Rules and Regulations of the State of Georgia
 

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  • 1. In the address bar, type about:config and press Enter.
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  1. On web browser menu click "Tools" and select "Internet Options"
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<xmp>.</xmp> <form name="form1" method="post" action="120-2-16?urlRedirected=yes&amp;data=admin&amp;lookingfor=120-2-16" id="form1"> <input type="hidden" name="__VIEWSTATE" id="__VIEWSTATE" value="/wEPDwUKLTY5ODkwOTM2Nw8WAh4Ec3BhbQIKFgJmD2QWAgIFDw8WAh4EVGV4dAUFNSArIDVkZGSLsqnETRpIWPQ0Te8t6JiB6wp5Ug==" /> <input type="hidden" name="__VIEWSTATEGENERATOR" id="__VIEWSTATEGENERATOR" value="EEBB6393" /> <input type="hidden" name="__EVENTVALIDATION" id="__EVENTVALIDATION" value="/wEWCAKY2cnnBALniKOhBALV5cpNAoa5iIEFAoznisYGAsrv5u0MAsrv4u0MAsrv3u0MV/WZoM3kl9kSeD/Ok/+Z6kBj4Jo=" /> <div class='popup'> <div class='cnt223'> <div style="margin-bottom:6px;"> <img alt="Rules and Regulations of the State of Georgia" src="/images/new.gif"/> </div> <div class="header"> Terms and Conditions of Agreement for Access to Rules and Regulations of the State of Georgia Website </div> <div class="scroll"> <p>(Note: certain features of this site have been disabled for the general public to prevent digital piracy. If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree that you will not copy, print, or download anything from this website for any commercial use. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website.</p> <p> You agree that you will not sell, will not license, and will not otherwise make available in exchange for anything of value, anything that you download, print, or copy from this site.</p> <p> You agree that you will not copy, print, or download any portion of the regulations posted on this site exceeding a single chapter of regulations for sale, license, or other transfer to a third party, except that you may quote a reasonable portion of the regulations in the course of rendering professional advice.</p> <p> If you violate this agreement, or if you access or use this website in violation of this agreement, you agree that Lawriter will suffer damages of at least $20,000. </p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." THE STATE OF GEORGIA AND LAWRITER EXPRESSLY DISCLAIM ALL WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT AND ARE NOT LIABLE TO ANY PERSON FOR ANY ERRORS IN INACCURACIES CONTAINED IN THIS WEBSITE. </p> <p> If you accept these terms enter the information below and click “I AGREE”.</p> </div> <table border="0" style="width: 810px"> <tr> </tr> <tr> <td style="vertical-align: text-top; width: 243px;"> Full Name:</td> <td style="width: 532px; vertical-align:super;"> <input name="firstName" type="text" id="firstName" class="txt" /> <span id="lbl_fname"><font color="Red"></font></span> </td> </tr> <tr><td style="width: 243px"> Human verification: <b> <span id="lblStopSpam">5 + 5</span>&nbsp;= </b></td><td style="width: 532px"> <input name="captcha" type="text" id="captcha" class="txt" /> <span id="lbl_captcha"><font color="Red"></font></span> &nbsp; <input name="sum" type="hidden" id="sum" value="10" /> </td></tr> </table> <input type="submit" name="Button1" value="I AGREE" id="Button1" disabled="disabled" /> <span id="alrtmsg"><font color="Red"></font></span> <input name="v1" type="hidden" id="v1" /> <input name="v2" type="hidden" id="v2" /> <input name="v3" type="hidden" id="v3" /> <p>Privacy Policy: the above information is for internal use only as related to this agreement and will not be sold or distributed.</p> </div> </div> </form> <html> <head runat="server"> <title>GA - GAC</title> <link href="_files/main.css" media="all" rel="Stylesheet" type="text/css" /> <link href="_files/treeview_old.css" media="all" rel="Stylesheet" type="text/css" /> <link href="/_files/popup.css" media="all" rel="stylesheet" type="text/css" /> <script type="text/javascript" src="/_files/treeview.js"></script> <script type="text/javascript" src="/_files/jquery-1.8.0.min.js"></script> <script type="text/javascript" src="/_files/jquery-1.10.2.js"></script> <script type="text/javascript" src="/_files/popup.js"></script> <script type="text/javascript" src="http://code.jquery.com/jquery-1.8.2.js"></script> <script type="text/javascript" src="https://ajax.googleapis.com/ajax/libs/jquery/1.8/jquery.min.js" /> <script type="text/javascript" src="/_files/jquery.popup.js"></script> <script type="text/javascript" src="/_files/jquery.popup.min.js"></script> <script type="text/javascript" src="/_files/ValidateForm.js"></script> <script src="https://code.jquery.com/jquery-1.11.3.js"></script> <link href="/_files/enablejs.css" rel="Stylesheet" type="text/css" /> <link href="/_files/forJavascript.css" rel="Stylesheet" type="text/css" /> <style type="text/css"> .collapse{background-image:url('/images/expcoll_right.png');} .expand{background-image:url('/images/expcoll_down.png');} </style> <script type="text/javascript"> $(document).ready(function(){ $("#History-parent").click(function(){ $("#History-Childs").toggle(); if ($('#History-parent img').hasClass('expand')) { $('#History-parent img').addClass('collapse'); $('#History-parent img').removeClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_right.png'); } else { $('#History-parent img').removeClass('collapse'); $('#History-parent img').addClass('expand'); $('#History-parent img').attr('src', '/images/expcoll_down.png'); } }); $("#History-Childs").hide(); var tocnode=document.getElementById('toc-children'); if (tocnode != null) { if(tocnode.childNodes.length != 0) { document.getElementById("doc-content").style.width="72%"; document.getElementById("toc").style.width="21%"; document.getElementById("toc").style.padding="10px"; } else { document.getElementById('toc').style.display="none"; } } }); function fnsetRDVal(id) { if (id=="y") { document.getElementById("y").value="yes" document.getElementById("n").value="" } else { document.getElementById("n").value="no" document.getElementById("y").value="" } } </script> <script type="text/javascript"> function TermsCon() { var overlay = $('<div id="overlay"></div>'); overlay.show(); overlay.appendTo(document.body); $('.popup2').show(); $('#btnAgree').click(function () { $('.popup2').hide(); $("#overlay").hide(); overlay.appendTo(document.body).remove(); }); $("#btnprint").click(function () { var contents = $("#popupterms").html(); var frame1 = $('<iframe />'); frame1[0].name = "frame1"; frame1.css({ "position": "absolute", "top": "-1000000px" }); $("body").append(frame1); var frameDoc = frame1[0].contentWindow ? 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If you are an entitled government entity pursuant the Georgia Administrative Procedures Act, <a target="_new" href="http://links.casemakerlegal.com/states/GA/books/Code_of_Georgia/browse?ci=25id=gasos&amp;codesec=50-13-7&amp;title=50&amp;#50-13-7(d)">O.C.G.A.§ 50-13-7(d)</a> contact the State of Georgia's Administrative Procedures Division at 678-364-3785 to enable these features for your location.)</p> <p>To access this website, you must agree to the following: </p> <p> These terms of use are a contract between you and/or your employer (if any), and Lawriter, LLC. </p> <p> You agree not to use any web crawler, scraper, or other robot or automated program or device to obtain data from the website. </p> <p> You agree that you will not sell or license anything that you download, print, or copy from this website.</p> <p> THIS WEBSITE AND ITS CONTENT ARE PROVIDED "AS IS." 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Chapter 33-42, 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.</P> <h2><a href="/GAC/120-2-16-.02" name="120-2-16-.02" title="120-2-16-.02">Rule 120-2-16-.02 Authority</a></h2> <P>This regulation is issued pursuant to the authority vested in the Commissioner under O.C.G.A. Sections <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-2-9&amp;title=33#" target="_newtab">33-2-9</a> and <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-7&amp;title=33#" target="_newtab">33-42-7</a>.</P> <h2><a href="/GAC/120-2-16-.03" name="120-2-16-.03" title="120-2-16-.03">Rule 120-2-16-.03 Applicability and Scope</a></h2> <P>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 the effective date by insurers; fraternal benefit societies; nonprofit health, nonprofit hospital and medical service corporations; healthcare plans; health maintenance organizations and all similar organizations. Certain provisions of this Regulation apply only to qualified long-term care insurance contracts as noted.</P> <P>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:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.03(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The benefits of the disability income policy are dependent upon or vary in amount based on the receipt of long-term care services;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.03(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The disability income policy is advertised, marketed or offered as insurance for long-term care services; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.03(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.04" name="120-2-16-.04" title="120-2-16-.04">Rule 120-2-16-.04 Definitions</a></h2> <P>For the purpose of this Regulation, the terms "long-term care insurance," "qualified long-term care insurance," "group long-term care insurance," "Commissioner," "applicant," "policy" and "certificate" shall have the meanings set forth in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>. In addition, the following definitions apply:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Exceptional increase" means only those increases filed by an insurer as exceptional for which the Commissioner determines the need for the premium rate increase is justified: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Due to changes in laws or regulations applicable to long-term care coverage in this state; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Due to increased and unexpected utilization that affects the majority of insurers of similar products.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as provided in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.20, exceptional increases are subject to the same requirements as other premium rate schedule increases.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner may request a review by an independent actuary or a professional actuarial body of the basis for a request that an increase be considered an exceptional increase.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner, in determining that the necessary basis for an exceptional increase exists, shall also determine any potential offsets to higher claims costs.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Incidental," as used in subsection (10) of Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.20, 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Qualified actuary" means a member in good standing of the American Academy of Actuaries.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.04(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Similar policy forms" means all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered. Certificates of groups that meet the definition in paragraph (4) of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> are not considered similar to certificates or policies otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications. For purposes of determining similar policy forms, long-term care benefit classifications are defined as follows: institutional long-term care benefits only, non-institutional long-term care benefits only, or comprehensive long-term care benefits.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.05" name="120-2-16-.05" title="120-2-16-.05">Rule 120-2-16-.05 Policy Definitions</a></h2> <P>No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Activities of daily living" means at least bathing, continence, dressing, eating, toileting and transferring.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Acute condition" means that the individual is medically unstable. Such an individual requires frequent monitoring by medical professionals, such as physicians and registered nurses, in order to maintain his or her health status.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Adult day care" means a program for six or more individuals, of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Bathing" means washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Cognitive impairment" means a deficiency in a person's short or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Continence" means the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Dressing" means putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Eating" means feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Hands-on assistance" means physical assistance (minimal, moderate or maximal) without which the individual would not be able to perform the activity of daily living.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(10)">(10)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Home health care services" means medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(11)">(11)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Medicare" means "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(12)">(12)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Mental or nervous disorder" shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(13)">(13)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Personal care" means the provision of hands-on services to assist an individual with activities of daily living.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(14)">(14)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Skilled nursing care," "personal care," "home care," "specialized care," "assisted living care" and other services shall be defined in relation to the level of skill required, the nature of the care and the setting in which care must be delivered.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(15)">(15)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(16)">(16)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Transferring" means moving into or out of a bed, chair or wheelchair.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.05(17)">(17)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All providers of services, including but not limited to "skilled nursing facility," "extended care facility," "convalescent nursing home," "personal care facility," "specialized care providers," "assisted living facility," and "home care agency" shall be defined in relation to the services and facilities required to be available and the licensure, certification, registration or degree status of those providing or supervising the services. When the definition requires that the provider be appropriately licensed, certified or registered, it shall also state what requirements a provider must meet in lieu of licensure, certification or registration when the state in which the service is to be furnished does not require a provider of these services to be licensed, certified or registered, or when the state licenses, certifies or registers the provider of services under another name.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.06" name="120-2-16-.06" title="120-2-16-.06">Rule 120-2-16-.06 Policy Practices and Provisions</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 <a title="120-2-16" href="120-2-16">120-2-16</a>-.09 of this Regulation: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A policy issued to an individual shall not contain renewal provisions other than "guaranteed renewable" or "noncancellable."</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The term "level premium" may only be used when the insurer does not have the right to change the premium.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Limitations and Exclusions. A policy may not be delivered or issued for delivery in this state as long-term care insurance if the policy limits or excludes coverage by type of illness, treatment, medical condition or accident, except as follows: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Preexisting conditions or diseases;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Mental or nervous disorders; however, this shall not permit exclusion or limitation of benefits on the basis of Alzheimer's Disease;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Alcoholism and drug addiction;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Illness, treatment or medical condition arising out of: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(d)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> War or act of war (whether declared or undeclared);</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(d)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Participation in a felony, riot or insurrection;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(d)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Service in the armed forces or units auxiliary thereto;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(d)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Suicide (sane or insane), attempted suicide or intentionally self-inflicted injury; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(d)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Aviation (this exclusion applies only to non-fare-paying passengers).</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Treatment provided in a government facility (unless otherwise required by law), services for which benefits are available under Medicare or other governmental program (except Medicaid), any state or federal workers' compensation, employer's liability or occupational disease law, or any motor vehicle no-fault law, services provided by a member of the covered person's immediate family and services for which no charge is normally made in the absence of insurance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Expenses for services or items available or paid under another long-term care insurance or health insurance policy;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the case of a qualified long-term care insurance contract, expenses for services or items to the extent that the expenses are reimbursable under Title XVIII of the Social Security Act or would be so reimbursable but for the application of a deductible or coinsurance amount.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(h)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This subparagraph is not intended to prohibit exclusions and limitations by type of provider. However, no long-term care issuer may deny a claim because services are provided in a state other than the state of policy issued under the following conditions: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(h)(i)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> When the state other than the state of policy issue does not have the provider licensing, certification or registration required in the policy, but where the provider satisfies the policy requirements outlined for providers in lieu of licensure, certification or registration; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(h)(i)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> When the state other than the state of policy issue licenses, certifies or registers the provider under another name.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(h)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of this subparagraph, "state of policy issue" means the state in which the individual policy or certificate was originally issued.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(2)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This subsection is not intended to prohibit territorial limitations.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Extension of Benefits. Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if the institutionalization began while the long-term care insurance was in force and continues without interruption after termination. The extension of benefits beyond the period the long-term care insurance was in force may be limited to the duration of the benefit period, if any, or to payment of the maximum benefits and may be subject to any policy waiting period, and all other applicable provisions of the policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Continuation or Conversion. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Group long-term care insurance issued in this state on or after the effective date of this section shall provide covered individuals with a basis for continuation or conversion of coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For the purposes of this subsection, "a basis for continuation of coverage" means a policy provision that maintains coverage under the existing group policy when the coverage would otherwise terminate and which is subject only to the continued timely payment of premium when due. Group policies that restrict provision of benefits and services to, or contain incentives to use certain providers or facilities may provide continuation benefits that are substantially equivalent to the benefits of the existing group policy. The Commissioner shall make a determination as to the substantial equivalency of benefits, and in doing so, shall take into consideration the differences between managed care and non-managed care plans, including, but not limited to, provider system arrangements, service availability, benefit levels and administrative complexity.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For the purposes of this subsection, "a basis for conversion of coverage" means a policy provision that an individual whose coverage under the group policy would otherwise terminate or has been terminated for any reason, including discontinuance of the group policy in its entirety or with respect to an insured class, and who has been continuously insured under the group policy (and any group policy which it replaced), for at least six months immediately prior to termination, shall be entitled to the issuance of a converted policy by the insurer under whose group policy he or she is covered, without evidence of insurability.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For the purposes of this subsection, "converted policy" means an individual policy of long-term care insurance providing benefits identical to or benefits determined by the Commissioner to be substantially equivalent to or in excess of those provided under the group policy from which conversion is made. Where the group policy from which conversion is made restricts provision of benefits and services to, or contains incentives to use certain providers or facilities, the Commissioner, in making a determination as to the substantial equivalency of benefits, shall take into consideration the differences between managed care and non-managed care plans, including, but not limited to, provider system arrangements, service availability, benefit levels and administrative complexity.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Written application for the converted policy shall be made and the first premium due, if any, shall be paid as directed by the insurer not later than 31 days after termination of coverage under the group policy. The converted policy shall be issued effective on the day following the termination of coverage under the group policy, and shall be renewable annually.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Unless the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age at inception of coverage under the group policy from which conversion is made. Where the group policy from which conversion is made replaced previous group coverage, the premium for the converted policy shall be calculated on the basis of the insured's age at inception of coverage under the group policy replaced.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Continuation of coverage or issuance of a converted policy shall be mandatory, except where: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(g)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Termination of group coverage resulted from an individual's failure to make any required payment of premium or contribution when due; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(g)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The terminating coverage is replaced not later than thirty-one (31) days after termination, by group coverage effective on the day following the termination of coverage: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(g)(ii)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Providing benefits identical to or benefits determined by the Commissioner to be substantially equivalent to or in excess of those provided by the terminating coverage; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(g)(ii)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The premium for which is calculated in a manner consistent with the requirements of subparagraph (f) of this paragraph.