Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-16 - LONG TERM CARE INSURANCE
Rule 120-2-16-.34 - Georgia Long - Term Care Insurance Partnership Program

Current through Rules and Regulations filed through September 23, 2024

Partnership Program Notice

Important Consumer Information regarding the Georgia Long Term Care Insurance Partnership Program

Some long term care insurance policies [certificates] sold in Georgia may qualify for the Georgia Long tern Care Insurance Partnership Program (the Partnership Program). The Partnership Program is a partnership between state government and private insurance companies to assist individuals in planning their long term care needs. Insurance companies voluntarily agree to participate in the Partnership Program by offering long term care insurance coverage that meets certain sate and federal requirements. Long Term care insurance policies [certificates] that qualify as partnership policies [certificates] may protect the policyholder's [certificateholder's] assets through a feature known as "asset disregard" under Georgia's Medicaid Program.

Asset Disregard means that an amount of the policyholder's [certificate holder's] assets equal to the amount of long term care insurance benefits received under a qualified Partnership Policy [Certificate] will be disregarded for the purpose of determining the insured's eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a qualified Partnership Policy [Certificate] without affecting the person's eligibility for Medicaid. All of the Medicaid eligibility criteria will apply and special rules may apply to persons whose home equity exceeds $500,000. Asset Disregard is not available under a long term care insurance policy [certificate] that is not a Partnership Policy [Certificate]. Therefore, you should consider if Asset Disregard is important to you, and whether a Partnership Policy meets your needs. The purchase of a Partnership Policy does not automatically qualify you for Medicaid.

What are the Requirements for a Partnership Policy [Certificate]? In order for a policy [certificate] to qualify as a Partnership Policy [Certificate], it must, among other requirements:

1. Be issued to an individual after January 1, 2007;

2. Cover an individual who was a State of Georgia resident when coverage first becomes effective under the policy;

3. Be a tax-qualified policy under Section 7702(B)(b) of the Internal Revenue Code of 1986;

4. Meet stringent consumer protection standards; and

5. Meet the following inflation protection requirements:

For ages 60 or younger - provides compound annual inflation protection

For ages 61 to 75 - provides some level of inflation protection

For ages 76 and older - no purchase of inflation protection is required

If you apply and are approved for long term care insurance coverage, [carrier name] will provide you with written documentation as to whether or not your policy [certificate] qualifies as a Partnership Policy [Certificate].

What Could Disqualify a Policy [Certificate] as a Partnership Policy. Certain types of changes to a Partnership Policy [Certificate] could affect whether or not such policy [certificate] continues to be a Partnership Policy [Certificate]. If you purchase a Partnership Policy [Certificate] and later decide to make any changes, you should first consult with [carrier name] to determine the effect of a proposed change. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy [certificate] as a Partnership Policy [Certificate], you would not receive beneficial treatment of your policy [certificate] under the Medicaid program of that state. The information contained in this disclosure is based on current Georgia and Federal law. These laws may be subject to change. Any change in law could reduce or eliminate the beneficial treatment of your policy [certificate] under Georgia's Medicaid Program.

Additional Information. If you have questions regarding long term care insurance policies [certificates] please contact [carrier name]. If you have questions regarding current laws governing Medicaid eligibility, you should contact the Georgia Department of Medical Assistance.

Office of Commissioner of Insurance

State of Georgia form LTCP 200-C

Long Term Care Partnership

Certification Form

Note: This Form must be completed and submitted with each long term care policy or certificate form for which the insurer is seeking Partnership qualification. A separate form must be completed for each policy form and a specimen copy of the form, including all riders and endorsement, must be attached. A long term care insurance policy or certificate form may not be issued in Georgia as a partnership policy or certificate unless and until this form has been submitted to an approved by the Office of Commissioner of Insurance, State of Georgia.

__________________________________________________

Under Section 1917(b)(5)(B)(iii) of the Social Security Act (42 U.S.C. 1396 p(b)(5)(B)(iii) and in accordance with O.C.G.A Section 33-42-6 and Rule 120-2-16-.34, the insurer hereby submits information relating to policy or certificate form _______________________ (form number) to substantiate that the form includes all required consumer protection requirements set forth in Section 1917(b)(5)(A) of the Social Security Act (42 U.S.C. 1396 p(b)(5)(B)(iii) and that it includes certain specified provisions of the Long Term Care Insurance Model Regulation and Long Term Care Insurance Model Act promulgated by the National Association of Insurance Commissioners (adopted as of October, 2000) (referred to herein as the "2000 Model Regulation" and "2000 Model Act," respectively).

