Current through Reg. 50, No. 187; September 24, 2024
(1)
Renewability. Individual long-term care insurance policies shall contain a
renewability provision.
(a) The provision:
1. Shall be appropriately
captioned;
2. Shall appear on the
first page of the policy;
3. Shall
clearly state that the coverage is guaranteed renewable or noncancellable;
and
4. Shall not apply to policies
that do not contain a renewability provision, and under which the right to
non-renew is reserved solely to the policyholder.
(b) 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, as
defined in paragraph 69O-157.104(1)(b),
F.A.C.
(2) Riders and
Endorsements.
(a) 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.
(b) After the date of
policy issue, any rider or endorsement that increases benefits or coverage with
a concomitant increase in premium during the policy term shall be agreed to in
writing and signed by the insured, except if increased benefits or coverage are
required by law.
(c) 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.
(3) 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 the policy and its accompanying outline of coverage in compliance
with Section 627.6044, F.S.
(4) 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."
(5) 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 Section
627.9407(5),
F.S., 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."
(6)
Disclosure of Tax Consequences.
(a) 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.
(b) The disclosure statement shall be
prominently displayed on the first page of the policy or rider and any other
related documents.
(c) This
disclosure requirement shall not apply to qualified long-term care insurance
contracts.
(7) Benefit
Triggers.
(a) Activities of daily living and
cognitive impairment shall be used to measure an insured's need for long term
care, shall be described in the policy or certificate in a separate paragraph,
and shall be labeled "Eligibility for the Payment of Benefits."
(b) Any additional benefit triggers shall
also be explained in this section.
(c) If these triggers differ for different
benefits, explanation of the trigger shall accompany each benefit
description.
(d) 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.
(8) A
qualified long-term care insurance contract shall include a disclosure
statement in the policy and in the outline of coverage as required by Section
627.9407(12),
F.S., 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.
(9) A nonqualified long-term care insurance
contract shall include a disclosure statement in the policy and in the outline
of coverage as required by Section
627.9407(12),
F.S., that the policy is not intended to be a qualified long-term care
insurance contract.
Rulemaking Authority 624.308(1), 627.9407(1), 627.9408 FS.
Law Implemented 624.307(1), 627.6044, 627.9402, 627.9407, 627.94074
FS.
New 1-13-03, Formerly
4-157.106.
