Ala. Admin. Code r. 482-1-091-AG
Appendix G
Replacement and Lapse Reporting Form
Long‑Term Care Insurance
Replacement and Lapse Reporting Form
For the State of _________________________________ For the Reporting Year of _____________
Company Name: ____________________________________ Due: June 30 annually
Company Address: ________________________________ Company NAIC
Number: _____________
Contact Person: _____________________________________ Phone Number: ( )_______________
Instructions
The purpose of this form is to report on a statewide basis information regarding long‑term care insurance policy replacements and lapses. Specifically, every insurer shall maintain records for each agent on that agent’s amount of long‑term care insurance replacement sales as a percent of the agent’s total annual sales and the amount of lapses of long‑term care insurance policies sold by the agent as a percent of the agent’s total annual sales. The tables below should be used to report the ten percent (10%) of the insurer’s agents with the greatest percentages of replacements and lapses.
Listing of the 10% of Agents with the Greatest Percentage of Replacements
| Agent’s Name | Number of Policies Sold By This Agent | Number of Policies Replaced By This Agent | Number of Replace Number Sold By |
Listing of the 10% of Agents with the Greatest Percentage of Lapses
| Agent’s Name | Number of Policies Sold By This Agent | Number of Policies Lapsed By This Agent | Number of Lapses And Number Sold By This Agent |
Company Totals
Percentage of Replacement Policies Sold to Total Annual Sales _______%
Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year) _______%
Percentage of Lapsed Policies to Total Annual Sales _______%
Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) _______%
Author: Reyn Norman, Associate Counsel
Statutory Authority: Code of Ala. 1975, §§27-2-17, 27-19-100, et seq.
History: New: December 21, 2005; effective July 1, 2006. Filed with LRS December 21, 2005. Rule is not subject to the Alabama Administrative Procedure Act.