(a) Every insurer shall maintain records for each agent of:
- (1) That agent’s amount of replacement sales as a percent of the agent’s total annual sales; and
- (2) The amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent’s total annual sales.
- (b) Every insurer shall report annually by June 30 the ten percent (10%) of its agents with the greatest percentages of lapses and replacements as measured by subsection (a) of this section (Appendix G).
(c)
- (1) Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing.
- (2) The reports are for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance.
- (d) 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 (Appendix G).
- (e) 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 (Appendix G).
- (f) 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 (Appendix E).
(g) For purposes of this section:
- (1) “Policy” means only long-term care insurance;
- (2) Subject to subdivision (g)(3) of this section, “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;
- (3) “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
- (4) “Report” means on a statewide basis.
- (h) Reports required under this section shall be filed with the Insurance Commissioner.