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding any other provision of this Section, a converted policy issued to an individual who at the time of conversion is covered by another long-term care insurance policy that provides benefits on the basis of incurred expenses, may contain a provision that results in a reduction of benefits payable if the benefits provided under the additional coverage, together with the full benefits provided by the converted policy, would result in payment of more than 100 percent of incurred expenses. The provision shall only be included in the converted policy if the converted policy also provides for a premium decrease or refund which reflects the reduction in benefits payable.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The converted policy may provide that the benefits payable under the converted policy, together with the benefits payable under the group policy from which conversion is made, shall not exceed those that would have been payable had the individual's coverage under the group policy remained in force and effect.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(j)">(j)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding any other provision of this Section, an insured individual whose eligibility for group long-term care coverage is based upon his or her relationship to another person shall be entitled to continuation of coverage under the group policy upon termination of the qualifying relationship by death or dissolution of marriage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(4)(k)">(k)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For the purposes of this Section a "managed-care plan" is a health care or assisted living arrangement designed to coordinate patient care or control costs through utilization review, case management or use of specific provider networks.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Discontinuance and Replacement. <P>If a group long-term care policy is replaced by another group long-term care policy issued to the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the previous group policy on its date of termination. Coverage provided or offered to individuals by the insurer and premiums charged to persons under the new group policy:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(5)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Shall not result in an exclusion for preexisting conditions that would have been covered under the group policy being replaced; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(5)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Shall not vary or otherwise depend on the individual's health or disability status, claim experience or use of long-term care services.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(6)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The premium charged to an insured shall not increase due to either: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(6)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The increasing age of the insured at ages beyond 65; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(6)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The duration the insured has been covered under the policy.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(6)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The purchase of additional coverage shall not be considered a premium rate increase, but for purposes of the calculation required under Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.26, the portion of the premium attributable to the additional coverage shall be added to and considered part of the initial annual premium.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(6)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A reduction in benefits shall not be considered a premium change, but for purpose of the calculation required under Section <a title="120-2-16" href="120-2-16">120-2-16</a>-26, the initial annual premium shall be based on the reduced benefits.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Electronic Enrollment for Group Policies. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(7)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the case of a group defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>, any requirement that a signature of an insured be obtained by an agent or insurer shall be deemed satisfied if: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(7)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The consent is obtained by telephonic or electronic enrollment by the group policyholder or insurer. A verification of enrollment information shall be provided to the enrollee;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(7)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The telephonic or electronic enrollment provides necessary and reasonable safeguards to assure the accuracy, retention and prompt retrieval of records; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(7)(a)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The telephonic or electronic enrollment provides necessary and reasonable safeguards to assure that the confidentiality of individually identifiable information and "privileged information" as defined by O.C.G.A. Chapter 33-39, is maintained.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.06(7)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer shall make available, upon request of the Commissioner, records that will demonstrate the insurer's ability to confirm enrollment and coverage amounts.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.07" name="120-2-16-.07" title="120-2-16-.07">Rule 120-2-16-.07 Unintentional Lapse</a></h2> <P>Each insurer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.07(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.07(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notice before lapse or termination. 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 <I>full name</I> and <I>home address</I>. 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." The insurer shall notify the insured of the right to change this written designation, no less often than once every 2 years.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.07(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 paragraph (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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.07(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 paragraph (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 5 days after the date of mailing.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.07(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Reinstatement. In addition to the requirement in subsection (1), a long-term care insurance policy or certificate shall include a provision that provides for reinstatement of coverage, in the event of lapse if the insurer is provided proof that the policyholder or certificateholder was cognitively impaired or had a loss of functional capacity before the grace period contained in the policy expired. This option shall be available to the insured if requested within 5 months after termination and shall allow for the collection of past due premium, where appropriate. The standard of proof of cognitive impairment or loss of functional capacity shall not be more stringent than the benefit eligibility criteria on cognitive impairment or the loss of functional capacity contained in the policy and certificate.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.08" name="120-2-16-.08" title="120-2-16-.08">Rule 120-2-16-.08 Required Disclosure Provisions</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Renewability. Individual long-term care insurance policies shall contain a renewability provision. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Riders and Endorsements. Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to an individual long-term care insurance policy after date of issue or at reinstatement or renewal that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the individual insured. After the date of policy issue, any rider or endorsement which increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing signed by the insured, except if the increased benefits or coverage are required by law. Where a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge shall be set forth in the policy, rider or endorsement.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Payment of Benefits. A long-term care insurance policy that provides for the payment of benefits based on standards described as "usual and customary," "reasonable and customary" or words of similar import shall include a definition of these terms and an explanation of the terms in its accompanying outline of coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Limitations. If a long-term care insurance policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate and shall be labeled as "Preexisting Condition Limitations."</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Other Limitations or Conditions on Eligibility for Benefits. A long-term care insurance policy or certificate containing any limitations or conditions for eligibility other than those prohibited in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#" target="_newtab">33-42-6</a> shall set forth a description of the limitations or conditions, including any required number of days of confinement, in a separate paragraph of the policy or certificate and shall label such paragraph "Limitations or Conditions on Eligibility for Benefits."</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Disclosure of Tax Consequences. With regard to life insurance policies that provide an accelerated benefit for long-term care, 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. This subsection shall not apply to qualified long-term care insurance contracts.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Benefit Triggers. Activities of daily living and cognitive impairment shall be used to measure an insured's need for long term care and shall be described in the policy or certificate in a separate paragraph and shall be labeled "Eligibility for the Payment of Benefits." Any additional benefit triggers shall also be explained in this section. If these triggers differ for different benefits, explanation of the trigger shall accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this too shall be specified.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A qualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as contained in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.31(5) that the policy is intended to be a qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.08(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A nonqualified long-term care insurance contract shall include a disclosure statement in the policy and in the outline of coverage as contained in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.31(5) that the policy is not intended to be a qualified long-term care insurance contract.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.09" name="120-2-16-.09" title="120-2-16-.09">Rule 120-2-16-.09 Required Disclosure of Rating Practices to Consumers</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section shall apply as follows: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as provided in paragraph (b), this section applies to any long-term care policy or certificate issued in this state on or after April 1, 2008.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For certificates issued on or after the effective date of this amended regulation under a group long-term care insurance policy as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>, 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 April 1, 2009.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Other than policies for which no applicable premium rate or rate schedule increases can be made, insurers shall provide all of the information listed in this subsection to the applicant at the time of application or enrollment, unless the method of application does not allow for delivery at that time. In such a case, an insurer shall provide all of the information listed in this section to the applicant no later than at the time of delivery of the policy or certificate: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the policy may be subject to rate increases in the future;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An explanation of potential future premium rate revisions, and the policyholder's or certificateholder's option in the event of a premium rate revision;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The premium rate or rate schedules applicable to the applicant that will be in effect until a request is made for an increase;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A general explanation for applying premium rate or rate schedule adjustments that shall include: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(d)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of when premium rate or rate schedule adjustments will be effective (e.g., next anniversary date, next billing date, etc.); and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(d)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The right to a revised premium rate or rate schedule as provided in paragraph (c) if the premium rate or rate schedule is changed;</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Information regarding each premium rate increase on this policy form or similar policy forms over the past 10 years for this state or any other state that, at a minimum, identifies: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(i)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy forms for which premium rates have been increased;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(i)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The calendar years when the form was available for purchase; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(i)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The amount or percent of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase, and may also be expressed as minimum and maximum percentages if the rate increase is variable by rating characteristics.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer may, in a fair manner, provide additional explanatory information related to the rate increases.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer shall have the right to exclude from the disclosure premium rate increases that only apply to blocks of business acquired from other nonaffiliated insurers or the long-term care policies acquired from other nonaffiliated insurers when those increases occurred prior to the acquisition.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If an acquiring insurer files for a rate increase on a long-term care policy form acquired from nonaffiliated insurers or a block of policy forms acquired from nonaffiliated insurers on or before the later of the effective date of this section or the end of a twenty-four-month period following the acquisition of the block or policies, the acquiring insurer may exclude that rate increase from the disclosure. However, the nonaffiliated selling company shall include the disclosure of that rate increase in accordance with subparagraph (i) of this paragraph.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(2)(e)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the acquiring insurer in subparagraph (iv) above files for a subsequent rate increase, even within the twenty-four-month period, on the same policy form acquired from nonaffiliated insurers or block of policy forms acquired from nonaffiliated insurers referenced in subparagraph (iv), the acquiring insurer shall make all disclosures required by paragraph (e), including disclosure of the earlier rate increase referenced in subparagraph (iv).</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An applicant shall sign an acknowledgement at the time of application, unless the method of application does not allow for signature at that time, that the insurer made the disclosure required under paragraphs (2)(a) and (2)(e). If due to the method of application the applicant cannot sign an acknowledgement at the time of application, the applicant shall signno later than at the time of delivery of the policy or certificate.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer shall use the forms in Appendices B and F to comply with the requirements of subsections (2) and (3) of this section.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.09(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer shall provide notice of an upcoming premium rate schedule increase to all policyholders or certificateholders, if applicable, at least 45 days prior to the implementation of the premium rate schedule increase by the insurer. The notice shall include the information required by subsection (2) when the rate increase is implemented.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.10" name="120-2-16-.10" title="120-2-16-.10">Rule 120-2-16-.10 Intial Filing Requirements</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section applies to any long-term care policy issued in this state on or after April 1, 2008.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer shall provide the information listed in this subsection to the Commissioner 30 days prior to making a long-term care insurance form available for sale. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A copy of the disclosure documents required in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.09; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An actuarial certification consisting of at least the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the policy design and coverage provided have been reviewed and taken into consideration;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the underwriting and claims adjudication processes have been reviewed and taken into consideration;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A complete description of the basis for contract reserves that are anticipated to be held under the form, to include: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Sufficient detail or sample calculations provided so as to have a complete depiction of the reserve amounts to be held;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the assumptions used for reserves contain reasonable margins for adverse experience;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that the net valuation premium for renewal years does not increase (except for attained-age rating where permitted); and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)(D)">(D)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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; <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)(D)(I)">(I)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An aggregate distribution of anticipated issues may be used as long as the underlying gross premiums maintain a reasonably consistent relationship;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(iv)(D)(II)">(II)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the gross premiums for certain age groups appear to be inconsistent with this requirement, the Commissioner may request a demonstration under subsection (3) based on a standard age distribution; and</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(v)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(2)(b)(v)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A comparison of the premium schedules for similar policy forms that are currently available from the insurer with an explanation of the differences.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner may request an actuarial demonstration that benefits are reasonable in relation to premiums. The actuarial demonstration shall include either premium and claim experience on similar policy forms, adjusted for any premium or benefit differences, relevant and credible data from other studies, or both.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.10(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event the Commissioner asks for additional information under this provision, the period in subsection (2) does not include the period during which the insurer is preparing the requested information.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.11" name="120-2-16-.11" title="120-2-16-.11">Rule 120-2-16-.11 Prohibition Against Post - Claims Underwriting</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except for policies or certificates which are guaranteed issue: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The following language shall be set out conspicuously and in close conjunction with the applicant's signature block on an application for a long-term care insurance policy or certificate: <P><B>Caution: If your answers on this application are incorrect or untrue, [company] has the right to deny benefits or rescind your policy.</B></P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The following language, or language substantially similar to the following, shall be set out conspicuously on the long-term care insurance policy or certificate at the time of delivery:</td> </tr> </table> <P><B>Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]</B></P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Prior to issuance of a long-term care policy or certificate to an applicant age 80 or older, the insurer shall obtain one of the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(c)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A report of a physical examination;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(c)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An assessment of functional capacity;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(c)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An attending physician's statement; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(3)(c)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Copies of medical records. </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A copy of the completed application or enrollment form (whichever is applicable) shall be delivered to the insured no later than at the time of delivery of the policy or certificate unless it was retained by the applicant at the time of application.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.11(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate rescissions, both state and countrywide, except those that the insured voluntarily effectuated and shall annually furnish this information to the Commissioner in the format prescribed by the National Association of Insurance Commissioners in Appendix A.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.12" name="120-2-16-.12" title="120-2-16-.12">Rule 120-2-16-.12 Minimum Standards for Home Health and Community Care Benefits in Long - Term Care Insurance Policies</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By requiring that the insured or claimant would need care in a skilled nursing facility if home health care services were not provided;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By limiting eligible services to services provided by registered nurses or licensed practical nurses;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By excluding coverage for personal care services provided by a home health aide;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By requiring that the insured or claimant have an acute condition before home health care services are covered;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By limiting benefits to services provided by Medicare-certified agencies or providers; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(1)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By excluding coverage for adult day care services.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A long-term care insurance policy or certificate, if it provides for home health or community care services, shall provide total home health or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, at the time covered home health or community care services are being received. This requirement shall not apply to policies or certificates issued to residents of continuing care retirement communities.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.12(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Home health care coverage may be applied to the nonhome health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.13" name="120-2-16-.13" title="120-2-16-.13">Rule 120-2-16-.13 Requirement to Offer Inflation Protection</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Increases benefit levels annually in a manner so that the increases are compounded annually at a rate not less than five percent (5%);</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Where the policy is issued to a group, the required offer in subsection (1) above shall be made to the group policyholder; except, if the policy is issued to a group defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> other than to a continuing care retirement community, the offering shall be made to each proposed certificateholder.