Rules & Regulations of the State of Tennessee
Title 0780 - Commerce and Insurance
Subtitle 0780-01 - Insurance Division
Chapter 0780-01-61 - Long-Term Care Insurance
Section 0780-01-61-.15 - REPORTING REQUIREMENTS

Universal Citation: TN Comp Rules and Regs 0780-01-61-.15

Current through September 24, 2024

(1) Every insurer shall maintain records for each insurance producer of that insurance producer's amount of replacement sales as a percent of the insurance producer's total annual sales and the amount of lapses of long-term care insurance policies sold by the insurance producer as a percent of the insurance producer's total annual sales.

(2) Every insurer shall report annually by June 30 the ten percent (10%) of its insurance producers with the greatest percentages of lapses and replacements as measured by Paragraph (1) of this rule. The insurer shall use the form as set out in Appendix J of this Chapter.

(3) Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely insurance producer activities regarding the sale of long-term care insurance.

(4) Every insurer shall report annually by June 30 the number of lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year. The insurer shall use the form as set out in Appendix J of this Chapter.

(5) Every insurer shall report annually by June 30 the number of replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the preceding calendar year. The insurer shall use the form as set out in Appendix J of this Chapter.

(6) Every insurer shall report annually by June 30, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied. The insurer shall use the form as set out in Appendix G of this Chapter.

(7) Every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate recissions, both state and nationwide, except those initiated by the insured and shall annually furnish this information to the Commissioner in the format as set out in Appendix C of this Chapter.

(8) For purposes of this rule:

(a) "Policy" means only long-term care insurance;

(b) Subject to Paragraph (8)(c) of this rule, "claim" means a request for payment of benefits under an in-force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

(c) "Denied" means the insurer refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition; and

(d) "Report" means on a statewide basis.

(9) Reports required under this rule shall be filed with the Commissioner.

Authority: T.C.A. § 56-42-105.

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