Code of Maine Rules
02 - DEPARTMENT OF PROFESSIONAL AND FINANCIAL REGULATION
031 - BUREAU OF INSURANCE
Chapter 425 - LONG-TERM CARE INSURANCE
Section 031-425-26 - Required Offer of Nonforfeiture Benefit; Contingent Nonforfeiture Benefit Upon Lapse

Universal Citation: 02 ME Code Rules ยง 031-425-26

Current through 2024-38, September 18, 2024

A. This section does not apply to life insurance policies or riders containing accelerated long-term care benefits.

B. To comply with the requirement to offer a nonforfeiture benefit to policyholders and certificateholders pursuant to 24-A M.R.S.A. §§5077(1) and 5077(2):

(1) A policy or certificate offered with nonforfeiture benefits shall have coverage elements, eligibility, benefit triggers and benefit length that are the same as coverage to be issued without nonforfeiture benefits. The nonforfeiture benefit included in the offer shall be the benefit described in Section 26(D); and

(2) The offer shall be in writing if the nonforfeiture benefit is not otherwise described in the Outline of Coverage or other materials given to the prospective policyholder.

C.

(1) After a rejection of the nonforfeiture benefit offer required under 24-A M.R.S.A. §5077, for individual and group policies without nonforfeiture benefits issued after the effective date of this rule, the insurer shall provide a contingent benefit upon lapse. For policies issued or renewed on or after January 1, 2008, even if this offer is accepted for a policy with a fixed or limited premium paying period, the contingent benefit on lapse in Section 26(C)(3) shall still apply.

(2) In the event a group policyholder elects to make the nonforfeiture benefit an option to the certificateholder, a certificate shall provide either the nonforfeiture benefit or the contingent benefit upon lapse.

(3) A contingent benefit on lapse shall be triggered, as shown in Appendix E, every time an insurer increases the premium rates to a level which results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth in the table in Appendix E, based on the insured's issue age, and the policy or certificate lapses within 120 days of the due date of the premium so increased. Unless otherwise required, policyholders shall be notified at least 30 days prior to the due date of the premium reflecting the rate increase.

(4) For policies issued or renewed on or after January 1, 2008, a contingent benefit on lapse shall also be triggered for policies with a fixed or limited premium paying period every time an insurer increases the premium rates to a level that results in a cumulative increase of the annual premium equal to or exceeding the percentage of the insured's initial annual premium set forth below based on the insured's issue age, the policy or certificate lapses within 120 days of the due date of the premium so increased, and the ratio in Paragraph (6)(b) below is forty percent (40%) or more. Unless otherwise required, policyholders shall be notified at least thirty (30) days prior to the due date of the premium reflecting the rate increase.

Triggers for a Substantial Premium Increase

Issue Age

Percent Increase Over Initial Premium

Under 65

50%

65-80

30%

Over 80

10%

This provision shall be in addition to the contingent benefit provided by Paragraph (3) above and where both are triggered, the benefit provided shall be at the option of the insured.

(5) On or before the effective date of a substantial premium increase as defined in Paragraph (3), the insurer shall:
(a) Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;

(b) Offer to convert the coverage to a paid-up status with a shortened benefit period in accordance with the terms of Subsection D. This option may be elected at any time during the 120-day period referenced in Paragraph (3); and

(c) Notify the policyholder or certificateholder that a default or lapse at any time during the 120-day period referenced in Paragraph (3) shall be deemed to be the election of the offer to convert in Subparagraph (b) unless the automatic option in Paragraph (6)(c) applies.

(6) For policies issued or renewed on or after January 1, 2008, on or before the effective date of a substantial premium increase as defined in Paragraph (4), the insurer shall:
(a) Offer to reduce policy benefits provided by the current coverage without the requirement of additional underwriting so that required premium payments are not increased;

(b) Offer to convert the coverage to a paid-up status where the amount payable for each benefit is ninety percent (90%) of the amount payable in effect immediately prior to lapse times the ratio of the number of completed months of paid premiums divided by the number of months in the premium paying period. This option may be elected at any time during the 120-day period referenced in Paragraph (4); and

(c) Notify the policyholder or certificateholder that a default or lapse at any time during the 120-day period referenced in Paragraph (4) shall be deemed to be the election of the offer to convert in Subparagraph (b) above if the ratio is forty percent (40%) or more.