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The offer in subsection (1) above shall not be required of life insurance policies or riders containing accelerated long-term care benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Insurers shall include the following information in or with the outline of coverage: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(4)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20 year period.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(4)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any expected premium increases or additional premiums to pay for automatic or optional benefit increases.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Inflation protection benefit increases under a policy which contains these benefits shall continue without regard to an insured's age, claim status or claim history, or the length of time the person has been insured under the policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An offer of inflation protection that provides for automatic benefit increases shall include an offer of a premium which the insurer expects to remain constant. The offer shall disclose in a conspicuous manner that the premium may change in the future unless the premium is guaranteed to remain constant.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(7)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Inflation protection as provided in paragraph (1)(a) of this section shall be included in a long-term care insurance policy unless an insurer obtains a rejection of inflation protection signed by the policyholder as required in this subsection. The rejection may be either in the application or on a separate form.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.13(7)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The rejection shall be considered a part of the application and shall state: <P>I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans ______, and I reject inflation protection.</P> </td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.14" name="120-2-16-.14" title="120-2-16-.14">Rule 120-2-16-.14 Requirements for Application Forms and Replacement Coverage</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 defined by O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</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. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Do you have another long-term care insurance policy or certificate in force (including health care service contract, health maintenance organization contract)?</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Did you have another long-term care insurance policy or certificate in force during the last 12 months? <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If so, with which company?</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If that policy lapsed, when did it lapse?</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Are you covered by Medicaid?</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Do you intend to replace any of your medical or health insurance coverage with this policy [certificate]?</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Agents shall list any other health insurance policies they have sold to the applicant. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> List policies sold that are still in force.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> List policies sold in the past 5 years that are no longer in force.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Solicitations Other than Direct Response. Upon determining that a sale will involve replacement, an insurer; other than an insurer using direct response solicitation methods, or its agent; shall furnish the applicant, prior to issuance or delivery of the individual long-term care insurance policy, a notice regarding replacement of accident and sickness or long-term care coverage. One copy of the notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer. The required notice shall be provided in the following manner:</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Direct Response Solicitations. Insurers using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy. The required notice shall be provided in the following manner:</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Where replacement is intended, the replacing insurer shall notify, in writing, the existing insurer of the proposed replacement. The existing policy shall be identified by the insurer, name of the insured and policy number or address including zip code. Notice shall be made within 5 working days from the date the application is received by the insurer or the date the policy is issued, whichever is sooner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Life insurance policies that accelerate benefits for long-term care shall comply with this section if the policy being replaced is a long-term care insurance policy. If the policy being replaced is a life insurance policy, the insurer shall comply with the replacement requirements of Chapter 120-2-24. If a life insurance policy that accelerates benefits for long-term care is replaced by another such policy, the replacing insurer shall comply with both the long-term care and the life insurance replacement requirements. <P><B>NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE</B></P> <P>[Insurance company's name and address]</P> <P>SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.</P> <P>According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing accident and sickness or long-term care insurance and replace it with an individual long-term care insurance policy to be issued by [company name] Insurance Company. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.</P> <P>You should review this new coverage carefully, comparing it with all accident and sickness or long-term care insurance coverage you now have, and terminate your present policy only if, after due consideration, you find that purchase of this long-term care coverage is a wise decision.</P> <P>STATEMENT TO APPLICANT BY AGENT [BROKER OR OTHER REPRESENTATIVE]:</P> <P>(Use additional sheets, as necessary.)</P> <P>I have reviewed your current medical or health insurance coverage. I believe the replacement of insurance involved in this transaction materially improves your position. My conclusion has taken into account the following considerations, which I call to your attention:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Health conditions that you may presently have (preexisting conditions), may not be immediately or fully covered under the new policy. This could result in denial or delay in payment of benefits under the new policy, whereas a similar claim might have been payable under your present policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> State law provides that your replacement policy or certificate may not contain new preexisting conditions or probationary periods. The insurer will waive any time periods applicable to preexisting conditions or probationary periods in the new policy (or coverage) for similar benefits to the extent such time was spent (depleted) under the original policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> If you are replacing existing long-term care insurance coverage, you may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)4.">4.</a></td> <td valign="top" style="text-align:left" class="leftalign"> If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before your sign it, reread it carefully to be certain that all information has been properly recorded. <P>(Signature of Agent, Broker or Other Representative)</P> <P>[Typed Name and Address of Agent or Broker]</P> <P>The above "Notice to Applicant" was delivered to me on:</P> <P>_____________________________ ______________________</P> <P>(Applicant's Signature) (Date)</P> </td> </tr> </table> <P><B>NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE</B></P> <P>[Insurance company's name and address]</P> <P>SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.</P> <P>According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing accident and sickness or long-term care insurance and replace it with the long-term care insurance policy delivered herewith issued by [company name] Insurance Company. Your new policy provides thirty (30) days within which you may decide, without cost, whether you desire to keep the policy. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.</P> <P>You should review this new coverage carefully, comparing it with all accident and sickness or long-term care insurance coverage you now have, and terminate your present policy only if, after due consideration, you find that purchase of this long-term care coverage is a wise decision.</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Health conditions which you may presently have (preexisting conditions), may not be immediately or fully covered under the new policy. This could result in denial or delay in payment of benefits under the new policy, whereas a similar claim might have been payable under your present policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> State law provides that your replacement policy or certificate may not contain new preexisting conditions or probationary periods. Your insurer will waive any time periods applicable to preexisting conditions or probationary periods in the new policy (or coverage) for similar benefits to the extent such time was spent (depleted) under the original policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> If you are replacing existing long-term care insurance coverage, you may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors involved in replacing your present coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.14(6)4.">4.</a></td> <td valign="top" style="text-align:left" class="leftalign"> [To be included only if the application is attached to the policy.] If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to [company name and address] within thirty (30) days if any information is not correct and complete, or if any past medical history has been left out of the application. <P>[Company Name]</P> </td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.15" name="120-2-16-.15" title="120-2-16-.15">Rule 120-2-16-.15 Reporting Requirements</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Every insurer shall report annually by June 30 the 10 percent of its agents with the greatest percentages of lapses and replacements as measured by subsection (1) above. (Appendix G)</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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)</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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)</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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)</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of this section: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(7)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Policy" means only long-term care insurance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(7)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Subject to paragraph (c), "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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(7)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "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</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(7)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Report" means on a statewide basis.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.15(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Reports required under this section shall be filed with the Commissioner.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.16" name="120-2-16-.16" title="120-2-16-.16">Rule 120-2-16-.16 Licensing</a></h2> <P>A producer is not authorized to sell, solicit or negotiate with respect to long-term care insurance except as authorized by O.C.G.A. Chapter 33-23.</P> <h2><a href="/GAC/120-2-16-.17" name="120-2-16-.17" title="120-2-16-.17">Rule 120-2-16-.17 Discretionary Powers of Commissioner</a></h2> <P>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:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.17(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The modification or suspension would be in the best interest of the insureds;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.17(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The purposes to be achieved could not be effectively or efficiently achieved without the modification or suspension; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.17(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.17(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The modification or suspension is necessary to the development of an innovative and reasonable approach for insuring long-term care; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.17(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.17(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.18" name="120-2-16-.18" title="120-2-16-.18">Rule 120-2-16-.18 Reserve Standards</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-10-13&amp;title=33#" target="_newtab">33-10-13</a>. Claim reserves shall also be established in the case when the policy or rider is in claim status. <P>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.</P> <P>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:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Definition of insured events;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Covered long-term care facilities;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Existence of home convalescence care coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Definition of facilities;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Existence or absence of barriers to eligibility;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Premium waiver provision;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Renewability;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Ability to raise premiums;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Marketing method;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(j)">(j)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Underwriting procedures;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(k)">(k)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Claims adjustment procedures;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(l)">(l)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Waiting period;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(m)">(m)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Maximum benefit;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(n)">(n)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Availability of eligible facilities;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(o)">(o)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Margins in claim costs;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(p)">(p)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Optional nature of benefit;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(q)">(q)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Delay in eligibility for benefit; </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(r)">(r)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Inflation protection provisions; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(1)(s)">(s)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Guaranteed insurability option. <P>Any applicable valuation morbidity table shall be certified as appropriate as a statutory valuation table by a member of the American Academy of Actuaries.</P> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.18(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> When long-term care benefits are provided other than as in subsection (1) above, reserves shall be determined in accordance with O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-10-8&amp;title=33#" target="_newtab">33-10-8</a>.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.19" name="120-2-16-.19" title="120-2-16-.19">Rule 120-2-16-.19 Loss Ratio</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section shall apply to all long-term care insurance policies or certificates except those covered under Sections <a title="120-2-16" href="120-2-16">120-2-16</a>-.10 and <a title="120-2-16-.20" href="120-2-16-.20">120-2-16-.20</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Statistical credibility of incurred claims experience and earned premiums;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The period for which rates are computed to provide coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Experienced and projected trends;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Concentration of experience within early policy duration;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Expected claim fluctuation;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Experience refunds, adjustments or dividends;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Renewability features;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All appropriate expense factors;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Interest;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(j)">(j)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Experimental nature of the coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(k)">(k)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Policy reserves;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(l)">(l)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Mix of business by risk classification; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(2)(m)">(m)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Product features such as long elimination periods, high deductibles and high maximum limits.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Subsection (2) shall not apply to life insurance policies that accelerate benefits for long-term care. A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums paid, if the policy complies with all of the following provisions: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The interest credited internally to determine cash value accumulations, including long-term care, if any, are guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-25-4&amp;title=33#" target="_newtab">33-25-4</a>;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy meets the disclosure requirements of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#" target="_newtab">33-42-6</a>;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any policy illustration that meets the applicable requirements of the NAIC Life Insurance Illustrations Model Regulation; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An actuarial memorandum is filed with the insurance department that includes: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the basis on which the long-term care rates were determined;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the basis for the reserves;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(vi)">(vi)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The estimated average annual premium per policy and the average issue age;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(vii)">(vii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.19(3)(e)(viii)">(viii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values and reserves on the underlying life insurance policy, both for active lives and those in long-term care claim status.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.20" name="120-2-16-.20" title="120-2-16-.20">Rule 120-2-16-.20 Premium Rate Schedule Increases</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section shall apply as follows: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as provided in paragraph (2), this section applies to any long-term care policy or certificate issued in this state on or after October 1, 2008.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For certificates issued on or after the effective date of this amended regulation under a group long-term care insurance policy as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>, 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 April 1, 2009.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer shall provide notice of a pending premium rate schedule increase, including an exceptional increase, to the Commissionerat least 90 days prior to the notice to the policyholders and shall include: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Information required by Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.09;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Certification by a qualified actuary that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the requested premium rate schedule increase is implemented and the underlying assumptions, which reflect moderately adverse conditions, are realized, no further premium rate schedule increases are anticipated;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The premium rate filing is in compliance with the provisions of this section;</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An actuarial memorandum justifying the rate schedule change request that includes: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Lifetime projections of earned premiums and incurred claims based on the filed premium rate schedule increase; and the method and assumptions used in determining the projected values, including reflection of any assumptions that deviate from those used for pricing other forms currently available for sale; <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Annual values for the five years preceding and the three years following the valuation date shall be provided separately;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The projections shall include the development of the lifetime loss ratio, unless the rate increase is an exceptional increase;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The projections shall demonstrate compliance with subsection (3); and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)(D)">(D)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For exceptional increases, <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)(D)(I)">(I)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The projected experience should be limited to the increases in claims expenses attributable to the approved reasons for the exceptional increase; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(i)(D)(II)">(II)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event the Commissioner determines as provided in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.04(1)(d) that offsets may exist, the insurer shall use appropriate net projected experience;</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Disclosure of how reserves have been incorporated in this rate increase whenever the rate increase will trigger contingent benefit upon lapse;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Disclosure of the analysis performed to determine why a rate adjustment is necessary, which pricing assumptions were not realized and why, and what other actions taken by the company have been relied on by the actuary;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that policy design, underwriting and claims adjudication practices have been taken into consideration; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(c)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event that it is necessary to maintain consistent premium rates for new certificates and certificates receiving a rate increase, the insurer will need to file composite rates reflecting projections of new certificates;</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement that renewal premium rate schedules are not greater than new business premium rate schedules except for differences attributable to benefits, unless sufficient justification is provided to the Commissioner; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(2)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Sufficient information for review and approval of the premium rate schedule increase by the Commissioner.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All premium rate schedule increases shall be determined in accordance with the following requirements: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Exceptional increases shall provide that 70 percent of the present value of projected additional premiums from the exceptional increase will be returned to policyholders in benefits;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Premium rate schedule increases shall be calculated such that the sum of the accumulated value of incurred claims, without the inclusion of active life reserves, and the present value of future projected incurred claims, without the inclusion of active life reserves, will not be less than the sum of the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The accumulated value of the initial earned premium times 58 percent;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 85 percent of the accumulated value of prior premium rate schedule increases on an earned basis;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(b)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The present value of future projected initial earned premiums times 58 percent; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(b)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 85 percent of the present value of future projected premiums not in subparagraph (iii) on an earned basis;</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event that a policy form has both exceptional and other increases, the values in subparagraphs (b)(ii) and (iv) will also include 70 percent for exceptional rate increase amounts; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All present and accumulated values used to determine rate increases shall use the maximum valuation interest rate for contract reserves. The actuary shall disclose as part of the actuarial memorandum the use of any appropriate averages.