Part I:

Name of Insurer __________________________________________

Company NAIC# __________________________________________

Address __________________________________________

__________________________________________

__________________________________________

Telephone: __________________________________________

Company Contact Name________________________________________

Title __________________________________________

Telephone __________________________________________

E-Mail __________________________________________

Part II:

___________________________________________________

2000 NAIC MODEL REGULATION AND 2000 NAIC MODEL ACT

Note to Insurer: Identify the page and/or provision within the policy or certificate form that addresses each requirement, or, if inapplicable, use the space identified to explain.

Policy/Certificate form ___________________ meets the following requirements of the 2000 NAIC Model Long Term Care Regulation and/or 2000 NAIC Model Long Term Care Act, as indicated below:

Part III. INFLATION PROTECTION

Identify the policy provision or provide form number of endorsement or amendment form (and date of approval) for inflation protection coverage in compliance with Rule 120-2-16-.13(1)(a)(i) through (iii):

_________________________________________________

_________________________________________________

_________________________________________________

Part IV. CERTIFICATION

I hereby certify that the answers, accompanying documents, and other information set forth herein are, to the best of my knowledge and belief, true, correct, complete and the policy [certificate] satisfies the requirements necessary for a qualified state long term care insurance partnership policy in the State of Georgia.

_________________________ _______________________________________

Date Name and Title of Officer of the Insurer

____________________________________________

Signature of Officer of the Insurer

Attachment C

GeorgiaDepartmentof Community Health

Division of Medical Assistance

Important Notice Regarding Your Policy's

Long-Term Care Insurance Partnership Status

(Please keep this Notice with Your Policy or Certificate)

The Georgia Long Term Care Partnership.

The Georgia Long-Term Care Partnership is an innovative partnership between Georgia and private insurers of Long-Term Care insurance policies (or certificates). The Georgia Long-Term Care Partnership became effective on January 1, 2007 and is provided in accordance with the Deficit Reduction Act of 2005 (P.L. 109-171).

Partnership Policy [Certificate] Status.

Your long term care insurance policy [certificate] is intended to qualify as a Partnership Policy [Certificate] under the Georgia Long Term Care Partnership Program as of your Policy's [Certificate's] effective date.

Medicaid Asset Protection Provided.

Long-Term care insurance is an important tool that helps individuals prepare for future long-term care needs. Partnership Policies provide an additional level of protection. In particular, such policies permit individuals to protect additional assets from spend-down requirements under the State's Medicaid program if assistance under this program is ever needed and you otherwise qualify for Medicaid.

Specifically, the asset eligibility and recovery provisions of the Medicaid program of Georgia are applied by disregarding an additional amount of assets which is equal to the amount of insurance benefits you have received from your Partnership Policy. For example, if you receive $200,000 of insurance benefits from your Partnership policy, you generally would be able to retain $200,000 of assets above and beyond the amount of assets normally permitted for Medicaid eligibility.

Other Medicaid eligibility requirements apart from permissible assets must be met, including special rules that may apply if the equity in your home exceeds $500,000. In addition, you must meet the Medicaid program's income requirements and may be required to contribute some of your income to the costs of your care once you become eligible for Medicaid. Medicaid eligibility requirements may change over time. The purchase of this Partnership Policy does not automatically qualify you for Medicaid.

Additional Consumer Protections.

In addition to providing Medicaid asset protection, your Partnership Policy has other important features. Under the rules governing Georgia Long-Term Care Partnership, your Partnership Policy must be a qualified long term care insurance contract under Federal tax law, and as such the insurance benefits you receive from the policy generally will be subject to beneficial income tax treatment. (Please note that a policy can be a qualified long-term care insurance contract under Federal tax law, with the same beneficial income tax treatment, even if it is not a Partnership Policy.) In addition, the long term care partnership policy must provide inflation protection as specified, according to the policy holder's age when the policy was issued:

- compound annual inflation protection, if the individual was under 61 years of age when the policy was issued,

- at least some level of inflation protection, if the individual was age 61 to 76 years when the policy was issued.

If the individual was 76 years of age or older when the policy was issued, inflation protection may be offered but is not required.

What Could Disqualify Your Policy as a Partnership Policy?

If you make any changes to your policy or certificate, such changes may affect whether your policy or certificate continues to qualify as a Partnership Policy. Before you make any changes, you should consult with the issuer of your policy (certificate) to determine the effect of a proposed change. In addition, if you move to a State that does not maintain a Qualified Partnership or does not recognize your policy (certificate) as a Partnership Policy, you would not receive Medicaid asset protection in that State. Changes in Federal or State law may affect the Medicaid asset protection available with respect to your Partnership Policy (Certificate).

Additional Information.

If you have questions regarding your insurance policy (certificate), please contact (carrier name). If you would like further information about the Medicaid asset protection provided by your Partnership Policy (Certificate) or the Georgia Long Term-Care Partnership Program, please call 1-800-669-8387 or visit www.dch.georgia.gov.

O.C.G.A. Secs. 33-2-9, 33-42-6, 33-42-7, 49-4-164, 49-4-165.