Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-83 - Long-term care insurance rules › Section 284-83-190 - Potential rate increase disclosure form

Current through Register Vol. 24-14, July 15, 2024
The following form must be used in this state to disclose a
				potential rate increase.
Instructions:
This form provides information to the applicant regarding
				premium rate schedules, rate schedule adjustments, potential rate revisions,
				and policyholder options in the event of a rate increase.
Issuers must provide all of the following information to
				the applicant:
Long-Term Care Insurance
Potential Rate Increase Disclosure Form
1.
[Premium Rate] [Premium Rate
			 Schedules]:
[Premium rate] [Premium rate schedules] that [is][are]
			 applicable to you and that will be in effect until a request is made and
			 [filed] for an increase [is][are] [on the application][$]
2.
The [premium] [premium rate schedule]
			 for this policy [will be shown on the schedule page of] [will be attached to]
			 your policy.
3.
Rate
			 Schedule Adjustments:
The company will provide a description of when premium rate or
				rate schedule adjustments will be effective (e.g., next anniversary date, next
				billing date, etc.) (fill in the blank):.
4.
Potential Rate Revisions:
This Policy is Guaranteed Renewable.
This means
				that the rates for this product may be increased in the future. Your rates
				CANNOT be increased due to your increasing age or declining health, but your
				rates may go up based on the experience of all policyholders with a policy
				similar to yours.
If you receive a premium rate or premium rate schedule
				increase in the future, you will be notified of the new premium amount and you
				will be able to exercise at least one of the following options:
. Pay the increased premium and continue your policy in force
				as is.
. Reduce your policy benefits to a level such that your
				premiums will not increase. (Subject to state law minimum standards.)
. Exercise your nonforfeiture option if purchased. (This option
				is available for purchase for an additional premium.)
. Exercise your contingent nonforfeiture rights.* (This option
				may be available if you do not purchase a separate nonforfeiture
				option.)
*Contingent Nonforfeiture
If the premium rate for your policy goes up in the future and
				you didn't buy a nonforfeiture option, you may be eligible for contingent
				nonforfeiture. Here's how to tell if you are eligible:
You will keep some long-term care insurance coverage,
				if:
Your premium after the increase exceeds your original premium
				by the percentage shown (or more) in the following table; and
You lapse (not pay more premiums) within 120 days of the
				increase.
The amount of coverage (i.e., new lifetime maximum benefit
				amount) you will keep will equal the total amount of premiums you've paid since
				your policy was first issued. If you have already received benefits under the
				policy, so that the remaining maximum benefit amount is less than the total
				amount of premiums you've paid, the amount of coverage will be that remaining
				amount.
Except for this reduced lifetime maximum benefit amount, all
				other policy benefits will remain at the levels attained at the time of the
				lapse and will not increase thereafter.
Should you choose this Contingent Nonforfeiture option, your
				policy, with this reduced maximum benefit amount, will be considered "paid-up"
				with no further premiums due.
Example:
You bought the policy at age 65 and paid the $1,000 annual
				premium for 10 years, so you have paid a total of $10,000 in premium.
In the eleventh year, you receive a rate increase of 50%, or
				$500 for a new annual premium of $1,500, and you decide to lapse the policy
				(not pay any more premiums).
Your "paid-up" policy benefits are $10,000 (provided you have a
				least $10,000 of benefits remaining under your policy.)
Contingent Nonforfeiture
Cumulative Premium Increase Over Initial
							 Premium
That qualifies for Contingent
							 Nonforfeiture
(Percentage increase is cumulative from date of
							 original issue. It does NOT represent a one-time increase.)
Issue Age
Percent Increase Over Initial
							 Premium
29 and under
200%
30-34
190%
35-39
170%
40-44
150%
45-49
130%
50-54
110%
55-59
90%
60
70%
61
66%
62
62%
63
58%
64
54%
65
50%
66
48%
67
46%
68
44%
69
42%
70
40%
71
38%
72
36%
73
34%
74
32%
75
30%
76
28%
77
26%
78
24%
79
22%
80
20%
81
19%
82
18%
83
17%
84
16%
85
15%
86
14%
87
13%
88
12%
89
11%
90 and over
10%
[The following contingent nonforfeiture disclosure need only be
				included for those limited pay policies to which WAC
				284-83-130(4)(d) and
				(f)  are applicable.]
In addition to the contingent nonforfeiture benefits described
				above, the following reduced "paid-up" contingent nonforfeiture benefit is an
				option in all policies that have a fixed or limited premium payment period,
				even if you selected a nonforfeiture benefit when you bought your policy. If
				both the reduced "paid-up" benefit AND the contingent benefit described above
				are triggered by the same rate increase, you can choose either of the two
				benefits.
You are eligible for the reduced "paid-up" contingent
				nonforfeiture benefit when all three conditions shown below are met:
1.The premium you are required to pay after
			 the increase exceeds your original premium by the same percentage or more shown
			 in the chart below;
Triggers for a Substantial Premium Increase
Issue Age
Percent Increase Over Initial Premium
Under 65
50%
65-80
30%
Over 80
10%
2.You
			 stop paying your premiums within 120 days of when the premium increase took
			 effect;
AND
3.The ratio of the
			 number of months you already paid premiums is 40% or more than the number of
			 months you originally agreed to pay.
If you exercise this option, your coverage will be converted to
				reduced "paid-up" status. That means there will be no additional premiums
				required. Your benefits will change in the following ways:
a.The total lifetime amount of benefits your
			 reduced paid up policy will provide can be determined by multiplying 90% of the
			 lifetime benefit amount at the time the policy becomes paid up by the ratio of
			 the number of months you already paid premiums to the number of months you
			 agreed to pay them.
b.The daily
			 benefit amounts you purchased will also be adjusted by the same ratio.
If you purchased lifetime benefits, only the daily benefit
				amounts you purchased will be adjusted by the applicable ratio.