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For each rate increase that is implemented, the insurer shall file for approval by the Commissioner updated projections, as defined in subsection (2)(c)(i), annually for the next three years and include a comparison of actual results to projected values. The Commissioner may extend the period to greater than three years if actual results are not consistent with projected values from prior projections. For group insurance policies that meet the conditions in subsection (11), the projections required by this subsection shall be provided to the policyholder in lieu of filing with the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If any premium rate in the revised premium rate schedule is greater than 200 percent of the comparable rate in the initial premium schedule, lifetime projections, as defined in subsection (2)(c)(i), shall be filed for approval by the Commissioner every five years following the end of the required period in subsection (4). For group insurance policies that meet the conditions in subsection (11), the projections required by this subsection shall be provided to the policyholder in lieu of filing with the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(6)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the Commissioner has determined that the actual experience following a rate increase does not adequately match the projected experience and that the current projections under moderately adverse conditions demonstrate that incurred claims will not exceed proportions of premiums specified in subsection (3), the Commissioner may require the insurer to implement any of the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(6)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Premium rate schedule adjustments; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(6)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Other measures to reduce the difference between the projected and actual experience.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(6)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In determining whether the actual experience adequately matches the projected experience, consideration should be given to Subsection (2)(c)(v) if applicable.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the majority of the policies or certificates to which the increase is applicable are eligible for the contingent benefit upon lapse, the insurer shall file: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(7)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A plan, subject to Commissioner approval, for improved administration or claims processing designed to eliminate the potential for further deterioration of the policy form requiring further premium rate schedule increases, or both, or to demonstrate that appropriate administration and claims processing have been implemented or are in effect; otherwise the Commissioner may impose the condition in subsection (8) of this section; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(7)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The original anticipated lifetime loss ratio, and the premium rate schedule increase that would have been calculated according to subsection (3) had the greater of the original anticipated lifetime loss ratio or 58 percent been used in the calculations described in subsection (3)(b)(i) and (iii).</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For a rate increase filing that meets the following criteria, the Commissioner shall review, for all policies included in the filing, the projected lapse rates and past lapse rates during the 12 months following each increase to determine if significant adverse lapsation has occurred or is anticipated: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The rate increase is not the first rate increase requested for the specific policy form or forms;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The rate increase is not an exceptional increase; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(a)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The majority of the policies or certificates to which the increase is applicable are eligible for the contingent benefit upon lapse.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event significant adverse lapsation has occurred, is anticipated in the filing or is evidenced in the actual results as presented in the updated projections provided by the insurer following the requested rate increase, the Commissioner may determine that a rate spiral exists. Following the determination that a rate spiral exists, the Commissioner may require the insurer to offer, without underwriting, to all in force insureds subject to the rate increase the option to replace existing coverage with one or more reasonably comparable products being offered by the insurer or its affiliates. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The offer shall: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(i)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Be subject to the approval of the Commissioner;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(i)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Be based on actuarially sound principles, but not be based on attained age; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(i)(C)">(C)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Provide that maximum benefits under any new policy accepted by an insured shall be reduced by comparable benefits already paid under the existing policy.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer shall maintain the experience of all the replacement insureds separate from the experience of insureds originally issued the policy forms. In the event of a request for a rate increase on the policy form, the rate increase shall be limited to the lesser of: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(ii)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The maximum rate increase determined based on the combined experience; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(8)(b)(ii)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The maximum rate increase determined based only on the experience of the insureds originally issued the form plus 10 percent.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the Commissioner determines that the insurer has exhibited a persistent practice of filing inadequate initial premium rates for long-term care insurance, the Commissioner may, in addition to the provisions of subsection (8) of this section, prohibit the insurer from either of the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(9)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Filing and marketing comparable coverage for a period of up to five years; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(9)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Offering all other similar coverages and limiting marketing of new applications to the products subject to recent premium rate schedule increases.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)">(10)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Subsections (1) through (9) shall not apply to policies for which the long-term care benefits provided by the policy are incidental, as defined in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.04(2), if the policy complies with all of the following provisions: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The interest credited internally to determine cash value accumulations, including long-term care, if any, are guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The portion of the policy that provides insurance benefits other than long-term care coverage meets the nonforfeiture requirements as applicable in any of the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-10-13&amp;title=33#" target="_newtab">33-10-13</a> for Life Insurance or Annuities; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-11-66&amp;title=33#33-11-66(i)" target="_newtab">33-11-66(i)</a>for Variable Annuities.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy meets the disclosure requirements of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#" target="_newtab">33-42-6</a>;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An actuarial memorandum is filed with the Georgia Insurance Department that includes: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the basis on which the long-term care rates were determined;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the basis for the reserves;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(vi)">(vi)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The estimated average annual premium per policy and the average issue age;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(vii)">(vii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(10)(d)(viii)">(viii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values and reserves on the underlying insurance policy, both for active lives and those in long-term care claim status.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(11)">(11)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Subsections (6) and (8) shall not apply to group insurance policies as defined in Section O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> where: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(11)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policies insure 250 or more persons and the policyholder has 5,000 or more eligible employees of a single employer; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.20(11)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policyholder, and not the certificateholders, pays a material portion of the premium, which shall not be less than twenty percent (20%) of the total premium for the group in the calendar year prior to the year a rate increase is filed.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.21" name="120-2-16-.21" title="120-2-16-.21">Rule 120-2-16-.21 Filing Requirement</a></h2> <P>Prior to an insurer or similar organization offering group long-term care insurance to a resident of this state pursuant to O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-5&amp;title=33#" target="_newtab">33-42-5</a>, it shall file with the Commissioner 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.</P> <h2><a href="/GAC/120-2-16-.22" name="120-2-16-.22" title="120-2-16-.22">Rule 120-2-16-.22 Filing Requirements for Advertising</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.22(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.22(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.23" name="120-2-16-.23" title="120-2-16-.23">Rule 120-2-16-.23 Standards for Marketing</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Every insurer, health care service plan or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Establish marketing procedures and agent training requirements to assure that: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any marketing activities, including any comparison of policies, by its agents or other producers will be fair and accurate; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Excessive insurance is not sold or issued.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Display prominently by type, stamp or other appropriate means, on the first page of the outline of coverage and policy the following: <P>"Notice to buyer: This policy may not cover all of the costs associated with long-term care incurred by the buyer during the period of coverage. The buyer is advised to review carefully all policy limitations."</P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Provide copies of the disclosure forms required in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.09(3) (Appendices B and F) to the applicant.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee for long-term care insurance already has accident and sickness or long-term care insurance and the types and amounts of any such insurance, except that in the case of qualified long-term care insurance contracts, an inquiry into whether a prospective applicant or enrollee for long-term care insurance has accident and sickness insurance is not required.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Every insurer or entity marketing long-term care insurance shall establish auditable procedures for verifying compliance with this subsection (1).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the state in which the policy or certificate is to be delivered or issued for delivery has a senior insurance counseling program approved by the Commissioner, the insurer shall, at solicitation, provide written notice to the prospective policyholder and certificateholder that the program is available and the name, address and telephone number of the program.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For long-term care health insurance policies and certificates, use the terms "noncancellable" or "level premium" only when the policy or certificate conforms to Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.06(1)(c) of this Regulation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(1)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Provide an explanation of contingent benefit upon lapse provided for in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.28(6)(c) and, if applicable, the additional contingent benefit upon lapse provided to policies with fixed or limited premium paying periods in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.28(6)(d).</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In addition to the practices prohibited in O.C.G.A. Chapter 33-6, the following acts and practices are prohibited: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on or convert any insurance policy or to take out a policy of insurance with another insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Cold lead advertising. Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Misrepresentation. Misrepresenting a material fact in selling or offering to sell a long-term care insurance policy.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> With respect to the obligations set forth in this subsection, the primary responsibility of an association, as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> (as a valid group), when endorsing or selling long-term care insurance shall be to educate its members concerning long-term care issues in general so that its members can make informed decisions. Associations shall provide objective information regarding long-term care insurance policies or certificates endorsed or sold by such associations to ensure that members of such associations receive a balanced and complete explanation of the features in the policies or certificates that are being endorsed or sold.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer shall file with the Georgia Insurance Department the following material: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy and certificate,</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A corresponding outline of coverage, and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(b)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All advertisements requested by the Georgia Insurance Department.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The association shall disclose in any long-term care insurance solicitation: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(c)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The specific nature and amount of the compensation arrangements (including all fees, commissions, administrative fees and other forms of financial support) that the association receives from endorsement or sale of the policy or certificate to its members; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(c)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A brief description of the process under which the policies and the insurer issuing the policies were selected.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the association and the insurer have interlocking directorates or trustee arrangements, the association shall disclose that fact to its members.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The board of directors of associations selling or endorsing long-term care insurance policies or certificates shall review and approve the insurance policies as well as the compensation arrangements made with the insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The association shall also: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(f)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> At the time of the association's decision to endorse, engage the services of a person with expertise in long-term care insurance not affiliated with the insurer to conduct an examination of the policies, including its benefits, features, and rates and update the examination thereafter in the event of material change;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(f)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Actively monitor the marketing efforts of the insurer and its agents; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(f)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Review and approve all marketing materials or other insurance communications used to promote sales or sent to members regarding the policies or certificates.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(f)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Subparagraphs (i) through (iii) shall not apply to qualified long-term care insurance contracts.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(g)">(g)</a></td> <td valign="top" style="text-align:left" class="leftalign"> No group long-term care insurance policy or certificate may be issued to an association unless the insurer files with the Georgia Insurance Department the information required in this subsection (3).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(h)">(h)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer shall not issue a long-term care policy or certificate to an association or continue to market such a policy or certificate unless the insurer certifies annually that the association has complied with the requirements set forth in this subsection (3).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.23(3)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Failure to comply with the filing and certification requirements of this section constitutes an unfair trade practice in violation of O.C.G.A. Chapter 33-6.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.24" name="120-2-16-.24" title="120-2-16-.24">Rule 120-2-16-.24 Suitability</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section shall not apply to life insurance policies that accelerate benefits for long-term care.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Every insurer, health care service plan or other entity marketing long-term care insurance (the "issuer") shall: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Train its agents in the use of its suitability standards; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Maintain a copy of its suitability standards and make them available for inspection upon request by the Commissioner.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> To determine whether the applicant meets the standards developed by the issuer, the agent and issuer shall develop procedures that take the following into consideration: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The ability to pay for the proposed coverage and other pertinent financial information related to the purchase of the coverage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The applicant's goals or needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(a)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The values, benefits and costs of the applicant's existing insurance, if any, when compared to the values, benefits and costs of the recommended purchase or replacement.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The issuer, and where an agent is involved, the agent shall make reasonable efforts to obtain the information set out in paragraph (a) above. The efforts shall include presentation to the applicant, at or prior to application, the "Long-Term Care Insurance Personal Worksheet." The personal worksheet used by the issuer shall contain, at a minimum, the information in the format contained in Appendix B, in not less than 12 point type. The issuer may request the applicant to provide additional information to comply with its suitability standards. A copy of the issuer's personal worksheet shall be filed with the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A completed personal worksheet shall be returned to the issuer prior to the issuer's consideration of the applicant for coverage, except the personal worksheet need not be returned for sales of employer group long-term care insurance to employees and their spouses.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The sale or dissemination outside the company or agency by the issuer or agent of information obtained through the personal worksheet in Appendix B is prohibited.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The issuer shall use the suitability standards it has developed pursuant to this section in determining whether issuing long-term care insurance coverage to an applicant is appropriate.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Agents shall use the suitability standards developed by the issuer in marketing long-term care insurance.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> At the same time as the personal worksheet is provided to the applicant, the disclosure form entitled "Things You Should Know Before You Buy Long-Term Care Insurance" shall be provided. The form shall be in the format contained in Appendix C, in not less than 12 point type.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the issuer determines that the applicant does not meet its financial suitability standards, or if the applicant has declined to provide the information, the issuer may reject the application. In the alternative, the issuer shall send the applicant a letter similar to Appendix D. However, if the applicant has declined to provide financial information, the issuer may use some other method to verify the applicant's intent. Either the applicant's returned letter or a record of the alternative method of verification shall be made part of the applicant's file.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.24(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The issuer shall report annually to the Commissioner the total number of applications received from residents of this state, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards, and the number of those who chose to confirm after receiving a suitability letter.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.25" name="120-2-16-.25" title="120-2-16-.25">Rule 120-2-16-.25 Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates</a></h2> <P>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.</P> <h2><a href="/GAC/120-2-16-.26" name="120-2-16-.26" title="120-2-16-.26">Rule 120-2-16-.26 Availability of New Services or Providers</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 12 months of the date of the new policy series is made available for sale in this state.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding subsection (1) above, notification is not required for any policy issued prior to the effective date of this section 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer shall make the new coverage available in one of the following ways: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> By adding a rider to the existing policy and charging a separate premium for the new rider based on the insured's attained age;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(3)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(3)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 Commissioner.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer is not required to notify policyholders of a new proprietary policy series created and filed for use in a limited distribution channel. For purposes of this subsection, "limited distribution channel" means through a discrete entity, such as a financial institution or brokerage, for which specialized products are available that are not available for sale to the general public. Policyholders that purchased such a new proprietary policy shall be notified when a new long-term care policy series that provides coverage for new long-term care services or providers material in nature is made available to that limited distribution channel.