal worksheet," which asked questions about your finances and your
				reasons for buying long term care insurance. For your protection, state law
				requires us to consider this information when we review your application, to
				avoid selling a policy to those who may not need coverage.
[Your answers indicate that long term care insurance may not
				meet your financial needs. We suggest that you review the information provided
				along with your application, including the booklet "Shopper's Guide to Long
				Term Care Insurance" and the page titled "Things You Should Know Before Buying
				Long Term Care Insurance." Your state insurance department also has information
				about long term care insurance and may be able to refer you to a counselor free
				of charge who can help you decide whether to buy this policy.]
[You chose not to provide any financial information for us to
				review.]
[Note: Choose the paragraph that applies.]
We have suspended our final review of your application. If,
				after careful consideration, you still believe this policy is what you want,
				check the appropriate box below and return this letter to us within the next 60
				days. We will then continue reviewing your application and issue a policy if
				you meet our medical standards.
If we do not hear from you within the next 60 days, we will
				close your file and not issue you a policy. You should understand that you will
				not have any coverage until we hear back from you, approve your application and
				issue you a policy.
Please check one box and return in the enclosed
				envelope.
[ ] Yes, [although my worksheet indicates that long term care
				insurance may not be a suitable purchase,] I wish to purchase this coverage.
				Please resume review of my application.
[Note: Delete the phrase in brackets if the applicant did not
				answer the questions about income.]
[ ] No. I have decided not to buy a policy at this time.
________________________________________________________________________
APPLICANT'S SIGNATURE DATE
Please return to [issuer] at [address] by [date].
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Appendix E - Claims Denial Reporting Form

Current through Register Vol. 48, No. 6, June 28, 2024
Long Term Care Insurance
For the State of __________
For the Reporting Year of __________
Company Name: __________Due: June 30 annually
Company Address: ___ ___
Company NAIC Number: ___
Contact Person: __________Phone Number: __________
Line of Business: Individual Group
Instructions
The purpose of this form is to report all long term care claim
				denials under in force long term care insurance policies. "Denied" means a
				claim that is not paid for any reason other than for claims not paid for
				failure to meet the waiting period or because of an applicable preexisting
				condition.
State Data
Nationwide Data [FN1]
1 Total Number of Long Term Care Claims
							 Reported
2 Total Number of Long Term Care Claims Denied/Not
							 Paid
3 Number of Claims Not Paid due to Preexisting
							 Condition Exclusion
4 Number of Claims Not Paid due to Waiting
							 (Elimination) Period Not Met
5 Net Number of Long Term Care Claims Denied for
							 Reporting Purposes (Line 2 Minus Line 3 Minus Line 4)
6 Percentage of Long Term Care Claims Denied of Those
							 Reported (Line 5 Divided By Line 1)
7 Number of Long Term Care Claim Denied due
							 to:
8 Long Term Care Services Not Covered under the
							 Policy [FN2]
9 Provider/Facility Not Qualified under the Policy
							 [FN3]
10 Benefit Eligibility Criteria Not Met [FN4]
11 Other
[FN1]. The nationwide data may be viewed as a more
							 representative and credible indicator where the data for claims reported and
							 denied for your state are small in number.
[FN2]. Example--home health care claim filed under a
							 nursing home only policy.
[FN3]. Example--a facility that does not meet the
							 minimum level of care requirements or the licensing requirements as outlined in
							 the policy.
[FN4]. Examples--a benefit trigger not met,
							 certification by a licensed health care practitioner not provided, no plan of
							 care.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Subchapter 69-44 - LONG TERM CARE INSURANCE › Appendix G - Long Term Care Insurance

Current through Register Vol. 48, No. 6, June 28, 2024
Replacement and Lapse Reporting Form
For the State of __________For the Reporting Year of
				__________
Company Name: __________Due: June 30 annually
Company Address: __________Company NAIC Number:
				__________
Contact Person: __________Phone Number:
				(__________)__________
Instructions
The purpose of this form is to report on a statewide basis
				information regarding long term care insurance policy replacements and lapses.
				Specifically, every insurer shall maintain records for each agent on that
				agent's amount of long term care insurance replacement sales as a percent of
				the agent's total annual sales and the amount of lapses of long term care
				insurance policies sold by the agent as a percent of the agent's total annual
				sales. The tables below should be used to report the ten percent (10%) of the
				insurer's agents with the greatest percentages of replacements and
				lapses.
Listing of the 10% of Agents with the Greatest Percentage of
				Replacements
Agent's Name
Number of Policies Sold By This Agent
Number of Policies Replaced By This Agent
Number of Replacements As % of Number Sold By This
							 Agent
Listing of the 10% of Agents with the Greatest Percentage of
				Lapses
Agent's Name
Number of Policies Sold By This Agent
Number of Policies Lapsed By This Agent
Number of Lapses As % of Number Sold By This
							 Agent
Company Totals
Percentage of Replacement Policies Sold to Total Annual Sales
				__________%
Percentage of Replacement Policies Sold to Policies In Force
				(as of the end of the preceding calendar year) __________%
Percentage of Lapsed Policies to Total Annual Sales
				__________%
Percentage of Lapsed Policies to Policies In Force (as of the
				end of the preceding calendar year)__________%
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Section 69-45 - Data Reporting and Determination of Excess Profits

