Current through Register Vol. 63, No. 9, September 1, 2024
(1) This rule applies as follows:
(a) Except as provided in subsection (b) of
this section, this rule applies to any long term care policy or certificate
issued in this state on or after March 1, 2006.
(b) For certificates issued on or after March
1, 2005 under a group long-term care insurance policy as defined in ORS
743.652(3)(a),
which policy was in force on March 1, 2005, the provisions of this rule shall
apply on the policy anniversary following March 1, 2006.
(2) Other than policies for which no
applicable premium rate or rate schedule increases can be made, an insurer
shall provide all of the information listed in this section to the applicant at
the time of application or enrollment, unless the method of application does
not allow for delivery at that time. In such a case, the insurer shall provide
all of the information listed in this rule to the applicant not later than at
the time of delivery of the policy or certificate. The information is as
follows:
(a) A statement that the policy may
be subject to rate increases in the future;
(b) An explanation of potential future
premium rate revisions and the policyholder's or certificate holder's option in
the event of a premium rate revision.
(c) The premium rate or rate schedules
applicable to the applicant that will be in effect until a request is made for
an increase.
(d) A general
explanation for applying premium rate or rate schedule adjustments, which shall
include:
(A) A description of when premium
rate or rate schedule adjustments will be effective (e.g. next anniversary
date, next billing date, etc.); and
(B) The right to a revised premium rate or
rate schedule as provided in subsection (c) of this section if the premium rate
or rate schedule is changed.
(e)
(A)
Information regarding each premium rate increase on this policy form or similar
policy forms over the past ten years for this state or any other state that at
a minimum identifies
(i) The policy forms for
which premium rates have been increased.
(ii) The calendar years when the form was
available for purchase; and
(iii)
The amount or percent of each increase. The percentage may be expressed as a
percentage of the premium rate prior to the increase and may also be expressed
as minimum and maximum percentages if the rate increase is variable by rating
characteristics.
(B) The
insurer may provide additional explanatory information related to the rate
increases.
(C) An insurer shall
have the right to exclude from the disclosure premium rate increases that apply
only 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 insurance policy form acquired from a
nonaffiliated insurer 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 block or policies, the
acquiring insurer may exclude that rate increase from the disclosure. The
nonaffiliated selling insurer shall include the disclosure of that rate
increase in accordance with paragraph (A) of this subsection.
(E) If the acquiring insurer in paragraph (D)
of this subsection files for a subsequent rate increase whether within the
24-month period or later, the acquiring insurer must make all disclosures
required by this section, on the same policy form acquired from nonaffiliated
insurer or block of policy forms acquired from nonaffiliated insurers
referenced in paragraph (D) of this subsection, including disclosure of the
earlier rate increase referenced in paragraph (A) of this
subsection.
(3) An applicant shall sign an
acknowledgement at the time of application, unless the method of application
does not allow for signature at that time, that the insurer made the disclosure
required under subsection (2)(a) and (e) of this section. If owing to the
method of application the applicant cannot sign an acknowledgement at the time
of application, the applicant shall sign an acknowledgement no later than at
the time of delivery of the policy or certificate.
(4) An insurer shall use the forms in
Exhibits 1 and 2 to comply with sections (2) and (3) of this rule.
(5) An insurer shall provide notice of an
upcoming premium rate schedule increase to all policyholders or certificate
holders, if applicable, at least 45 days prior to the implementation of the
premium rate schedule increase by the insurer. The notice shall include the
information required by section (2) of this rule when the rate increase is
implemented.
Exhibits referenced are available from the
agency.
Stat. Auth.: ORS
731.244,
742.023,
743.013,
743.655,
743.656 &
746.240
Stats. Implemented: ORS
731.244,
742.003,
742.005,
742.009,
743.010(3),
743.013(3),
743.650,
743.653,
743.655,
743.656 &
746.240