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Policies issued pursuant to this section shall be considered exchanges and not replacements. These exchanges shall not be subject to Sections <a title="120-2-16" href="120-2-16">120-2-16</a>-.14 and 120-2-16-24, and the reporting requirements of Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.15(1) through (5) of this Regulation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Where the policy is offered through an employer, labor organization, professional, trade or occupational association, the required notification in subsection (1) above shall be made to the offering entity. However, if the policy is issued to a group defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>, the notification shall be made to each certificateholder.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Nothing in this section shall prohibit an insurer from offering any policy, rider, certificate or coverage change to any policyholder or certificateholder. However, upon request any policyholder may apply for currently available coverage that includes the new services or providers. 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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.26(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section shall become effective on or after April 1, 2008.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.27" name="120-2-16-.27" title="120-2-16-.27">Rule 120-2-16-.27 Right to Reduce Coverage and Lower Premiums</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(1)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Reducing the maximum benefit; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(1)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Reducing the daily, weekly or monthly benefit amount.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer may also offer other reduction options that are consistent with the policy or certificate design or the carrier's administrative processes.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The provision shall include a description of the ways in which coverage may be reduced and the process for requesting and implementing a reduction in coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The age to determine the premium for the reduced coverage shall be based on the age used to determine the premiums for the coverage currently in force.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The insurer may limit any reduction in coverage to plans or options available for that policy form and to those for which benefits will be available after consideration of claims paid or payable.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If a policy or certificate is about to lapse, the insurer shall provide a written reminder to the policyholder or certificateholder of his or her right to reduce coverage and premiums in the notice required by Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.07(1)(c) of this regulation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.27(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The requirements of this section shall apply to any long-term care policy issued in this state on or after April 1, 2009.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.28" name="120-2-16-.28" title="120-2-16-.28">Rule 120-2-16-.28 Nonforfeiture Benefit Requirement</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as provided in subsection (2), a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificateholder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. In the event the policyholder or certificateholder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> When a group long term care insurance policy is issued, the offer required in subsection (1) shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>, other than to a continuing care retirement community or similar entity, the offering shall be made to each proposed certificateholder.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> To comply with the requirement to offer a nonforfeiture benefit pursuant to the provisions of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#" target="_newtab">33-42-6</a> and Rule Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.28(1): <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 (5); and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the offer required to be made under subsection (1) is rejected, the insurer shall provide the contingent benefit upon lapse described in this Section. Even if this offer is accepted for a policy with a fixed or limited premium paying period, the contingent benefit on lapse in subsection (6)(d) shall still apply.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> After rejection of the offer required under subsection (1), for individual and group policies without nonforfeiture benefits issued after the effective date of this section, the insurer shall provide a contingent benefit upon lapse.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the event a group policyholder elects to make the nonforfeiture benefit an option to the certificateholder, a certificate shall provide either the nonforfeiture benefit or the contingent benefit upon lapse.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A contingent benefit on lapse shall be triggered every time an insurer increases the premium rates to a level which results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth below based on the insured's issue age, and the policy or certificate lapses within 120 days of the due date of the premium so increased. Unless otherwise required, policyholders shall be notified at least 30 days prior to the due date of the premium reflecting the rate increase. <P> <TABLE> <TBODY> <TR> <TD colspan="2" rowspan="1"> <P>Triggers for a Substantial Premium Increase</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Issue Age</P> </TD> <TD rowspan="1" colspan="1"> <P>Percent Increase Over</P> <P> Initial Premium</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>29 and under</P> </TD> <TD rowspan="1" colspan="1"> <P>200%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>30-34</P> </TD> <TD rowspan="1" colspan="1"> <P>190%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>35-39</P> </TD> <TD rowspan="1" colspan="1"> <P>170%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>40-44</P> </TD> <TD rowspan="1" colspan="1"> <P>150%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>45-49</P> </TD> <TD rowspan="1" colspan="1"> <P>130%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>50-54</P> </TD> <TD rowspan="1" colspan="1"> <P>110%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>55-59</P> </TD> <TD rowspan="1" colspan="1"> <P>90%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>60</P> </TD> <TD rowspan="1" colspan="1"> <P>70%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>61</P> </TD> <TD rowspan="1" colspan="1"> <P>66%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>62</P> </TD> <TD rowspan="1" colspan="1"> <P>62%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>63</P> </TD> <TD rowspan="1" colspan="1"> <P>58%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>64</P> </TD> <TD rowspan="1" colspan="1"> <P>54%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>65</P> </TD> <TD rowspan="1" colspan="1"> <P>50%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>66</P> </TD> <TD rowspan="1" colspan="1"> <P>48%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>67</P> </TD> <TD rowspan="1" colspan="1"> <P>46%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>68</P> </TD> <TD rowspan="1" colspan="1"> <P>44%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>69</P> </TD> <TD rowspan="1" colspan="1"> <P>42%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>70</P> </TD> <TD rowspan="1" colspan="1"> <P>40%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>71</P> </TD> <TD rowspan="1" colspan="1"> <P>38%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>72</P> </TD> <TD rowspan="1" colspan="1"> <P>36%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>73</P> </TD> <TD rowspan="1" colspan="1"> <P>34%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>74</P> </TD> <TD rowspan="1" colspan="1"> <P>32%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>75 </P> </TD> <TD rowspan="1" colspan="1"> <P>30%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>76</P> </TD> <TD rowspan="1" colspan="1"> <P>28%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>77</P> </TD> <TD rowspan="1" colspan="1"> <P>26%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>78</P> </TD> <TD rowspan="1" colspan="1"> <P>24%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>79</P> </TD> <TD rowspan="1" colspan="1"> <P>22%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>80</P> </TD> <TD rowspan="1" colspan="1"> <P>20%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>81</P> </TD> <TD rowspan="1" colspan="1"> <P>19%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>82</P> </TD> <TD rowspan="1" colspan="1"> <P>18%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>83</P> </TD> <TD rowspan="1" colspan="1"> <P>17%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>84</P> </TD> <TD rowspan="1" colspan="1"> <P>16%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>85</P> </TD> <TD rowspan="1" colspan="1"> <P>15%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>86</P> </TD> <TD rowspan="1" colspan="1"> <P>14%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>87</P> </TD> <TD rowspan="1" colspan="1"> <P>13%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>88</P> </TD> <TD rowspan="1" colspan="1"> <P>12%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>89</P> </TD> <TD rowspan="1" colspan="1"> <P>11%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>90 and over</P> </TD> <TD rowspan="1" colspan="1"> <P>10%</P> </TD> </TR> </TBODY> </TABLE> </P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A contingent benefit on lapse shall also be triggered for policies with a fixed or limited premium paying period every time an insurer increases the premium rates to a level that results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth below based on the insured's issue age, the policy or certificate lapses within 120 days of the due date of the premium so increased, and the ratio in subparagraph (f)(i) is 40 percent or more. Unless otherwise required, policyholders shall be notified at least 30 days prior to the due date of the premium reflecting the rate increase. <P> <TABLE> <TR> <TD colspan="2" rowspan="1"> <P>Triggers for a Substantial Premium Increase</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Percent Increase</P> <P>Issue Age</P> </TD> <TD rowspan="1" colspan="1"> <P>Over Initial Premium </P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Under 65</P> </TD> <TD rowspan="1" colspan="1"> <P> 50%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>65-80</P> </TD> <TD rowspan="1" colspan="1"> <P> 30%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Over 80</P> </TD> <TD rowspan="1" colspan="1"> <P> 10%</P> </TD> </TR> </TABLE> </P> <P>This provision shall be in addition to the contingent benefit provided by paragraph (c) above and where both are triggered, the benefit provided shall be at the option of the insured.</P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> On or before the effective date of a substantial premium increase as defined in paragraph (c) above, the insurer shall: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(e)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(e)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Offer to convert the coverage to a paid-up status with a shortened benefit period in accordance with the terms of subsection (5). This option may be elected at any time during the 120-day period referenced in subsection (6)(c); and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(e)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notify the policyholder or certificateholder that a default or lapse at any time during the 120-day period referenced in subsection (6)(c) shall be deemed to be the election of the offer to convert in subparagraph (ii) above unless the automatic option in paragraph (f)(iii) applies.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(f)">(f)</a></td> <td valign="top" style="text-align:left" class="leftalign"> On or before the effective date of a substantial premium increase as defined in paragraph (6)(c) above, the insurer shall: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(f)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(f)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Offer to convert the coverage to a paid-up status where the amount payable for each benefit is 90 percent of the amount payable in effect immediately prior to lapse times the ratio of the number of completed months of paid premiums divided by the number of months in the premium paying period. This option may be elected at any time during the 120-day period referenced in subsection (6)(d); and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(6)(f)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notify the policyholder or certificateholder that a default or lapse at any time during the 120-day period referenced in subsection (6)(d) shall be deemed to be the election of the offer to convert in subparagraph (ii) above if the ratio is 40 percent or more.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Benefits continued as nonforfeiture benefits, including contingent benefits upon lapse in accordance with subsection (6)(c) but not subsection (6)(d), are described in this subsection: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of this subsection, attained age rating is defined as a schedule of premiums starting from the issue date which increases age at least one percent per year prior to age 50, and at least 3 percent per year beyond age 50.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of this subsection, the nonforfeiture benefit shall be of a shortened benefit period providing paid-up long-term care insurance coverage after lapse. The same benefits (amounts and frequency in effect at the time of lapse but not increased thereafter) will be payable for a qualifying claim, but the lifetime maximum dollars or days of benefits shall be determined as specified in paragraph (c).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The standard nonforfeiture credit will be equal to 100 percent of the sum of all premiums paid, including the premiums paid prior to any changes in benefits. The insurer may offer additional shortened benefit period options, as long as the benefits for each duration equal or exceed the standard nonforfeiture credit for that duration. However, the minimum nonforfeiture credit shall not be less than 30 times the daily nursing home benefit at the time of lapse. In either event, the calculation of the nonforfeiture credit is subject to the limitation of subsection (8).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(d)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The nonforfeiture benefit shall begin not later than the end of the third year following the policy or certificate issue date. The contingent benefit upon lapse shall be effective during the first three years as well as thereafter.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(d)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Notwithstanding subparagraph (i), for a policy or certificate with attained age rating, the nonforfeiture benefit shall begin on the earlier of: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(d)(ii)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The end of the tenth year following the policy or certificate issue date; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(d)(ii)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The end of the second year following the date the policy or certificate is no longer subject to attained age rating.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(7)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Nonforfeiture credits may be used for all care and services qualifying for benefits under the terms of the policy or certificate, up to the limits specified in the policy or certificate.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All benefits paid by the insurer while the policy or certificate is in premium paying status and in the paid up status will not exceed the maximum benefits which would be payable if the policy or certificate had remained in premium paying status.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(9)">(9)</a></td> <td valign="top" style="text-align:left" class="leftalign"> There shall be no difference in the minimum nonforfeiture benefits as required under this section for group and individual policies.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(10)">(10)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The requirements set forth in this section shall become effective 12 months after adoption of this provision and shall apply as follows: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(10)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as provided in paragraphs (b) and (c) below, the provisions of this section apply to any long-term care policy issued in this state on or after the effective date of this amended regulation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(10)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For certificates issued on or after the effective date of this section, under a group long-term care insurance policy as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a>, which policy was in force at the time this amended regulation became effective, the provisions of this section shall not apply.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(10)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The last sentence in subsection (5) and subsections (6)(d) and (6)(f) shall apply to any long-term care insurance policy or certificate issued in this state after six months after their adoption, except new certificates on a group policy as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> one year after adoption.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(11)">(11)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Premiums charged for a policy or certificate containing nonforfeiture benefits or a contingent benefit on lapse shall be subject to the loss ratio requirements of Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.19 or Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.20, whichever is applicable, treating the policy as a whole.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(12)">(12)</a></td> <td valign="top" style="text-align:left" class="leftalign"> To determine whether contingent nonforfeiture upon lapse provisions are triggered under subsection (6)(c) or (6)(d), a replacing insurer that purchased or otherwise assumed a block or blocks of long-term care insurance policies from another insurer shall calculate the percentage increase based on the initial annual premium paid by the insured when the policy was first purchased from the original insurer.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)">(13)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A nonforfeiture benefit for qualified long-term care insurance contracts that are level premium contracts shall be offered that meets the following requirements: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The nonforfeiture provision shall be appropriately captioned;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The nonforfeiture provision shall provide a benefit available in the event of a default in the payment of any premiums and shall state that the amount of the benefit may be adjusted subsequent to being initially granted only as necessary to reflect changes in claims, persistency and interest as reflected in changes in rates for premium paying contracts approved by the Commissioner for the same contract form; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The nonforfeiture provision shall provide at least one of the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(c)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Reduced paid-up insurance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(c)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Extended term insurance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(c)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Shortened benefit period; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(13)(c)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Other similar offerings approved by the Commissioner.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.28(14)">(14)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The requirements of this section shall apply to any long-term care policy issued in this state on or after April 1, 2009.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.29" name="120-2-16-.29" title="120-2-16-.29">Rule 120-2-16-.29 Standards for Benefit Triggers</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 of the activities of daily living or the presence of cognitive impairment.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Activities of daily living shall include at least the following as defined in Section <a title="120-2-16" href="120-2-16">120-2-16</a>-.05 and in the policy: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Bathing;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Continence;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)(iii)">(iii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Dressing;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)(iv)">(iv)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Eating;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)(v)">(v)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Toileting; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(a)(vi)">(vi)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Transferring.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Insurers may use activities of daily living to trigger covered benefits in addition to those contained in paragraph (a) as long as they are defined in the policy.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer may use additional provisions for the determination of when benefits are payable under a policy or certificate; however the provisions shall not restrict, and are not in lieu of, the requirements contained in subsections (1) and (2).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of this section the determination of a deficiency shall not be more restrictive than: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Requiring the hands-on assistance of another person to perform the prescribed activities of daily living; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the deficiency is due to the presence of a cognitive impairment, supervision or verbal cueing by another person is needed in order to protect the insured or others.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Assessments of activities of daily living and cognitive impairment shall be performed by licensed or certified professionals, such as physicians, nurses or social workers.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Long term care insurance policies shall include a clear description of the process for appealing and resolving benefit determinations.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The requirements set forth in this section shall be effective April 1, 2008, and shall apply as follows: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(7)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Except as provided in paragraph (b), the provisions of this section apply to a long-term care policy issued in this state on or after the effective date of the amended regulation.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.29(7)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For certificates issued on or after the effective date of this section, under a group long-term care insurance policy as defined in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> that was in force at the time this amended regulation became effective, the provisions of this section shall not apply.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.30" name="120-2-16-.30" title="120-2-16-.30">Rule 120-2-16-.30 Additional Standards for Benefit Triggers for Qualified Long - Term Care Insurance Contracts</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For purposes of this section, the following definitions apply: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(b)(i)">(i)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "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: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(b)(i)(A)">(A)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Being unable to perform (without substantial assistance from another individual) at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity; or</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(b)(i)(B)">(B)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(b)(ii)">(ii)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "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.