A. This section shall apply as follows:
(1) Except as provided in Section 9(A)(2),
this section applies to any long-term care policy or certificate delivered or
issued for delivery in this state on or after October 1, 2004.
(2) For certificates issued under a group
long-term care policy issued to an employee group as defined in
24-A M.R.S.A.
§2804, a labor union groups as defined
in
24-A M.R.S.A.
§2805, or a trustee groups as defined in
24-A M.R.S.A.
§2806, which policy is in force on or
after the effective date of this rule, the provisions of this section shall
apply on or after the first policy anniversary following April 1,
2005.
B. Other than
policies for which no applicable premium rate or rate schedule increases can be
made, insurers shall provide to the applicant all the following information at
the time of application or enrollment, unless the method of application does
not allow for delivery at that time. The insurer shall provide all the required
information no later than at the time of the delivery of the policy or
certificate, as follows:
(1) A statement that
the policy may be subject to rate increases in the future;
(2) An explanation of potential future
premium rate revisions, and a statement of the options available to the
policyholder or certificateholder in the event of any revision;
(3) The premium rate or rate schedules for
which the applicant is responsible until the insurer requests a premium
increase;
(4) An explanation for
applying rate adjustments, minimally including:
(a) A description of when premium rate
adjustments will be effective, such as next anniversary date, next billing
date, etc.; and
(b) The right to a
revised premium as provided in Section 9(B)(2) if the premium is
changed;
(5)
(a) Premium increase information for the
policy form or similar policy forms occurring in the last 10 years for this
state or any state, minimally identifying:
(i)
Each policy form for which premium rates have increased;
(ii) Each calendar year when the form was
available for purchase; and
(iii)
The amount or percentage of each increase. The percentage may be expressed as a
percent of the premium rate prior to the increase or as minimum and maximum
percents if the rate increase is variable by rating characteristics.
(b) The insurer may provide
additional rate increase information.
(c) An insurer shall have the right to
exclude from the disclosure premium rate increases that only apply to blocks of
business acquired from other nonaffiliated insurers or the long-term care
policies acquired from other nonaffiliated insurers when those increases
occurred prior to the acquisition.
(d) If an acquiring insurer files for a rate
increase on a long-term care policy form or a block of policy forms acquired
from a nonaffiliated insurer on or before the later of the effective date of
this rule or the end of a 24-month period following the acquisition of the
policy or block, the acquiring insurer may exclude that rate increase from the
disclosure. The nonaffiliated selling company, however, shall include the
disclosure of each such rate increase in accordance with Section
9(B)(5)(a).
(e) If the acquiring
insurer requests approval of any rate increase after the increase referred to
in the preceding paragraph, even within the 24-month period following the
acquisition, for any acquired policy form or block of forms, the acquiring
insurer shall disclose all the information required by Section 9(B)(5),
including the earlier rate increase to which Section 9(B)(5)(d)
refers.
C. At
the time of application, an insurer shall present to an applicant, unless the
method of application does not then allow for signature, an acknowledgement
that the insurer made the disclosures required under Section 9(B). In instances
where the insured cannot obtain the applicant's signature at the time of
application, the insurer shall present the acknowledgement for signature no
later than at the time of the delivery of the policy or certificate.
D. An insurer shall provide written notice of
an upcoming rate increase to all policyholders and certificateholders at least
90 days before the increase is to become effective. The notice shall contain
all the information required under Paragraph B.
