Current through Reg. 50, No. 187; September 24, 2024
(1) No group long-term care insurance
coverage may be offered to a resident of this state under a group policy issued
in another state to a group described in Section
627.9405(1)(c) or
(d), F.S., unless this state or such other
state having statutory and regulatory long-term care insurance requirements
substantially similar to those adopted in this state has made a determination
that such requirements have been met. Evidence to this effect shall be filed by
the insurer with the Office pursuant to the procedures specified in Section
627.410, F.S. Such evidence
shall consist of:
(a) Filing of policy and
certificate forms, including rates and rate development information, which
demonstrate that the requirements of Sections 627.9401-.9408, F.S., and these
rules have been met, except Section
627.9405(2)
F.S.; or
(b)
1. Filing of a truthful certification by an
officer of the insurer that another state having statutory and regulatory
long-term care insurance requirements substantially similar to those adopted in
Florida has made a determination that such requirements have been met;
and
2. Filing of the policy and
certificate forms to be issued and delivered, including rates and rate
development information, which demonstrate that the requirements of another
state having statutory and regulatory long-term care insurance requirements
substantially similar to those adopted in Florida have been
met.
(2) In
order for a state to be deemed to have statutory and regulatory long-term care
insurance requirements substantially similar to those adopted in Florida, such
state must require that long-term care policies meet at least all of the
following requirements:
(a) A minimum period
of coverage of at least 24 consecutive months for each covered person. This
provision is not applicable to coverage issued or renewed after July 1,
2006.
(b) Minimum loss ratio
standards at levels at which benefits are reasonable in relation to premiums
and calculated in a manner which provides for adequate reserving of the
long-term care insurance risk;
(c)
A 30-day "free look" period, or longer, within which individual
certificateholders have the right to return the certificate after its delivery
and to have the premium refunded for any reason;
(d) A prohibition or limitation on
pre-existing condition exclusions at least as favorable to a policyholder as
that specified in Section
627.9407(4),
F.S.;
(e) A prohibition against a
policy or certificate excluding or using waivers or riders of any kind to
exclude, limit, or reduce coverage or benefits for specifically named or
described pre-existing diseases or physical conditions beyond any pre-existing
condition waiting period;
(f) A
prohibition or limitation on prior institutionalization provisions at least as
favorable to a policyholder as that specified in Section
627.9407(5),
F.S., including the mandatory offer provisions of paragraph (5)(c) of such
section;
(g) A prohibition or
limitation on policy cancellations or nonrenewals at least as favorable to a
policyholder as that specified in Section
627.9407(3)(a),
F.S.;
(h) A prohibition against a
policy restricting its coverage to care only in a nursing home or providing
significantly more coverage for such care than coverage for lower levels of
care;
(i) A requirement that
policies prominently disclose that the policy may not cover all of the costs
associated with long-term care which may be incurred by the buyer during the
period of coverage and that the buyer is advised to periodically review the
policy in relation to the changes in the cost of long-term care; and
(j) Except for nonpayment of premiums and as
provided by Section 627.94076, F.S., provide all
insureds an endorsement that provides that upon renewal of a policy on or after
July 1, 2008, the coverage shall be incontestable after it has been in force
during the lifetime of the insured for a period of 2 years after its date of
issue.
(3) Unless a group
policy issued in another state has been filed for approval in Florida, no such
policy or certificate issued thereunder shall contain a statement that the
policy has been approved as a long-term care policy meeting the requirements of
Florida law or words of similar meaning.
(4)
(a) All
changes to rates, together with an actuarial memorandum developing and
justifying the rate change, shall be filed with the Office pursuant to the
procedures specified in Section
627.410, F.S., and rule Chapter
69O-149, F.A.C., as though the policy had been issued in Florida.
(b) For those policies which have been
determined to be regulated by a state with substantially similar long-term care
insurance requirements, pursuant to paragraph
69O-157.004(1)(b),
F.A.C., form and rate changes shall be filed for informational purposes at
least 30 days prior to use.
Rulemaking Authority 624.308(1), 627.9407(1) FS. Law
Implemented 624.307(1), 627.410, 627.9403, 627.9406, 627.9407(1), (8)
FS.
New 5-17-89, Formerly 4-81.004, Amended 1-13-03, Formerly
4-157.004, Amended 9-16-08.