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(1)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "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).</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A qualified long term care insurance contract shall pay only for qualified long term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's inability to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity or to severe cognitive impairment.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Certifications regarding activities of daily living and cognitive impairment required pursuant to subsection (3) shall be performed by the following licensed or certified professionals: physicians, registered professional nurses, licensed social workers, or other individuals who meet requirements prescribed by the Secretary of the Treasury.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Certifications required pursuant to subsection (3) may be performed by a licensed health care professional at the direction of the carrier as is reasonably necessary with respect to a specific claim, except that when a licensed health care practitioner has certified that an insured is unable to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity and the insure is in claim status, the certification may not be rescinded and additional certifications may not be performed until after the expiration of the 90-day period.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.30(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Qualified long-term care insurance contracts shall include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.31" name="120-2-16-.31" title="120-2-16-.31">Rule 120-2-16-.31 Standard Format Outline of Coverage</a></h2> <P>This section of the Regulation implements, interprets and makes specific, the provisions of O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#33-42-6(g)" target="_newtab">33-42-6(g)</a>in prescribing a standard format and the content of an outline of coverage.</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The outline of coverage shall be a free-standing document, using no smaller than ten-point type.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The outline of coverage shall contain no material of an advertising nature.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Text that is capitalized or underscored in the standard format outline of coverage may be emphasized by other means that provide prominence equivalent to the capitalization or underscoring.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Use of the text and sequence of text of the standard format outline of coverage is mandatory, unless otherwise specifically indicated.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Format for outline of coverage: <P><B>[COMPANY NAME]</B></P> <P><B>[ADDRESS - CITY &amp; STATE]</B></P> <P><B>[TELEPHONE NUMBER]</B></P> <P><B>LONG-TERM CARE INSURANCE</B></P> <P><B>OUTLINE OF COVERAGE</B></P> <P>[Policy Number or Group Master Policy and Certificate Number]</P> <P>[Except for policies or certificates which are guaranteed issue, the following caution statement, or language substantially similar, must appear as follows in the outline of coverage.]</P> <P>Caution: The issuance of this long-term care insurance [policy] [certificate] is based upon your responses to the questions on your application. A copy of your [application] [enrollment form] [is enclosed] [was retained by you when you applied]. If your answers are incorrect or untrue, the company has the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: [insert address]</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> This policy is [an individual policy of insurance]([a group policy] which was issued in the [indicate jurisdiction in which group policy was issued]).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage provides a very brief description of the important features of the policy. You should compare this outline of coverage to outlines of coverage for other policies available to you. This is not an insurance contract, but only a summary of coverage. Only the individual or group policy contains governing contractual provisions. This means that the policy or group policy sets forth in detail the rights and obligations of both you and the insurance company. Therefore, if you purchase this coverage, or any other coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE) CAREFULLY!</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> FEDERAL TAX CONSEQUENCES. <P>This [POLICY] [CERTIFICATE] is intended to be a federally tax-qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986, as amended.</P> </td> </tr> </table> <P>OR</P> <P>Federal Tax Implications of this [POLICY] [CERTIFICATE]. This [POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified long-term care insurance contract under Section 7702B(b) of the Internal Revenue Code of 1986 as amended. Benefits received under the [POLICY] [CERTIFICATE] may be taxable as income.</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)4.">4.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Terms Under Which the Policy OR Certificate May Be Continued in Force or Discontinued. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)4.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> For long-term care health insurance policies or certificates describe one of the following permissible policy renewability provisions: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)4.(a)(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Policies and certificates that are guaranteed renewable shall contain the following statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS GUARANTEED RENEWABLE. This means you have the right, subject to the terms of your policy, [certificate] to continue this policy as long as you pay your premiums on time. [Company Name] cannot change any of the terms of your policy on its own, except that, in the future, IT MAY INCREASE THE PREMIUM YOU PAY.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)4.(a)(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Policies and certificates that are noncancellable shall contain the following statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS NONCANCELLABLE. This means that you have the right, subject to the terms of your policy, to continue this policy as long as you pay your premiums on time. [Company Name] cannot change any of the terms of your policy on its own and cannot change the premium you currently pay. However, if your policy contains an inflation protection feature where you choose to increase your benefits, [Company Name] may increase your premium at that time for those additional benefits.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)4.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [For group coverage, specifically describe continuation/conversion provisions applicable to the certificate and group policy;]</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)4.(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Describe waiver of premium provisions or state that there are not such provisions.]</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)5.">5.</a></td> <td valign="top" style="text-align:left" class="leftalign"> TERMS UNDER WHICH THE COMPANY MAY CHANGE PREMIUMS. <P>[In bold type larger than the maximum type required to be used for the other provisions of the outline of coverage, state whether or not the company has a right to change the premium, and if a right exists, describe clearly and concisely each circumstance under which the premium may change.]</P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)6.">6.</a></td> <td valign="top" style="text-align:left" class="leftalign"> TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)6.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Provide a brief description of the right to return-"free look" provision of the policy.]</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)6.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Include a statement that the policy either does or does not contain provisions providing for a refund or partial refund of premium upon the death of an insured or surrender of the policy or certificate. If the policy contains such provisions, include a description of them.]</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)7.">7.</a></td> <td valign="top" style="text-align:left" class="leftalign"> THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide available from the insurance company. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)7.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [For agents] Neither [insert company name] nor its agents represent Medicare, the federal government or any state government.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)7.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [For direct response] [insert company name] is not representing Medicare, the federal government or any state government.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)8.">8.</a></td> <td valign="top" style="text-align:left" class="leftalign"> LONG-TERM CARE COVERAGE. Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital, such as in a nursing home, in the community or in the home. <P>This policy provides coverage in the form of a fixed dollar indemnity benefit for covered long-term care expenses, subject to policy [limitations] [waiting periods] and [coinsurance] requirements. [Modify this paragraph if the policy is not an indemnity policy.]</P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)9.">9.</a></td> <td valign="top" style="text-align:left" class="leftalign"> BENEFITS PROVIDED BY THIS POLICY. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)9.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Covered services, related deductibles, waiting periods, elimination periods and benefit maximums.]</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)9.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Institutional benefits, by skill level.]</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)9.(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> [Non-institutional benefits, by skill level.]</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)9.(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Eligibility for Payment of Benefits <P>[Activities of daily living and cognitive impairment shall be used to measure an insured's need for long-term care and must be defined and described as part of the outline of coverage.]</P> <P>[Any additional benefit triggers must also be explained. If these triggers differ for different benefits, explanation of the triggers should accompany each benefit description. If an attending physician or other specified person must certify a certain level of functional dependency in order to be eligible for benefits, this too must be specified.]</P> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)10.">10.</a></td> <td valign="top" style="text-align:left" class="leftalign"> LIMITATIONS AND EXCLUSIONS. <P>[Describe:</P> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)10.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Preexisting conditions;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)10.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Non-eligible facilities and provider;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)10.(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Non-eligible levels of care (e.g., unlicensed providers, care or treatment provided by a family member, etc.);</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)10.(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Exclusions and exceptions;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)10.(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Limitations.] <P>[This section should provide a brief specific description of any policy provisions which limit, exclude, restrict, reduce, delay, or in any other manner operate to qualify payment of the benefits described in Number 6 above.]</P> <P>THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH YOUR LONG-TERM CARE NEEDS.</P> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)11.">11.</a></td> <td valign="top" style="text-align:left" class="leftalign"> RELATIONSHIP OF COST OF CARE AND BENEFITS. Because the costs of long-term care services will likely increase over time, you should consider whether and how the benefits of this plan may be adjusted. [As applicable, indicate the following: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)11.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> That the benefit level will not increase over time;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)11.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Any automatic benefit adjustment provisions;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)11.(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Whether the insured will be guaranteed the option to buy additional benefits and the basis upon which benefits will be increased over time if not by a specified amount or percentage;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)11.(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If there is such a guarantee, include whether additional underwriting or health screening will be required, the frequency and amounts of the upgrade options, and any significant restrictions or limitations;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)11.(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> And finally, describe whether there will be any additional premium charge imposed, and how that is to be calculated.]</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)12.">12.</a></td> <td valign="top" style="text-align:left" class="leftalign"> ALZHEIMER'S DISEASE AND OTHER ORGANIC BRAIN DISORDERS. <P>[State that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's disease or related degenerative and dementing illnesses. Specifically describe each benefit screen or other policy provision which provides preconditions to the availability of policy benefits for such an insured.]</P> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)13.">13.</a></td> <td valign="top" style="text-align:left" class="leftalign"> PREMIUM. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)13.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign">[ State the total annual premium for the policy;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)13.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the premium varies with an applicant's choice among benefit options, indicate the portion of annual premium which corresponds to each benefit option.]</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)14.">14.</a></td> <td valign="top" style="text-align:left" class="leftalign"> ADDITIONAL FEATURES. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)14.(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign">[ Indicate if medical underwriting is used;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)14.(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Describe other important features.]</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.31(5)15.">15.</a></td> <td valign="top" style="text-align:left" class="leftalign"> CONTACT THE STATE SENIOR HEALTH INSURANCE ASSISTANCE PROGRAM IF YOU HAVE GENERAL QUESTIONS REGARDING LONG-TERM CARE INSURANCE. CONTACT THE INSURANCE COMPANY IF YOU HAVE SPECIFIC QUESTIONS REGARDING YOUR LONG-TERM CARE INSURANCE POLICY OR CERTIFICATE.</td> </tr> </table> </td> </tr> </table> <h2><a href="/GAC/120-2-16-.32" name="120-2-16-.32" title="120-2-16-.32">Rule 120-2-16-.32 Requirements to Deliver Shopper's Guide</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.32(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> 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 Commissioner, shall be provided to all prospective applicants of a long-term care insurance policy or certificate. <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.32(1)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the case of agent solicitations, an agent must deliver the shopper's guide prior to the presentation of an application or enrollment form.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.32(1)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In the case of direct response solicitations, the shopper's guide must be presented in conjunction with any application or enrollment form.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.32(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Life insurance policies or riders containing accelerated long-term care benefits are not required to furnish the above-referenced guide, but shall furnish the policy summary required under O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#" target="_newtab">33-42-6</a>.</td> </tr> </table> <h2><a href="/GAC/120-2-16-.33" name="120-2-16-.33" title="120-2-16-.33">Rule 120-2-16-.33 Penalties</a></h2> <P>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 such fines and penalties as provided under O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-2-24&amp;title=33#" target="_newtab">33-2-24</a>.</P> <P>APPENDIX A</P> <P>RESCISSION REPORTING FORM FOR</P> <P>LONG-TERM CARE POLICIES</P> <P>FOR THE STATE OF _______________</P> <P>FOR THE REPORTING YEAR 20[ ]</P> <P>Company Name: ___________________________________________________</P> <P>Address: ___________________________________________________ ___________________________________________________</P> <P>Phone Number: ____________________________________________________</P> <P>Due: March 1 annually</P> <P>Instructions:</P> <P>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.</P> <P> <TABLE> <TBODY> <TR> <TD rowspan="1" colspan="1"> <P>Policy</P> <P>Form #</P> </TD> <TD rowspan="1" colspan="1"> <P>Policy and</P> <P>Certificate #</P> </TD> <TD rowspan="1" colspan="1"> <P>Name of</P> <P>Insured</P> </TD> <TD rowspan="1" colspan="1"> <P>Date of</P> <P>Policy</P> <P>Issuance</P> </TD> <TD rowspan="1" colspan="1"> <P>Date/s</P> <P>Claim/s</P> <P>Submitted</P> </TD> <TD rowspan="1" colspan="1"> <P>Date of</P> <P>Rescission</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> </TBODY> </TABLE> </P> <P>Detailed reason for rescission:</P> <P>_____________________________________________________</P> <P>_____________________________________________________</P> <P>_____________________________________________________</P> <P>_____________________________________________________</P> <P>__________________________________</P> <P>Signature</P> <P>__________________________________</P> <P>Name and Title (please type)</P> <P>__________________________________</P> <P>Date</P> <P>APPENDIX B</P> <P>Long Term Care Insurance</P> <P>Personal Worksheet</P> <P>People buy long-term care insurance for many reasons. Some don't want to use their own assets to pay for long-term care. Some buy insurance to make sure they can choose the type of care they get. Others don't want their family to have to pay for care or don't want to go on Medicaid. But long term care insurance may be expensive, and may not be right for everyone.</P> <P>By state law, the insurance company must fill out part of the information on this worksheet and <B>ask</B> you to fill out the rest to help you and the company decide if you should buy this policy.</P> <P><B>Premium Information</B></P> <P>Policy Form Numbers__________________________</P> <P>The premium for the coverage you are considering will be [$_________ per month, or $_______ per year,] [a one-time single premium of $____________.]</P> <P><B>Type of Policy </B>(noncancellable/guaranteed renewable):</P> <P>________________________________________</P> <P><B>The Company's Right to Increase Premiums: </B></P> <P>______________________________________________</P> <P>[The company cannot raise your rates on this policy.] [The company has a right to increase premiums on this policy form in the future, provided it raises rates for all policies in the same class in this state.] [Insurers shall use appropriate bracketed statement. Rate guarantees shall not be shown on this form.]</P> <P><B>Rate Increase History</B></P> <P>The company has sold long-term care insurance since [year] and has sold this policy since [year]. [The company has never raised its rates for any long-term care policy it has sold in this state or any other state.] [The company has not raised its rates for this policy form or similar policy forms in this state or any other state in the last 10 years.] [The company has raised its premium rates on this policy form or similar policy forms in the last 10 years. Following is a summary of the rate increases.]</P> <P><B>Questions Related to Your Income</B></P> <P>How will you pay each year's premium?</P> <P>[] From my Income [] From my Savings/Investments [] My Family will Pay</P> <P>[ [] Have you considered whether you could afford to keep this policy if the premiums went up, for example, by 20%?]</P> <P>What is your annual income? (check one)</P> <P>[] Under $10,000 [] $[10-20,000] [] $[20-30,000] [] $[30-50,000] [] Over $50,000</P> <P>How do you expect your income to change over the next 10 years? (check one)</P> <P>[] No change [] Increase [] Decrease</P> <P><I>If you will be paying premiums with money received only from your own income, a rule of thumb is that you may not be able to afford this policy if the premiums will be more than 7% of your income.</I></P> <P><B>Will you buy inflation protection? </B>(check one) [] Yes [] No</P> <P>If not, have you considered how you will pay for the difference between future costs and your daily benefit amount?</P> <P>[] From my Income [] From my Savings/Investments [] My Family will Pay</P> <P><I>The national average annual cost of care in [insert year] was [insert $ amount], but this figure varies across the country. In ten years the national average annual cost would be about [insert $ amount] if costs increase 5% annually.</I></P> <P><B>What elimination period are you considering?</B> Number of days _______Approximate cost $__________ for that period of care.</P> <P><B>How are you planning to pay for your care during the elimination period?</B> (check one)</P> <P>[] From my Income [] From my Savings/Investments [] My Family will Pay</P> <P><B>Questions Related to Your</B><B>Savings and Investments</B></P> <P>Not counting your home, about how much are all of your assets (your savings and investments) worth? (check one)</P> <P>[] Under $20,000 [] $20,000-$30,000 [] $30,000-$50,000 [] Over $50,000</P> <P>How do you expect your assets to change over the next ten years? (check one)</P> <P>[] Stay about the same [] Increase [] Decrease</P> <P><I>If you are buying this policy to protect your assets and your assets are less than $30,000, you may wish to consider other options for financing your long-term care.</I></P> <P><B>Disclosure Statement</B></P> <P> <TABLE> <TBODY> <TR> <TD rowspan="1" colspan="1"> <P>[] The answers to the questions above describe my financial situation.</P> <P><B>Or</B></P> <P>[] I choose not to complete this information.</P> <P> (Check one.)</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>[] I acknowledge that the carrier and/or its agent (below) has reviewed this form with me including the premium, premium rate increase history and potential for premium increases in the future. [For direct mail situations, use the following: I acknowledge that I have reviewed this form including the premium, premium rate increase history and potential for premium increases in the future.] I understand the above disclosures. <B>I understand that the rates for this policy may increase in the future. </B>(This box must be checked).</P> </TD> </TR> </TBODY> </TABLE> </P> <P>Signed: _____________________________ _________________________</P> <P>(Applicant) (Date)</P> <P>[ [] I explained to the applicant the importance of completing this information.</P> <P>Signed: _____________________________ _________________________</P> <P>(Agent) (Date)</P> <P>Agent's Printed Name: [_________________________________________]</P> <P>[In order for us to process your application, please return this signed statement to [name of company], along with your application.]</P> <P>[My agent has advised me that this policy does not seem to be suitable for me. However, I still want the company to consider my application.</P> <P>Signed: ______________________________ _______________________]</P> <P>(Applicant) (Date)</P> <P><I>The company may contact you to verify your answers.</I></P> <P>APPENDIX C</P> <P>Things You Should Know Before You Buy</P> <P>Long-Term Care Insurance</P> <P> <TABLE> <TBODY> <TR> <TD rowspan="1" colspan="1"> <P><B>Long-Term</B></P> <P><B>Care</B></P> <P><B>Insurance</B></P> </TD> <TD rowspan="1" colspan="1"> <P> * A long-term care insurance policy may pay most of the costs for your care in a nursing home. Many policies also pay for care at home or other community settings. Since policies can vary in coverage, you should read this policy and make sure you understand what it covers before you buy it.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1"> <P>* [You should <B>not </B>buy this insurance policy unless you can afford to pay the premiums every year.] [Remember that the company can increase premiums in the future.]