Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter Y - STANDARDS FOR LONG-TERM CARE INSURANCE, NON-PARTNERSHIP AND PARTNERSHIP LONG-TERM CARE INSURANCE COVERAGE UNDER INDIVIDUAL AND GROUP POLICIES AND ANNUITY CONTRACTS, AND LIFE INSURANCE POLICIES THAT PROVIDE LONG-TERM CARE BENEFITS WITHIN THE POLICY
Division 4 - PARTNERSHIP LONG-TERM CARE INSURANCE ONLY
Section 3.3871 - Standards and Reporting Requirements for Approved Long-Term Care Partnership Policies and Certificates
Universal Citation: 28 TX Admin Code § 3.3871
Current through Reg. 50, No. 13; March 28, 2025
(a) Standards.
(1) General requirements. In addition to the
required filing and approval pursuant to §
3.3873 of this title (relating to
Filing Requirements for Long-Term Care Partnership Policies), any policy or
certificate marketed or represented to qualify as a long-term care partnership
policy or certificate must comply with the following requirements:
(A) the insured individual was a resident of
Texas when coverage first became effective under the policy. If the policy or
certificate is later exchanged for a different long-term care policy or
certificate, the individual was a resident of Texas when coverage under the
first policy became effective;
(B)
the policy is intended to be a qualified long-term care insurance policy under
the provisions of §
3.3847 of this title (relating to
Qualified Long-Term Care Insurance Contracts: Prohibited
Representations);
(C) the policy or
certificate is issued with and retains inflation coverage that meets the
inflation standards specified in §
3.3872 of this title (relating to
Inflation Protection Requirements for Long-Term Care Partnership Policies and
Certificates) based on the insured's then attained age;
(D) the effective date of the newly issued
partnership policy, which is shown on the policy schedule page, must be either
the date that the partnership policy is issued or the date the application for
the partnership policy was signed. The insurer has the option of using either
date, but the insurer must use the same option in all partnership policies
issued by that insurer.
(2) Required disclosure notice.
(A) A policy or certificate represented or
marketed as a long-term care partnership policy or certificate must be
accompanied by a disclosure notice that explains the benefits associated with
the policy or certificate. The required disclosure notice is set forth in Form
Number LHL569(LTC) Partnership Status Disclosure Notice for Long-Term Care
Partnership Policies/Certificates as specified in Figure: 28 TAC §
3.3871(a)(2)(B)(vii).
(B) The following requirements and procedures
apply to Form Number LHL569(LTC).
(i) The
text in the notice must be in at least 12-point type and must follow the order
of the information presented in Figure: 28 TAC §
3.3871(a)(2)(B)(vii).
(ii) The text in the notice as specified in
Figure: 28 TAC §
3.3871(a)(2)(B)(vii)
is mandated; the format for the form is a
recommended format. An insurer may format the mandated text in a different
format from that specified in Figure: 28 TAC §
3.3871(a)(2)(B)(vii)
if the insurer files the form for review and
approval by the commissioner.
(iii)
Any form filed pursuant to clause (ii) of this subparagraph must be filed no
later than 60 days prior to use and is subject to the requirements and
procedures set forth in Subchapter A of this chapter (relating to Submission
Requirements for Filings and Departmental Actions Related to Such
Filings).
(iv) An insurer may add a
company name and identifying form number to Form Number LHL569(LTC) as
specified in Figure: 28 TAC §
3.3871(a)(2)(B)(vii)
without obtaining commissioner
approval.
(v) The Instructions to
Company that are included in Figure: 28 TAC §
3.3871(a)(2)(B)(vii)
are to aid the insurer in drafting the form
and should not be included in the disclosure notice provided by the
insurer.
(vi) Any form filed
pursuant to clause (ii) of this subparagraph should be filed with the Texas
Department of Insurance, Life and Health Division, Filings Intake, MC-LH-LHL,
P.O. Box 12030, Austin, Texas 78711-2030.
(vii) A representation of Form Number
LHL569(LTC) Partnership Status Disclosure Notice for Long-Term Care Partnership
Policies/Certificates is as follows:
(viii)
Any policyholder that exchanges their policy for a partnership policy must be
provided with the required Form Number LHL569(LTC) Partnership Status
Disclosure Notice for Long-Term Care Partnership Policies/Certificates as
specified in Figure: 28 TAC §
3.3871(a)(2)(B)(vii).
(ix) When an insurer is made aware that a
policyholder or certificate holder has initiated action that will result in the
loss of partnership status, the insurer must provide an explanation of how such
action impacts the insured in writing. The insurer must also advise the
policyholder or certificate holder on how to retain partnership status if
possible.
(x) If a partnership plan
subsequently loses partnership status, the insurer must explain to the
policyholders or certificate holders in writing the reason for the loss of
status.
(3)
Commissioner certification. Under §1917(b)(5)(B)(iii) of the Social
Security Act (42
U.S.C. §
1396p(b)(5)(B)(iii)), the
Commissioner of Insurance, in implementing the Texas Long-Term Care Partnership
Insurance Program (Partnership Program), may certify that long-term care
insurance policies and certificates covered under the Partnership Program meet
certain consumer protection requirements, and policies so certified are deemed
to satisfy such requirements. These consumer protection requirements are set
forth in §1917(b)(5)(A) of the Social Security Act and principally include
certain specified provisions of the NAIC Long-Term Care Model Act and Model
Regulations (adopted as of October 2000). In providing this certification, the
commissioner may reasonably rely upon the certification by insurers of the
policy forms that is made in accordance Form Number LHL570(LTC) Long-Term Care
Partnership Program Insurer Certification Form as specified in Figure: 28 TAC
§
3.3873(a)(2)(F).
(b) Reporting requirements. In accordance with §1917(b)(1)(C)(iii)(VI) and (v) of the Social Security Act, all issuers of partnership policies or certificates must provide regular reports to the Secretary of the Department of Health and Human Services (Secretary) in accordance with regulations to be developed by the Secretary. Such information must include but not be limited to the following:
(1) notification regarding when insurance
benefits provided under partnership policies or certificates have been paid and
the amount of such benefits paid;
(2) notification regarding when such policies
or certificates otherwise terminate; and
(3) any other information the Secretary
determines is appropriate.
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