Current through Register Vol. 41, No. 3, September 23, 2024
A. In accordance with § 6021 of the
Deficit Reduction Act of 2005 (
Pub.L.
109-171) and § 32.1-325 of the Code of
Virginia, in addition to the applicable provisions of this chapter, the
provisions of this section shall apply to any qualified state long-term care
insurance partnership policy.
B.
"Qualified state long-term care insurance partnership policy" or "partnership
policy" means an insurance policy that meets all the requirements specified in
12VAC30-40-290 and meets the
following requirements:
1. The policy covers
an insured who was a resident of the Commonwealth of Virginia (a Partnership
State) when coverage first became effective under the policy.
2. The policy is a qualified long-term care
insurance policy as defined in § 7702B(b) of the Internal Revenue Code of
1986 and was issued no earlier than September 1, 2007.
3. The policy meets all the applicable
requirements of this chapter and the requirements of the National Association
of Insurance Commissioners long-term care insurance model act and model
regulation as those requirements are set forth in § 1917(b)(5)(A) of the
Social Security Act ( 42 USC § 1396p(b)(5)(A)).
4. The policy provides the following
inflation protections:
a. If the policy is
sold to an individual who has not attained age 61 as of the date of purchase,
the policy shall provide a compound annual inflation protection feature at
least equivalent to the provisions of
14VAC5-200-100;
b. If the policy is sold to an individual who
has attained age 61 but has not attained age 76 as of the date of purchase, the
policy shall provide an inflation protection feature at least equivalent to the
provisions of
14VAC5-200-100;
c. If the policy is sold to an individual who
has attained age 76 as of the date of purchase, the policy may provide
inflation protection, but shall at least comply with the provisions of
14VAC5-200-100.
C.
1. An insurer or its agent, soliciting or
offering to sell a policy that is intended to qualify as a partnership policy,
shall provide to each prospective applicant a Partnership Program Notice (Form
200-A), outlining the requirements and benefits of a partnership policy. A
similar notice may be used for this purpose if filed and approved by the
commission. The Partnership Program Notice shall be provided with the required
Outline of Coverage.
2. A
partnership policy issued or issued for delivery in the Commonwealth of
Virginia shall include a Partnership Disclosure Notice (Form 200-B) explaining
the benefits associated with a partnership policy and indicating that at the
time issued, the policy is a qualified state long-term care insurance
partnership policy. A similar notice may be used if filed and approved by the
commission. The Partnership Disclosure Notice shall also include a statement
indicating that by purchasing this partnership policy, the insured does not
automatically qualify for Medicaid.
D.
1. A
partnership policy shall not be issued or issued for delivery in this
Commonwealth unless filed with and approved by the commission in accordance
with the procedures set forth in § 38.2-316 of the Code of Virginia. Any
policy submitted for approval as a partnership policy shall be accompanied by a
Partnership Certification Form (Form 200-C), or a similar form filed and
approved by the commission.
2.
Insurers requesting to make use of a previously approved policy form as a
qualified state long-term care partnership policy shall submit to the
commission a Partnership Certification Form signed by an officer of the
company. The Partnership Certification Form shall be accompanied by a copy of
the policy or certificate form listed, the approval date, and a bookmark for
each of the requirements listed in sections II and III of the form. A
Partnership Certification Form shall be required for each policy form submitted
for partnership qualification.
E. Agent training requirements. An individual
may not sell, solicit or negotiate a partnership policy unless the individual
is a licensed and appointed insurance agent in accordance with provisions of
Chapter 18 (§ 38.2-1800 et seq.) of Title 38.2 of the Code of Virginia and
has completed an initial training component and ongoing training every 24
months thereafter. The training shall meet the following requirements:
1. All training shall be approved as
continuing education by the Insurance Continuing Education Board in accordance
with § 38.2-1867 of the Code of Virginia.
2. The initial training required by this
subsection shall be no less than eight hours, and the on-going training
required by this subsection shall be no less than four hours.
3. The training required under subdivision 2
of this subsection shall consist of topics related to long-term care insurance,
long-term care services, and qualified state long-term care insurance
partnership programs, including, but not limited to:
a. State and federal regulations and
requirements and the relationship between qualified state long-term care
insurance partnership programs and other public and private coverage of
long-term care services, including Medicaid;
b. Available long-term care services and
providers;
c. Changes or
improvements in long-term care services or providers;
d. Alternatives to the purchase of private
long-term care insurance;
e. The
effect of inflation on benefits and the importance of inflation protection;
and
f. Consumer suitability
standards and guidelines.
F. Insurers offering a partnership policy
shall obtain verification that an agent has received the training required by
subsection E of this section before the agent is permitted to sell, solicit or
negotiate the insurer's partnership policy.
G. Each insurer shall maintain records with
respect to the training of its agents qualified to sell, solicit or negotiate
partnership policies, to include training received and that the agent has
demonstrated an understanding of the partnership policies and their
relationship to public and private coverage of long-term care, including
Medicaid, in this Commonwealth. These records shall be maintained for a period
of not less than five years and shall be made available to the commission upon
request.
H. Each insurer issuing a
partnership policy shall provide regular reports to the United States Secretary
of Health and Human Services in accordance with regulations of the Secretary
that include notification of the date benefits were paid, the amount paid, the
date the policy terminates, and such other information as the Secretary
determines may be appropriate to the administration of partnerships.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.