</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1"> <P> * The personal worksheet includes questions designed to help you and the company determine whether this policy is suitable for your needs.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P><B>Medicare</B></P> </TD> <TD rowspan="1" colspan="1"> <P>* Medicare does <B>not</B> pay for most long-term care.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P><B>Medicaid</B></P> </TD> <TD rowspan="1" colspan="1"> <P>* Medicaid will generally pay for long-term care if you have very little income and few assets. You probably should <B>not</B> buy this policy if you are now eligible for Medicaid.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1"> <P> * Many people become eligible for Medicaid after they have used up their own financial resources by paying for long-term care services.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1"> <P>* When Medicaid pays your spouse's nursing home bills, you are allowed to keep your house and furniture, a living allowance, and some of your joint assets.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1"> <P>* Your choice of long-term care services may be limited if you are receiving Medicaid. To learn more about Medicaid, contact your local or state Medicaid agency.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P><B>Shopper's</B></P> <P><B>Guide</B></P> </TD> <TD rowspan="1" colspan="1"> <P>* Make sure the insurance company or agent gives you a copy of a book called the National Association of Insurance Commissioners' "Shopper's Guide to Long-Term Care Insurance." Read it carefully. If you have decided to apply for long-term care insurance, you have the right to return the policy within 30 days and get back any premium you have paid if you are dissatisfied for any reason or choose not to purchase the policy.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P><B>Counseling</B></P> </TD> <TD rowspan="1" colspan="1"> <P>* Free counseling and additional information about long-term care insurance are available through your state's insurance counseling program. Contact your state insurance department or department on aging for more information about the senior health insurance counseling program in your state.</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P><B>Facilities</B></P> </TD> <TD rowspan="1" colspan="1"> <P>Some long-term care insurance contracts provide for benefit payments in certain facilities only if they are licensed or certified, such as in assisted living centers. However, not all states regulate these facilities in the same way. Also, many people move into a different state from where they purchased their long-term care insurance policy. Read the policy carefully to determine what types of facilities qualify for benefit payments, and to determine that payment for a covered service will be made if you move to a state that has a different licensing scheme for facilities than the one in which you purchased the policy.</P> </TD> </TR> </TBODY> </TABLE> </P> <P>APPENDIX D</P> <P>Long-Term Care Insurance Suitability Letter</P> <P>Dear [Applicant]:</P> <P>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.</P> <P>[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.]</P> <P>[You chose not to provide any financial information for us to review.]</P> <P><B>Drafting Note:</B> Choose the paragraph that applies.</P> <P>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.</P> <P>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.</P> <P><I>Please check one box and return in the enclosed envelope.</I></P> <P>[] <B>Yes</B>, [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.</P> <P><B>Drafting Note:</B> Delete the phrase in brackets if the applicant did not answer the questions about income.</P> <P>[] <B>No</B>. I have decided not to buy a policy at this time.</P> <P>____________________________ _______________________</P> <P>APPLICANT'S SIGNATURE DATE</P> <P><I>Please return to [issuer] at [address] by [date].</I></P> <P>APPENDIX E</P> <P>Claims Denial Reporting Form</P> <P>Long-Term Care Insurance</P> <P>For the State of __________________________</P> <P>For the Reporting Year of ________________</P> <P>Company Name:______________________________________________ Due: June 30 annually</P> <P>Company Address:________________________________________________________</P> <P>________________________________________________________________</P> <P>Company NAIC Number:_________________________________________</P> <P>Contact Person: ____________________Phone Number: ______________</P> <P>Line of Business: <U>Individual</U><U>Group</U></P> <P><U>Instructions</U></P> <P>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.</P> <P> <TABLE border="1"> <TBODY> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1"> <P><B>State Data</B></P> </TD> <TD rowspan="1" colspan="1"> <P><B>Nationwide Data</B><SUP>1</SUP></P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>1</P> </TD> <TD rowspan="1" colspan="1"> <P>Total Number of Long-Term Care Claims Reported</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>2</P> </TD> <TD rowspan="1" colspan="1"> <P>Total Number of Long-Term Care Claims Denied/Not Paid</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>3</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Claims Not Paid due to Preexisting Condition Exclusion</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>4</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Claims Not Paid due to Waiting (Elimination) Period Not Met</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>5</P> </TD> <TD rowspan="1" colspan="1"> <P>Net Number of Long-Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>6</P> </TD> <TD rowspan="1" colspan="1"> <P>Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>7</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Long-Term Care Claim Denied due to:</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>8</P> </TD> <TD rowspan="1" colspan="1"> <P>Long-Term Care Services Not Covered under the Policy<SUP>2</SUP></P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>9</P> </TD> <TD rowspan="1" colspan="1"> <P>Provider/Facility Not Qualified under the Policy<SUP>3</SUP></P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>10</P> </TD> <TD rowspan="1" colspan="1"> <P>Benefit Eligibility Criteria Not Met<SUP>4</SUP></P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>11</P> </TD> <TD rowspan="1" colspan="1"> <P>Other</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> </TBODY> </TABLE> </P> <P>1. 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.</P> <P>2. Example-home health care claim filed under a nursing home only policy.</P> <P>3. Example-a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy.</P> <P>4. Examples-a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care. </P> <P>APPENDIX F</P> <P>Instructions:</P> <P>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.</P> <P><B><U>Insurers shall provide all of the following information to the applicant: </U></B></P> <P><B>Long Term Care Insurance</B></P> <P><B>Potential Rate Increase Disclosure Form</B></P> <P>1. <B>[Premium Rate] [Premium Rate Schedules]</B>: [Premium rate] [Premium rate schedules] that [is][are] applicable to you and that will be in effect until a request is made and [filed][approved] for an increase [is][are] [on the application][$_____])</P> <P>2. <B>The [premium] [premium rate schedule] for this policy [will be shown on the schedule page of] [will be attached to] your policy.</B></P> <P>3. <B>Rate Schedule Adjustments</B>: </P> <P>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): __________________.</P> <P>4. <B>Potential Rate Revisions:</B></P> <P><B>This policy is Guaranteed Renewable</B>. This means that the rates for this product may be increased in the future. Your rates can NOT 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.</P> <P><B>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:</B></P> <P>* Pay the increased premium and continue your policy in force as is.</P> <P>* Reduce your policy benefits to a level such that your premiums will not increase. (Subject to state law minimum standards.)</P> <P>* Exercise your nonforfeiture option if purchased. (This option is available for purchase for an additional premium.)</P> <P>* Exercise your contingent nonforfeiture rights.* (This option may be available if you do not purchase a separate nonforfeiture option.)</P> <P><I>Turn the Page</I></P> <P><B>* <U>Contingent Nonforfeiture</U></B></P> <P>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:</P> <P>You will keep some long-term care insurance coverage, if:</P> <P>* Your premium after the increase exceeds your original premium by the percentage shown (or more) in the following table; and</P> <P>* You lapse (not pay more premiums) within 120 days of the increase.</P> <P>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.</P> <P>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.</P> <P>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.</P> <P><B>Example: </B> 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.)</P> <P><I>Turn the Page</I></P> <P> <TABLE> <TBODY> <TR> <TD colspan="2" rowspan="1"> <P><B><U>Contingent Nonforfeiture</U></B></P> <P><B>Cumulative Premium Increase over Initial Premium</B></P> <P><B>That qualifies for Contingent Nonforfeiture</B></P> <P>(Percentage increase is cumulative from date of original issue. It does NOT represent a one-time increase.)</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P><B>Issue Age</B></P> </TD> <TD rowspan="1" colspan="1"> <P><B>Percent Increase Over Initial Premium</B></P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>29 and under</P> </TD> <TD rowspan="1" colspan="1"> <P>200%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>30-34</P> </TD> <TD rowspan="1" colspan="1"> <P>190%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>35-39</P> </TD> <TD rowspan="1" colspan="1"> <P>170%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>40-44</P> </TD> <TD rowspan="1" colspan="1"> <P>150%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>45-49</P> </TD> <TD rowspan="1" colspan="1"> <P>130%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>50-54</P> </TD> <TD rowspan="1" colspan="1"> <P>110%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>55-59</P> </TD> <TD rowspan="1" colspan="1"> <P>90%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>60</P> </TD> <TD rowspan="1" colspan="1"> <P>70%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>61</P> </TD> <TD rowspan="1" colspan="1"> <P>66%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>62</P> </TD> <TD rowspan="1" colspan="1"> <P>62%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>63</P> </TD> <TD rowspan="1" colspan="1"> <P>58%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>64</P> </TD> <TD rowspan="1" colspan="1"> <P>54%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>65</P> </TD> <TD rowspan="1" colspan="1"> <P>50%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>66</P> </TD> <TD rowspan="1" colspan="1"> <P>48%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>67</P> </TD> <TD rowspan="1" colspan="1"> <P>46%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>68</P> </TD> <TD rowspan="1" colspan="1"> <P>44%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>69</P> </TD> <TD rowspan="1" colspan="1"> <P>42%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>70</P> </TD> <TD rowspan="1" colspan="1"> <P>40%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>71</P> </TD> <TD rowspan="1" colspan="1"> <P>38%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>72</P> </TD> <TD rowspan="1" colspan="1"> <P>36%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>73</P> </TD> <TD rowspan="1" colspan="1"> <P>34%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>74</P> </TD> <TD rowspan="1" colspan="1"> <P>32%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>75</P> </TD> <TD rowspan="1" colspan="1"> <P>30%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>76</P> </TD> <TD rowspan="1" colspan="1"> <P>28%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>77</P> </TD> <TD rowspan="1" colspan="1"> <P>26%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>78</P> </TD> <TD rowspan="1" colspan="1"> <P>24%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>79</P> </TD> <TD rowspan="1" colspan="1"> <P>22%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>80</P> </TD> <TD rowspan="1" colspan="1"> <P>20%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>81</P> </TD> <TD rowspan="1" colspan="1"> <P>19%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>82</P> </TD> <TD rowspan="1" colspan="1"> <P>18%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>83</P> </TD> <TD rowspan="1" colspan="1"> <P>17%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>84</P> </TD> <TD rowspan="1" colspan="1"> <P>16%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>85</P> </TD> <TD rowspan="1" colspan="1"> <P>15%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>86</P> </TD> <TD rowspan="1" colspan="1"> <P>14%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>87</P> </TD> <TD rowspan="1" colspan="1"> <P>13%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>88</P> </TD> <TD rowspan="1" colspan="1"> <P>12%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>89</P> </TD> <TD rowspan="1" colspan="1"> <P>11%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>90 and over</P> </TD> <TD rowspan="1" colspan="1"> <P>10%</P> </TD> </TR> </TBODY> </TABLE> </P> <P>[The following contingent nonforfeiture disclosure need only be included for those limited pay policies to which Sections 28D(4) and 28D(6) of the regulation are applicable].</P> <P>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 chose either of the two benefits.</P> <P>You are eligible for the reduced "paid-up" contingent nonforfeiture benefit when all three conditions shown below are met:</P> <P>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; </P> <P> <TABLE> <TR> <TD colspan="2" rowspan="1"> <P>Triggers for a Substantial Premium Increase</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Issue Age</P> </TD> <TD rowspan="1" colspan="1"> <P>Percent Increase</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;&nbsp;</TD> <TD rowspan="1" colspan="1"> <P>Over Initial Premium</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Under 65</P> </TD> <TD rowspan="1" colspan="1"> <P> 50%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>65-80</P> </TD> <TD rowspan="1" colspan="1"> <P> 30%</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Over 80</P> </TD> <TD rowspan="1" colspan="1"> <P> 10%</P> </TD> </TR> </TABLE> </P> <P>2. You stop paying your premiums within 120 days of when the premium increase took effect; AND</P> <P>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. </P> <P>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:</P> <P>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.</P> <P>b. The daily benefit amounts you purchased will also be adjusted by the same ratio. </P> <P>If you purchased lifetime benefits, only the daily benefit amounts you purchased will be adjusted by the applicable ratio.</P> <P><B>Example:</B></P> <P>* You bought the policy at age 65 with an annual premium payable for 10 years.</P> <P>* In the sixth year, you receive a rate increase of 35% and you decide to stop paying premiums.</P> <P>* Because you have already paid 50% of your total premium payments and that is more than the 40% ratio, your "paid-up" policy benefits are .45 (.90 times .50) times the total benefit amount that was in effect when you stopped paying your premiums. If you purchased inflation protection, it will not continue to apply to the benefits in the reduced "paid-up" policy.</P> <P>Appendix G</P> <P>Long-Term Care Insurance</P> <P>Replacement and Lapse Reporting Form</P> <P>For the State of _________________________</P> <P>For the Reporting Year of ______________</P> <P>Company Name: _______________________________</P> <P>Due: June 30 annually</P> <P>Company Address: _______________________________</P> <P>Company NAIC Number: _________</P> <P>Contact Person: _______________________________</P> <P>Phone Number: (____)___________</P> <P><B>Instructions</B></P> <P>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.</P> <P><B>Listing of the 10% of Agents with the Greatest Percentage of Replacements</B></P> <P> <TABLE> <TBODY> <TR> <TD rowspan="1" colspan="1"> <P>Agent's Name</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Policies Sold By This Agent</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Policies Replaced By This Agent</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Replacements As % of Number Sold By This Agent</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> </TBODY> </TABLE> </P> <P><B>Listing of the 10% of Agents with the Greatest Percentage of Lapses</B></P> <P> <TABLE> <TBODY> <TR> <TD rowspan="1" colspan="1"> <P>Agent's Name</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Policies Sold By This Agent</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Policies Lapsed By This Agent</P> </TD> <TD rowspan="1" colspan="1"> <P>Number of Lapses As % of Number Sold By This Agent</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> </TBODY> </TABLE> </P> <P><B>Company Totals</B></P> <P>Percentage of Replacement Policies Sold to Total Annual Sales ____%</P> <P>Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year) ____%</P> <P>Percentage of Lapsed Policies to Total Annual Sales _____%</P> <P>Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) _____%</P> <h2><a href="/GAC/120-2-16-.34" name="120-2-16-.34" title="120-2-16-.34">Rule 120-2-16-.34 Georgia Long - Term Care Insurance Partnership Program</a></h2> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(1)">(1)</a></td> <td valign="top" style="text-align:left" class="leftalign"> In accordance with § 6021 of the Deficit Reduction Act of 2005 ( Pub.L. 109-171 ) and O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=49-4-162&amp;title=49#" target="_newtab">49-4-162</a>, in addition to the applicable provisions of this Rule Chapter, the provisions of this section shall apply to any qualified state long-term care insurance partnership policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)">(2)</a></td> <td valign="top" style="text-align:left" class="leftalign"> "Qualified state long-term care insurance partnership policy'' or "partnership policy'' means an insurance policy that meets all the requirements specified in O.C.G.A Sections <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-4&amp;title=33#" target="_newtab">33-42-4</a> and <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=49-4-162&amp;title=49#" target="_newtab">49-4-162</a> and meets the following requirements: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy covers an insured who was a resident of the State of Georgia (a Partnership State) when coverage first became effective under the policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy is a qualified long-term care insurance policy as defined in § 7702B(b) of the Internal Revenue Code of 1986 and was issued no earlier than January 1, 2007.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy meets all the applicable requirements of this Rule and the requirements of the National Association of Insurance Commissioners long-term care insurance model act and model regulation as those requirements are set forth in § 1917(b)(5)(A) of the Social Security Act <I>( <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1396&amp;title=42#" target="_newtab">42 USC § 1396</a> p</I><I>(b)(5)(A)</I>).</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(d)">(d)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The policy provides the following inflation protections: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(d)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the policy is sold to an individual who has not attained age 61 as of the date of purchase, the policy shall provide compound annual inflation protection;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(d)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the policy is sold to an individual who has attained age 61 but has not attained age 76 as of the date of purchase, the policy shall provide some level of inflation protection;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(d)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> If the policy is sold to an individual who has attained age 76 as of the date of purchase, the policy may provide inflation protection, but is not required.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(2)(e)">(e)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The Commissioner may also approve new and innovative inflation protection methods so long as such method is submitted to the Commissioner with an explanation and demonstration as to how the alternative method 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. No such method may be used until the Commissioner has approved such method.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(3)">(3)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(3)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> An insurer or its agent, soliciting or offering to sell a policy that is intended to qualify as a partnership policy, shall provide to each prospective applicant a Partnership Program Notice (Form LTCP 200-A), outlining the requirements and benefits of a partnership policy. A similar notice may be used for this purpose if filed and approved by the Commissioner. The Partnership Program Notice shall be provided with the required Outline of Coverage.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(3)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A partnership policy issued or issued for delivery in the State of Georgia shall be accompanied by a Partnership Disclosure Notice (Form LTCP 200-B) explaining the benefits associated with a partnership policy and indicating that at the time issued, the policy is a qualified state long-term care insurance partnership policy. A similar notice may be used if filed and approved by the Commissioner. The Partnership Disclosure Notice shall also include a statement indicating that by purchasing this partnership policy, the insured does not automatically qualify for Medicaid.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(4)">(4)</a></td> <td valign="top" style="text-align:left" class="leftalign"> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(4)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> A partnership policy shall not be issued or issued for delivery in this State unless filed with and approved by the Commissioner in accordance with the procedures set forth in O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-24-9&amp;title=33#" target="_newtab">33-24-9</a>. Any policy submitted for approval as a partnership policy shall be accompanied by a Partnership Certification Form (Form LTCP 200-C), or a similar form filed and approved by the Commissioner.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(4)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Insurers requesting to make use of a previously approved policy form as a qualified state long-term care partnership policy shall submit to the Commissioner a Partnership Certification Form signed by an officer of the company. The Partnership Certification Form shall be accompanied by a copy of the policy or certificate form listed, the approval date, and a bookmark for each of the requirements listed in sections II and III of the form. A Partnership Certification Form shall be required for each policy form submitted for partnership qualification.</td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)">(5)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Agent training requirements. On and after January 1, 2009 an individual may not sell, solicit or negotiate a partnership policy unless the individual is a licensed and appointed insurance agent in accordance with provisions of O.C.G.A. Chapter 33-23 and has completed an initial training component and ongoing training every 24 months thereafter. The training shall meet the following requirements: <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(a)">(a)</a></td> <td valign="top" style="text-align:left" class="leftalign"> All training shall be approved as continuing education by the Commissioner in accordance with O.C.G.A. Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-23-18&amp;title=33#" target="_newtab">33-23-18</a>.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(b)">(b)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The initial training required by this subsection shall be no less than eight hours, and the on-going training required by this subsection shall be no less than four hours.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)">(c)</a></td> <td valign="top" style="text-align:left" class="leftalign"> The training required under subdivision (b) of this subsection shall consist of topics related to long-term care insurance, long-term care services, and qualified state long-term care insurance partnership programs, including, but not limited to <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)1.">1.