Current through Register Vol. 48, No. 6, June 28, 2024
Section 1. Purpose.
The purpose of this regulation is to provide standards for both
			 the reporting of the loss and expense experience data required by South
			 Carolina Code Section
			 38-13-300
			 (1976), as amended, as well as for the determination of the calculation of
			 excess profits required by South Carolina Code Sections
			 38-73-1100
			 and
			 38-73-1110
			 (1976), as amended.
Section
		  2. Data Reporting.
South Carolina Code Section
			 38-13-300
			 requires that all licensed property or casualty insurers record and report to
			 the Chief Insurance Commissioner, loss and expense experience and any other
			 data which may be necessary to determine that rates are not excessive,
			 inadequate or unfairly discriminatory.
The loss and expense experience report required by this
			 regulation and Section
			 38-13-300
			 shall be used, in addition to the supplemental report required by Section
			 38-13-310,
			 and any other data which the Commissioner may find necessary, to determine
			 whether an insurer has, pursuant to the provisions of Section
			 38-73-1100
			 and Section
			 38-73-1110,
			 earned an aggregate operating profit in excess of a reasonable amount.
Section 3. Determination of Excess
		  Profits.
(A) Procedure.
If the Commissioner determines that an insurer writing property,
			 casualty, surety, marine, title or allied lines of insurance in South Carolina
			 has earned an aggregate operating profit in excess of either
			 15% of earned premiums or 25% of the
			 average policyholder surplus over a five-year period, he may:
(1) Order a general reduction in the rates
		  applicable to such line(s) which will reduce the operating profit to a
		  reasonable amount; and
(2) Order a
		  prorata refund of any excessive or unreasonable operating profits, with
		  interest.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Section 69-48 - Life And Health Reinsurance Agreements

Current through Register Vol. 48, No. 6, June 28, 2024
Section I. Preamble.
A. The South Carolina Department of Insurance
		  recognizes that licensed insurers routinely enter into reinsurance agreements
		  that yield legitimate relief to the ceding insurer from strain to
		  surplus.
B. However, it is improper
		  for a licensed insurer, in the capacity of ceding insurer, to enter into
		  reinsurance agreements for the principal purpose of producing significant
		  surplus aid for the ceding insurer, typically on a temporary basis, while not
		  transferring all of the significant risks inherent in the business being
		  reinsured. In substance or effect, the expected potential liability to the
		  ceding insurer remains basically unchanged by the reinsurance transaction,
		  notwithstanding certain risk elements in the reinsurance agreement, such as
		  catastrophic mortality or extraordinary survival. The terms of such agreements
		  referred to herein and described in Section III violate:
1. Statutory provisions relating to financial
		  statements which do not properly reflect the financial condition of the ceding
		  insurer;
2. Statutory provisions
		  relating to reinsurance reserve credits, thus resulting in a ceding insurer
		  improperly reducing liabilities or establishing assets for reinsurance ceded;
		  and
3. Statutory provisions
		  relating to creating a situation that may be hazardous to policyholders and the
		  people of this State.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Section 69-50 - Continuing Insurance Education

Current through Register Vol. 48, No. 6, June 28, 2024
I. Purpose
The purpose of this regulation is to establish rules and
			 standards which shall apply to continuing insurance education for individuals
			 qualified or licensed to act as insurance producers in this State.
II. Scope
A. The rules contained in this regulation
		  shall apply to all individuals qualified or licensed to act as insurance
		  producers in this State, except:
1. Limited
		  line insurance producers;
2.
		  Limited line credit insurance producers; and
3. Nonresident producers who have
		  successfully satisfied continuing insurance education requirements of their
		  resident state, regardless of the requirements of that other state.
South Carolina Code of Regulations › Chapter 69 - DEPARTMENT OF INSURANCE › Section 69-52 - Actuarial Opinion And Memorandum Regulation

Current through Register Vol. 48, No. 6, June 28, 2024
Section
		  I. Purpose
The purpose of this regulation is to prescribe:
A. Requirements for statements of actuarial
		  opinion that are to be submitted in accordance with Section
		  38-9-180
		  of the Code of Laws of South Carolina (hereinafter "Standard Valuation Law"),
		  and for memoranda in support thereof;
B. Rules applicable to the appointment of an
		  appointed actuary; and
C. Guidance
		  as to the meaning of "adequacy of reserves."