Nevada Administrative Code
Chapter 687B - Contracts of Insurance
CONTRACTS FOR LONG-TERM CARE
Section 687B.052 - Required reports

Universal Citation: NV Admin Code 687B.052

Current through December 31, 2024

1. An insurer shall maintain records for each agent which:

(a) Specify the amount of replacement sales by the agent as a percentage of the total annual sales by the agent; and

(b) Specify the amount of lapses in policies sold by the agent as a percentage of the total annual sales by the agent.

2. On or before June 30 of each year, an insurer shall provide to the Commissioner the names of its agents in this State who, as measured by the records maintained pursuant to subsection 1, rank in the top 10 percent of all its agents in this State with the highest percentages of:

(a) Replacement sales in this State; and

(b) Lapses in policies sold by the agent in this State.

3. On or before June 30 of each year, an insurer shall report to the Commissioner the number of lapsed policies issued by the insurer in this State as a percentage of the total annual sales of the insurer in this State and as a percentage of the total number of policies issued by the insurer in this State which are in force on December 31 of the immediately preceding calendar year in this State.

4. On or before June 30 of each year, an insurer shall report to the Commissioner the number of replacement policies issued by the insurer in this State as a percentage of the total annual sales of the insurer in this State and as a percentage of the total number of policies issued by the insurer in this State which are in force on December 31 of the immediately preceding calendar year in this State.

5. On or before June 30 of each year, an insurer shall report to the Commissioner, for qualified long-term care insurance contracts issued by the insurer in this State, the number of claims denied in this State for each class of business, expressed as a percentage of all claims denied in this State.

6. An insurer or similar organization that issues partnership contracts or partnership certificates in this State shall report to the Department of Health and Human Services, using a form prescribed by the Department and including the amount of any benefits that have been provided under the contract or certificate, when:

(a) A partnership contract or partnership certificate is terminated;

(b) Benefits are provided under a partnership contract or partnership certificate; or

7. An insurer shall use:

(a) Form NDOI-946, which is available from the Division, to satisfy the reporting requirements of subsections 2, 3 and 4; and

(b) Form NDOI-948, which is available from the Division, to satisfy the reporting requirements of subsection 5.

8. Reported replacement and lapse rates may not be used as a sole basis for adverse action against an insurer or agent, but may be used as a method to review agent activities regarding the sale of long-term care insurance.

9. Any report made pursuant to this section must be made on the basis of statewide information.

10. As used in this section:

(a) "Claim" means a request for payment of benefits under a policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met.

(b) "Denied" means the refusal of an insurer to pay a claim for any reason other than:

(1) Failure of the insured to meet an applicable waiting period; or

(2) An applicable preexisting condition.

Added to NAC by Comm'r of Insurance by R121-07, 9-18-2008, eff. 10-1-2008; A by R028-10, 12-16-2010, eff. 10-1-2011

NRS 679B.130

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