</a></td> <td valign="top" style="text-align:left" class="leftalign"> State and federal regulations and requirements and the relationship between qualified state long-term care insurance partnership programs and other public and private coverage of long-term care services, including Medicaid;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)2.">2.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Available long-term care services and providers;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)3.">3.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Changes or improvements in long-term care services or providers;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)4.">4.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Alternatives to the purchase of private long-term care insurance;</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)5.">5.</a></td> <td valign="top" style="text-align:left" class="leftalign"> The effect of inflation on benefits and the importance of inflation protection; and</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(5)(c)6.">6.</a></td> <td valign="top" style="text-align:left" class="leftalign"> Consumer suitability standards and guidelines.</td> </tr> </table> </td> </tr> </table> </td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(6)">(6)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Insurers offering a partnership policy shall obtain verification that an agent has received the training required by subsection (5) of this section before the agent is permitted to sell, solicit or negotiate the insurer's partnership policy.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(7)">(7)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each insurer shall maintain records with respect to the training of its agents qualified to sell, solicit or negotiate partnership policies, to include training received and that the agent has demonstrated an understanding of the partnership policies and their relationship to public and private coverage of long-term care, including Medicaid, in this State. These records shall be maintained for a period of not less than five years and shall be made available to the Commissioner upon request.</td> </tr> </table> <table border="0" width="100%" cellspacing="4" cellpadding="4"> <tr> <td valign="top" width="1%" style="white-space:nowrap;text-align:left;width:18px;"><a style="white-space:nowrap;" name="120-2-16-.34(8)">(8)</a></td> <td valign="top" style="text-align:left" class="leftalign"> Each insurer issuing a partnership policy shall provide regular reports to the United States Secretary of Health and Human Services in accordance with regulations of the Secretary that include notification of the date benefits were paid, the amount paid, the date the policy terminates, and such other information as the Secretary determines may be appropriate to the administration of partnerships. <P>Office of Commissioner of Insurance</P> <P>State of Georgia form LTCP 200-A</P> </td> </tr> </table> <P><B>Partnership Program Notice</B></P> <P>Important Consumer Information regarding the Georgia Long Term Care Insurance Partnership Program</P> <P>Some long term care insurance policies [certificates] sold in Georgia may qualify for the Georgia Long tern Care Insurance Partnership Program (the Partnership Program). The Partnership Program is a partnership between state government and private insurance companies to assist individuals in planning their long term care needs. Insurance companies voluntarily agree to participate in the Partnership Program by offering long term care insurance coverage that meets certain sate and federal requirements. Long Term care insurance policies [certificates] that qualify as partnership policies [certificates] may protect the policyholder's [certificateholder's] assets through a feature known as "asset disregard" under Georgia's Medicaid Program.</P> <P><B><U> Asset Disregard</U></B> means that an amount of the policyholder's [certificate holder's] assets equal to the amount of long term care insurance benefits received under a qualified Partnership Policy [Certificate] will be disregarded for the purpose of determining the insured's eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a qualified Partnership Policy [Certificate] without affecting the person's eligibility for Medicaid. All of the Medicaid eligibility criteria will apply and special rules may apply to persons whose home equity exceeds $500,000. Asset Disregard is <B>not</B> available under a long term care insurance policy [certificate] that is not a Partnership Policy [Certificate]. Therefore, you should consider if Asset Disregard is important to you, and whether a Partnership Policy meets your needs. <B>The purchase of a Partnership Policy does not automatically qualify you for Medicaid.</B></P> <P><B><U>What are the Requirements for a Partnership Policy [Certificate]?</U></B> In order for a policy [certificate] to qualify as a Partnership Policy [Certificate], it must, among other requirements:</P> <P>1. Be issued to an individual after January 1, 2007;</P> <P>2. Cover an individual who was a State of Georgia resident when coverage first becomes effective under the policy;</P> <P>3. Be a tax-qualified policy under Section 7702(B)(b) of the Internal Revenue Code of 1986;</P> <P>4. Meet stringent consumer protection standards; and</P> <P>5. Meet the following inflation protection requirements: </P> <P>For ages 60 or younger - provides compound annual inflation protection</P> <P>For ages 61 to 75 - provides some level of inflation protection</P> <P>For ages 76 and older - no purchase of inflation protection is required</P> <P>If you apply and are approved for long term care insurance coverage, [carrier name] will provide you with written documentation as to whether or not your policy [certificate] qualifies as a Partnership Policy [Certificate].</P> <P><B><U>What Could Disqualify a Policy [Certificate] as a Partnership Policy.</U></B> Certain types of changes to a Partnership Policy [Certificate] could affect whether or not such policy [certificate] continues to be a Partnership Policy [Certificate]. If you purchase a Partnership Policy [Certificate] and later decide to make any changes, you should first consult with [carrier name] to determine the effect of a proposed change. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy [certificate] as a Partnership Policy [Certificate], you would not receive beneficial treatment of your policy [certificate] under the Medicaid program of that state. The information contained in this disclosure is based on current Georgia and Federal law. These laws may be subject to change. Any change in law could reduce or eliminate the beneficial treatment of your policy [certificate] under Georgia's Medicaid Program.</P> <P><B><U>Additional Information.</U></B> If you have questions regarding long term care insurance policies [certificates] please contact [carrier name]. If you have questions regarding current laws governing Medicaid eligibility, you should contact the Georgia Department of Medical Assistance.</P> <P>Office of Commissioner of Insurance</P> <P>State of Georgia form LTCP 200-C</P> <P><B>Long Term Care Partnership</B></P> <P><B>Certification Form</B></P> <P>Note: This Form must be completed and submitted with each long term care policy or certificate form for which the insurer is seeking Partnership qualification. A separate form must be completed for each policy form and a specimen copy of the form, including all riders and endorsement, must be attached. A long term care insurance policy or certificate form may not be issued in Georgia as a partnership policy or certificate unless and until this form has been submitted to an approved by the Office of Commissioner of Insurance, State of Georgia.</P> <P>__________________________________________________</P> <P>Under Section 1917(b)(5)(B)(iii) of the Social Security Act ( <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1396&amp;title=42#" target="_newtab">42 U.S.C. 1396</a> p(b)(5)(B)(iii) and in accordance with O.C.G.A Section <a href="https://links.casemakerlegal.com/states/ga/books/Code_of_Georgia/browse?ci=25&amp;id=gasos&amp;codesec=33-42-6&amp;title=33#" target="_newtab">33-42-6</a> and Rule <a title="120-2-16-.34" href="120-2-16-.34">120-2-16-.34</a>, the insurer hereby submits information relating to policy or certificate form _______________________ (form number) to substantiate that the form includes all required consumer protection requirements set forth in Section 1917(b)(5)(A) of the Social Security Act ( <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=1396&amp;title=42#" target="_newtab">42 U.S.C. 1396</a> p(b)(5)(B)(iii) and that it includes certain specified provisions of the Long Term Care Insurance Model Regulation and Long Term Care Insurance Model Act promulgated by the National Association of Insurance Commissioners (adopted as of October, 2000) (referred to herein as the "2000 Model Regulation" and "2000 Model Act," respectively).</P> <P><B><U>Part I:</U></B></P> <P>Name of Insurer __________________________________________</P> <P>Company NAIC# __________________________________________</P> <P>Address __________________________________________</P> <P>__________________________________________</P> <P>__________________________________________</P> <P>Telephone: __________________________________________</P> <P>Company Contact Name________________________________________</P> <P>Title __________________________________________</P> <P>Telephone __________________________________________</P> <P>E-Mail __________________________________________</P> <P><B>Part II:</B></P> <P>___________________________________________________</P> <P><B>2000 NAIC MODEL REGULATION AND 2000 NAIC MODEL ACT</B></P> <P>Note to Insurer: Identify the page and/or provision within the policy or certificate form that addresses each requirement, or, if inapplicable, use the space identified to explain.</P> <P>Policy/Certificate form ___________________ meets the following requirements of the 2000 NAIC Model Long Term Care Regulation and/or 2000 NAIC Model Long Term Care Act, as indicated below:</P> <P> <TABLE> <TBODY> <TR> <TD rowspan="1" colspan="1"> <P>NAIC Model Regulation Requirement</P> </TD> <TD rowspan="1" colspan="1"> <P>Identify Policy Page # and Provision OR use this space to explain if requirement is inapplicable</P> </TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6A (relating to guaranteed renewal or noncancellability), other than paragraph (5) thereof, and the requirements of Section 6B of the 2000 Model Act relating to such Section 6A.</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6B (relating to prohibitions on limitations and exclusions) other than paragraph (7) thereof.</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6C (relating to extension of benefits)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6D (relating to continuation or conversion of coverage)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6E (relating to discontinuance and replacement of policies)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 7 (relating to unintentional lapse)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 8 (relating to disclosure), other than Sections 8F, 8G, 8H and 8I thereof.</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 9 (relating to required disclosure of rating practices to consumer)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 11 (relating to prohibitions against post-claims underwriting)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 12 (relating to minimum standards)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 14 (relating to application forms and replacement coverage)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 15 (relating to reporting requirements)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 22 (relating to filing requirements for marketing)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 23 (relating to standards for marketing), including inaccurate completion of medical histories, other than paragraphs (1), (6), and (9) of Section 23C.</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 24 (relating to suitability)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 25 (relating to prohibition against preexisting conditions and probationary periods in replacement policies or certificates)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 26, (relating to contingent nonforfeiture benefits, if the policyholder declines the offer of a nonforfeiture provision described in Section 7702B(g)(4) of the Internal Revenue Code of 1986 ( <a href="https://links.casemakerlegal.com/states/us/books/United_States_Code/browse?ci=25&amp;id=gasos&amp;codesec=7702&amp;title=26#" target="_newtab">26 U.S.C. 7702</a> B(g)(4).)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 29 (relating to standard format outline of coverage)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 30 (relating to requirement to deliver shopper's guide)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6C (relating to preexisting conditions)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6D (relating to prior hospitalization)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 8 (relating to contingent nonforfeiture benefits)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6F (relating to right to return)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6G (relating to outline of coverage)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6H (relating to requirements for certificates under group plans)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6J (relating to policy summary)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 6K (relating to monthly reports on accelerated death benefits)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> <TR> <TD rowspan="1" colspan="1"> <P>Section 7 (relating to incontestability period)</P> </TD> <TD rowspan="1" colspan="1">&nbsp;</TD> </TR> </TBODY> </TABLE> </P> <P><B><U>Part III.</U></B><B> INFLATION PROTECTION</B></P> <P>Identify the policy provision or provide form number of endorsement or amendment form (and date of approval) for inflation protection coverage in compliance with Rule <a title="120-2-16-.13(1)(a)(i) through (iii)" href="120-2-16-.13#120-2-16-.13(1)(a)(i) through (iii)">120-2-16-.13(1)(a)(i) through (iii)</a>:</P> <P>_________________________________________________</P> <P>_________________________________________________</P> <P>_________________________________________________</P> <P><B><U>Part IV.</U></B><B> CERTIFICATION</B></P> <P>I hereby certify that the answers, accompanying documents, and other information set forth herein are, to the best of my knowledge and belief, true, correct, complete and the policy [certificate] satisfies the requirements necessary for a qualified state long term care insurance partnership policy in the State of Georgia.</P> <P>_________________________ _______________________________________</P> <P>Date Name and Title of Officer of the Insurer</P> <P>____________________________________________</P> <P>Signature of Officer of the Insurer</P> <P><B>Attachment C</B></P> <P><B>Georgia</B><B>Department</B><B>of Community Health</B></P> <P><B>Division of Medical Assistance</B></P> <P><B>Important Notice Regarding Your Policy's</B></P> <P><B>Long-Term Care Insurance Partnership Status</B></P> <P>(Please keep this Notice with Your Policy or Certificate)</P> <P><B>The Georgia Long Term Care Partnership. </B></P> <P>The Georgia Long-Term Care Partnership is an innovative partnership between Georgia and private insurers of Long-Term Care insurance policies (or certificates). The Georgia Long-Term Care Partnership became effective on January 1, 2007 and is provided in accordance with the Deficit Reduction Act of 2005 ( P.L. 109-171 ).</P> <P><B>Partnership Policy [Certificate] Status. </B></P> <P>Your long term care insurance policy [certificate] is intended to qualify as a Partnership Policy [Certificate] under the Georgia Long Term Care Partnership Program as of your Policy's [Certificate's] effective date.</P> <P><B>Medicaid Asset Protection Provided. </B></P> <P>Long-Term care insurance is an important tool that helps individuals prepare for future long-term care needs. Partnership Policies provide an additional level of protection. In particular, such policies permit individuals to protect additional assets from spend-down requirements under the State's Medicaid program if assistance under this program is ever needed and you otherwise qualify for Medicaid.</P> <P>Specifically, the asset eligibility and recovery provisions of the Medicaid program of Georgia are applied by disregarding an additional amount of assets which is equal to the amount of insurance benefits you have received from your Partnership Policy. For example, if you receive $200,000 of insurance benefits from your Partnership policy, you generally would be able to retain $200,000 of assets above and beyond the amount of assets normally permitted for Medicaid eligibility.</P> <P>Other Medicaid eligibility requirements apart from permissible assets must be met, including special rules that may apply if the equity in your home exceeds $500,000. In addition, you must meet the Medicaid program's income requirements and may be required to contribute some of your income to the costs of your care once you become eligible for Medicaid. Medicaid eligibility requirements may change over time. The purchase of this Partnership Policy does not automatically qualify you for Medicaid.</P> <P><B>Additional Consumer Protections. </B></P> <P>In addition to providing Medicaid asset protection, your Partnership Policy has other important features. Under the rules governing Georgia Long-Term Care Partnership, your Partnership Policy must be a qualified long term care insurance contract under Federal tax law, and as such the insurance benefits you receive from the policy generally will be subject to beneficial income tax treatment. (Please note that a policy can be a qualified long-term care insurance contract under Federal tax law, with the same beneficial income tax treatment, even if it is not a Partnership Policy.) In addition, the long term care partnership policy must provide inflation protection as specified, according to the policy holder's age when the policy was issued:</P> <P>- compound annual inflation protection, if the individual was under 61 years of age when the policy was issued,</P> <P>- at least some level of inflation protection, if the individual was age 61 to 76 years when the policy was issued.</P> <P>If the individual was 76 years of age or older when the policy was issued, inflation protection may be offered but is not required.</P> <P><B>What Could Disqualify Your Policy as a Partnership Policy? </B></P> <P>If you make any changes to your policy or certificate, such changes may affect whether your policy or certificate continues to qualify as a Partnership Policy. Before you make any changes, you should consult with the issuer of your policy (certificate) to determine the effect of a proposed change. In addition, if you move to a State that does not maintain a Qualified Partnership or does not recognize your policy (certificate) as a Partnership Policy, you would not receive Medicaid asset protection in that State. Changes in Federal or State law may affect the Medicaid asset protection available with respect to your Partnership Policy (Certificate).</P> <P><B>Additional Information. </B></P> <P>If you have questions regarding your insurance policy (certificate), please contact (carrier name)<B>. </B>If you would like further information about the Medicaid asset protection provided by your Partnership Policy (Certificate) or the Georgia Long Term-Care Partnership Program, please call 1-800-669-8387 or visit <a class="LinkOut" href="http://www.dch.georgia. gov" target="_blank">www.dch.georgia.gov</a>.</P> </div> </div> </HTML> </div> <div id="toc" class="sidebar noprint"> <ul id="toc-children" class="children"><li><a href="/GAC/120-2-16-.01" name="120-2-16-.01" title="120-2-16-.01">Rule 120-2-16-.01 Purpose</a></li><li><a href="/GAC/120-2-16-.02" name="120-2-16-.02" title="120-2-16-.02">Rule 120-2-16-.02 Authority</a></li><li><a href="/GAC/120-2-16-.03" name="120-2-16-.03" title="120-2-16-.03">Rule 120-2-16-.03 Applicability and Scope</a></li><li><a href="/GAC/120-2-16-.04" name="120-2-16-.04" title="120-2-16-.04">Rule 120-2-16-.04 Definitions</a></li><li><a href="/GAC/120-2-16-.05" name="120-2-16-.05" title="120-2-16-.05">Rule 120-2-16-.05 Policy Definitions</a></li><li><a href="/GAC/120-2-16-.06" name="120-2-16-.06" title="120-2-16-.06">Rule 120-2-16-.06 Policy Practices and Provisions</a></li><li><a href="/GAC/120-2-16-.07" name="120-2-16-.07" title="120-2-16-.07">Rule 120-2-16-.07 Unintentional Lapse</a></li><li><a href="/GAC/120-2-16-.08" name="120-2-16-.08" title="120-2-16-.08">Rule 120-2-16-.08 Required Disclosure Provisions</a></li><li><a href="/GAC/120-2-16-.09" name="120-2-16-.09" title="120-2-16-.09">Rule 120-2-16-.09 Required Disclosure of Rating Practices to Consumers</a></li><li><a href="/GAC/120-2-16-.10" name="120-2-16-.10" title="120-2-16-.10">Rule 120-2-16-.10 Intial Filing Requirements</a></li><li><a href="/GAC/120-2-16-.11" name="120-2-16-.11" title="120-2-16-.11">Rule 120-2-16-.11 Prohibition Against Post - Claims Underwriting</a></li><li><a href="/GAC/120-2-16-.12" name="120-2-16-.12" title="120-2-16-.12">Rule 120-2-16-.12 Minimum Standards for Home Health and Community Care Benefits in Long - Term Care Insurance Policies</a></li><li><a href="/GAC/120-2-16-.13" name="120-2-16-.13" title="120-2-16-.13">Rule 120-2-16-.13 Requirement to Offer Inflation Protection</a></li><li><a href="/GAC/120-2-16-.14" name="120-2-16-.14" title="120-2-16-.14">Rule 120-2-16-.14 Requirements for Application Forms and Replacement Coverage</a></li><li><a href="/GAC/120-2-16-.15" name="120-2-16-.15" title="120-2-16-.15">Rule 120-2-16-.15 Reporting Requirements</a></li><li><a href="/GAC/120-2-16-.16" name="120-2-16-.16" title="120-2-16-.16">Rule 120-2-16-.16 Licensing</a></li><li><a href="/GAC/120-2-16-.17" name="120-2-16-.17" title="120-2-16-.17">Rule 120-2-16-.17 Discretionary Powers of Commissioner</a></li><li><a href="/GAC/120-2-16-.18" name="120-2-16-.18" title="120-2-16-.18">Rule 120-2-16-.18 Reserve Standards</a></li><li><a href="/GAC/120-2-16-.19" name="120-2-16-.19" title="120-2-16-.19">Rule 120-2-16-.19 Loss Ratio</a></li><li><a href="/GAC/120-2-16-.20" name="120-2-16-.20" title="120-2-16-.20">Rule 120-2-16-.20 Premium Rate Schedule Increases</a></li><li><a href="/GAC/120-2-16-.21" name="120-2-16-.21" title="120-2-16-.21">Rule 120-2-16-.21 Filing Requirement</a></li><li><a href="/GAC/120-2-16-.22" name="120-2-16-.22" title="120-2-16-.22">Rule 120-2-16-.22 Filing Requirements for Advertising</a></li><li><a href="/GAC/120-2-16-.23" name="120-2-16-.23" title="120-2-16-.23">Rule 120-2-16-.23 Standards for Marketing</a></li><li><a href="/GAC/120-2-16-.24" name="120-2-16-.24" title="120-2-16-.24">Rule 120-2-16-.24 Suitability</a></li><li><a href="/GAC/120-2-16-.25" name="120-2-16-.25" title="120-2-16-.25">Rule 120-2-16-.25 Prohibition Against Preexisting Conditions and Probationary Periods in Replacement Policies or Certificates</a></li><li><a href="/GAC/120-2-16-.26" name="120-2-16-.26" title="120-2-16-.26">Rule 120-2-16-.26 Availability of New Services or Providers</a></li><li><a href="/GAC/120-2-16-.27" name="120-2-16-.27" title="120-2-16-.27">Rule 120-2-16-.27 Right to Reduce Coverage and Lower Premiums</a></li><li><a href="/GAC/120-2-16-.28" name="120-2-16-.28" title="120-2-16-.28">Rule 120-2-16-.28 Nonforfeiture Benefit Requirement</a></li><li><a href="/GAC/120-2-16-.29" name="120-2-16-.29" title="120-2-16-.29">Rule 120-2-16-.29 Standards for Benefit Triggers</a></li><li><a href="/GAC/120-2-16-.30" name="120-2-16-.30" title="120-2-16-.30">Rule 120-2-16-.30 Additional Standards for Benefit Triggers for Qualified Long - Term Care Insurance Contracts</a></li><li><a href="/GAC/120-2-16-.31" name="120-2-16-.31" title="120-2-16-.31">Rule 120-2-16-.31 Standard Format Outline of Coverage</a></li><li><a href="/GAC/120-2-16-.32" name="120-2-16-.32" title="120-2-16-.32">Rule 120-2-16-.32 Requirements to Deliver Shopper's Guide</a></li><li><a href="/GAC/120-2-16-.33" name="120-2-16-.33" title="120-2-16-.33">Rule 120-2-16-.33 Penalties</a></li><li><a href="/GAC/120-2-16-.34" name="120-2-16-.34" title="120-2-16-.34">Rule 120-2-16-.34 Georgia Long - Term Care Insurance Partnership Program</a></li></ul> </div> </div> <!--content ends here--> <div id="footer" class="noprint"><span class="footer">Copyright &copy; 2019 Lawriter LLC - All rights reserved.</span>| <a href="mailto:support@casemakerlegal.com?subject=Rules and Regulations of the State of Georgia">Email Us</a> | 844-838-0769 | <a href="http://livechat.casemakerlegal.com/client.php?locale=en" target="_blank" onclick="if(navigator.userAgent.toLowerCase().indexOf('opera') != -1 && window.event.preventDefault)window.event.preventDefault();this.newWindow = window.open('http://livechat.casemakerlegal.com/client.php?locale=en&url='+escape(document.location.href)+'&referrer='+escape(document.referrer), 'webim','toolbar=0,scrollbars=0,location=0,status=1,menubar=0,width=640,height=480,resizable=1');this.newWindow.focus();this.newWindow.opener=window;return false;">Live Chat</a> </div> </div> </body> </html>