Section 26-A2611. REPORTING REQUIREMENTS

 

2611.1Every 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.

 

2611.2Every insurer shall report annually by June 30 the ten percent (10%) of its agents with the greatest percentages of lapses and replacements as measured by subsection 2611.1 above.

 

2611.3Reported 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.

 

2611.4Every 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.

 

2611.5Every 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.

 

2611.6Every 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)

 

2611.7The following terms are defined for purposes of this section as follows:

 

(a)"Policy" - only long-term care insurance;

 

(b)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;

 

(c)"Denied" - 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

 

(d)"Report" - on a statewide basis.

 

2611.8Reports required under this section shall be filed with the Commissioner.

 

source

Final Rulemaking published at 52 DCR 10902 (December 16, 2005).