Florida Administrative Code
69 - DEPARTMENT OF FINANCIAL SERVICES
69O - OIR - Insurance Regulation
Chapter 69O-157 - LONG-TERM CARE INSURANCE
Section 69O-157.201 - Standards for Approved Long-Term Care Partnership Program Policies
Universal Citation: FL Admin Code R 69O-157.201
Current through Reg. 50, No. 187; September 24, 2024
(1)
(a) A
policy or certificate, herein referred to as policy, marketed or represented to
qualify as an approved long-term care partnership program policy as provided by
Section 409.9102, F.S., hereinafter
referred to as a 'partnership', shall be a policy where:
1. Such form and rates are filed and approved
pursuant to the provisions of Part II of this rule chapter and Chapter 69O-149,
F.A.C.,
2. The policy is intended
to be a qualified long-term care insurance policy under the provisions of
Section 627.9404(12),
F.S.,
3. The insured individual was
a resident of Florida or another state that has entered into a reciprocal
agreement with Florida when coverage first became effective under the policy.
If the policy is later exchanged for a different long-term care policy, the
individual was a resident of Florida or another state that has entered into a
reciprocal agreement with Florida when coverage under the earliest policy
became effective,
4. The policy is
issued with and retains inflation coverage which meets the inflation standards
based on the insured's then attained age as defined in subsection (4)
below,
5. The effective date of the
coverage is on or after January 1, 2007, and
6. Compliance is met with the provisions of
these rules.
(b)
Insurance benefit payments, for purposes of asset disregard when applying for
Medicaid long-term care services, are payments made for long-term care benefits
and services and do not include such benefits as cash surrender values, return
of premiums, premium waiver, or death benefits.
(2)
(a) An
insurer issuing or marketing policies that qualify as partnership policies,
shall provide a disclosure notice, on the insurer's letterhead, indicating that
at the time of issue of the coverage, the policy is an approved long-term care
partnership policy. The disclosure notice shall also explain the benefits
associated with a partnership policy, and disclose that the partnership status
may be lost if the insured moves to a different state or modifies the coverage
after issue, or if changes in federal or state laws occur. The insurer may use
Form OIR-B2-1786 (1/2007), Partnership Status Disclosure Notice, which is
hereby adopted and incorporated into this rule by reference. This notice shall
be provided to the insured no later than the time of policy or certificate
delivery. If the insurer uses Form OIR-B2-1786 without modification, no filing
is required. If the carrier chooses to modify the language found in this
disclosure notice, such notice shall be filed for approval with the
Office.
(b)
1. When an insurer is made aware that the
policyholders or certificateholders initiate action that will result in the
loss of partnership status, the insurer shall provide an explanation of how
such action impacts the insured in writing. The policyholders or
certificateholders shall also be advised how to retain partnership status if
possible.
2. If a partnership plan
subsequently loses partnership status, the insurer shall explain to the
policyholders or certificateholders in writing the reason for the loss of
status.
(3)
(a) An insurer issuing or marketing policies
that qualify as partnership policies, shall notify all of its policyholders
with existing long-term care coverage issued on or after March 1, 2003, of the
benefits associated with a partnership policy. The insurer shall offer all such
existing policyholders the option to exchange their policy, as provided by Rule
69O-157.1100, F.A.C., for a
partnership policy.
(b) Any
policyholder that exchanges their policy shall be provided the required
disclosure as provided in subsection (2) above.
(c) The effective date of the partnership
policy shall be the date of the exchanged policy.
(4) The issued policy shall meet the following inflation coverage limitations:
(a)
Policies or certificates issued to an individual who has not yet attained age
61 shall contain annual compound inflation coverage.
(b) Policies or certificates issued to an
individual who has attained age 61 but has not attained age 76 shall contain
annual inflation coverage.
(c) For
policies or certificates issued with inflation coverage, the policyholders or
certificateholders must have the inflation coverage at a level based upon the
insured's current age as described in paragraphs (a) and (b)
above.
(5) Reporting.
(a) All insurers shall report to the Health
and Human Services Secretary such information as required by Centers for
Medicare & Medicaid Services (CMS), including but not limited to:
1. Notification regarding when insurance
benefits provided under partnership plans have been paid and the amount of such
benefits paid, and
2. Notification
regarding when such policies otherwise terminate.
(b) All insurers shall provide to any insured
requesting such information a copy of the Form OIR-B2-1781 (12/06), Approved
Long-Term Care Partnership Program Policy Summary, which is hereby adopted and
incorporated into this rule by reference. An insurer may use its own form as
long as the information and content is consistent with the information
contained in Form OIR-B2-1781 (12/06).
Rulemaking Authority 624.308(1), 627.9408(1), 627.94075 FS. Law Implemented 624.307(1), 409.9102, 627.94075 FS.
New 8-1-07.
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