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 the 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. The evidence shall
consist of:
(a) Filing of policy and
certificate forms, including rates and rate development information, as though
the policy/certificate were issued in this state, which demonstrate that the
requirements of Sections
627.9401 -
627.9408, F.S., and these rules
have been met; 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, that
state shall 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 coverage in a nursing home
for each covered person and an additional coverage of 50 percent for lower
levels of care as provided in subsection
69O-157.104(4),
F.A.C. The minimum 24 month nursing home coverage is not applicable to coverage
issued or renewed after July 1, 2006.
(b) The standards of Rules
69O-157.108 and
69O-157.113, F.A.C.;
(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 certificateholder as that specified in Section
627.9407(5),
F.S., including the mandatory offer provisions of paragraph (5)(c) of that
section;
(g) A prohibition or
limitation on certificate cancellations or nonrenewals at least as favorable to
a certificateholder as that specified in Section
627.9407(3)(a),
F.S.;
(h) A requirement that a
policy and certificate prominently disclose that the policy and certificate 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 certificate in relation to the changes in the cost of
long-term care;
(i) A minimum 30
day grace period for nonpayment of premium with notice and protection
requirements as provided by Section
627.94073, F.S.;
(j) Pursuant to Section
627.94072, F.S., a mandatory
offer to the potential insured policyholder or certificateholder, as
applicable, of a nonforfeiture provision meeting the standards of Rule
69O-157.118, F.A.C.;
(k) Pursuant to Section
627.94072, F.S., a mandatory
offer to the potential insured policyholder or certificateholder, as
applicable, of an inflation protection provision:
(l) Contain a contingent benefit upon lapse
provision at least as favorable to the insured as that in Rule
69O-157.118, F.A.C.;
(m) Disclosure of rating practices to
consumers as outlined in Rule
69O-157.107, F.A.C.;
(n) A conversion or continuation privilege at
least as favorable as subsection
69O-157.104(8),
F.A.C.;
(o) A prohibition or
limitation on an elimination period in excess of 180 days; and
(p) Pursuant to Section
627.94076, F.S., provide that
the policy 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 except
for nonpayment of premiums. For any long-term care insurance policy issued
prior to July 1, 2006, the provisions of Section
627.94076, F.S., shall apply to
such policy only upon renewal of such policy on or after July 1, 2008, and the
policy shall so provide by endorsement to the policy.
(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 this rule
chapter 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-157.114(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), 627.9408 FS.
Law Implemented 624.307(1), 627.410, 627.9402, 627.9406, 627.9407(1), (3), (4),
(8), (9), 627.94076, 627.9408 FS.
New 1-13-03, Formerly 4-157.114, Amended
9-16-08.