(7) For any long-term care policy issued in this state on or after January 1, 2021:
(a) If the policy or certificate was issued at least twenty (20) years before the effective date of the increase, a value of 0% shall be used in place of all values in the table in Appendix E.

(b) Values above 100% in the table in Appendix E shall be reduced to 100%.

D. Benefits continued as nonforfeiture benefits, including contingent benefits upon lapse provided in accordance with Subsection C(3) but not those provided in accordance with Subsection C(4), are described in this Subsection:

(1) For purposes of this Subsection, "attained age rating" is defined as a schedule of premiums starting from the issue date which increases age at least one percent per year prior to age 50, and at least three percent per year beyond age 50.

(2) For purposes of this Subsection, the contingent nonforfeiture benefit shall be for a shortened benefit period providing paid-up long-term care insurance coverage after lapse. The same benefits (amounts and frequency in effect at the time of lapse but not increased thereafter) will be payable for a qualifying claim, but the lifetime maximum dollars or days of benefits shall be determined as specified in Section 26(D)(3).

(3) The standard nonforfeiture credit will be equal to 100% of the sum of all premiums paid, including the premiums paid prior to any changes in benefits. The insurer may offer additional shortened benefit period options, as long as the benefits for each duration equal or exceed the standard nonforfeiture credit for that duration. However, the minimum nonforfeiture credit shall not be less than 30 times the daily nursing home benefit at the time of lapse. In either event, the calculation of the nonforfeiture credit is subject to the limitation of Section 26(E).

(4)
(a) The nonforfeiture benefit shall begin not later than the end of the third year following the policy or certificate issue date. The contingent benefit upon lapse shall be effective immediately on the policy or certificate issue date.

(b) Notwithstanding Section 26(D)(4)(a), for a policy or certificate with attained age rating, the nonforfeiture benefit shall begin on the earlier of:
(i) The end of the tenth year following the policy or certificate issue date; or

(ii) The end of the second year following the date the policy or certificate is no longer subject to attained age rating.

(5) Nonforfeiture credits may be used for all care and services qualifying for benefits under the terms of the policy or certificate, up to the limits specified in the policy or certificate.

E. All benefits paid by the insurer while the policy or certificate is in premium paying status and in the paid up status will not exceed the maximum benefits which would be payable if the policy or certificate had remained in premium paying status.

F. There shall be no difference in the minimum nonforfeiture benefits as required under this section for group and individual policies.

G. The requirements of this section shall become effective on April 1, 2005, and shall apply as follows:

(1) Except as provided in Sections 26(G)(2) and (3), this section shall apply to any long-term care policy issued in this state on or after the effective date of this rule.

(2) For certificates issued on or after the effective date of this rule under employee groups as defined in 24-A M.R.S.A. §2804, labor union groups as defined in 24-A M.R.S.A. §2805, or trustee groups as defined in 24-A M.R.S.A. §2806, the provisions of this section shall not apply if the group policy was in force at the time this rule became effective.

(3) The last sentence in Section 26(C)(1) and Sections 26(C)(4) and 26(C)(6) shall apply only to long-term care insurance policies or certificates issued in this state after six months after the effective date of such sections, and only to new certificates on a group policy as defined in 24-A M.R.S.A. §5072 issued in this state after one year after the effective dates of such sections.

H. To determine whether contingent nonforfeiture upon lapse provisions are triggered under Section 26(C)(3) or (4), a replacing insurer that purchased or otherwise assumed a block or blocks of long-term care insurance policies from another insurer shall calculate the percentage increase based on the initial annual premium paid by the insured when the policy was first purchased from the original insurer.

I. A nonforfeiture benefit for federally qualified long-term care insurance contracts that are level premium contracts shall be offered that meets the following requirements:

(1) The nonforfeiture provision shall be appropriately captioned;

(2) The nonforfeiture provision shall provide a benefit available in the event of a default in the payment of any premiums and shall state that the amount of the benefit may be adjusted subsequent to being initially granted only as necessary to reflect changes in claims, persistency and interest as reflected in changes in rates for premium paying contracts approved by the superintendent for the same contract form; and

(3) The nonforfeiture provision shall provide at least one of the following:
(a) Reduced paid-up insurance;

(b) Extended term insurance;

(c) Shortened benefit period; or

(d) Other similar offerings approved by the superintendent.

Disclaimer: These regulations may not be the most recent version. Maine may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.