2619 INITIAL FILING REQUIREMENTS

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2619

2619.1 The requirements of this section shall apply to a long-term care insurance policy issued in the District of Columbia on or after June 16, 2006.

2619.2 An insurer shall provide the following information to the Commissioner at least thirty (30) days prior to making a long-term care insurance form available for sale:

(a) A copy of the disclosure documents required by section 2618; and

(b) An actuarial certification consisting of the following:

(1) A statement that the initial premium rate schedule is sufficient to cover anticipated costs under moderately adverse experience and that the premium rate schedule is reasonably expected to be sustainable over the life of the form with no future premium increases anticipated;

(2) A statement that the policy design and coverage provided have been reviewed and taken into consideration;

(3) A statement that the underwriting and claims adjudication processes have been reviewed and taken into consideration;

(4) A complete description of the basis for contract reserves that are anticipated to be held under the form, including the following:

(A) Sufficient detail or sample calculations so as to completely depict the reserve amounts to be held;

(B) A statement that the assumptions used for reserves contain reasonable margins for adverse experience;

(C) A statement that the net valuation premium for renewal years does not increase (except for attained-age rating where permitted); and

(D) A statement that the difference between the gross premium and the net valuation premium for renewal years is sufficient to cover expected renewal expenses; or, if such a statement cannot be made, a complete description of the situations where the difference is not sufficient. An aggregate distribution of anticipated issues may be used as long as the underlying gross premiums maintain a reasonably consistent relationship. If the gross premiums for certain age groups appear to be inconsistent with this requirement, the Commissioner may request a demonstration under subsection 2619.3 based on a standard age distribution; and

(5) (A) A statement that the premium rate schedule is not less than the premium rate schedule for existing similar policy forms also available from the insurer except for reasonable differences attributable to benefits; or

(B) A comparison of the premium rate schedules for similar policy forms that are currently available from the insurer with an explanation of the differences between the premium rate schedule for the policy form and similar policy forms.

2619.3 The Commissioner may request an actuarial demonstration that benefits are reasonable in relation to premiums. The actuarial demonstration shall include either premium and claim experience on similar policy forms, adjusted for any premium or benefit differences, relevant and credible data from other studies,

or both.

2619.4 If the Commissioner asks for additional information under this section, the period in subsection 2619.2 shall not include the period during which the insurer is preparing the requested information.

SOURCE: Final Rulemaking published at 52 DCR 10902 (December 16, 2005); as amended by Final Rulemaking published at 55 DCR 3759 (April 11, 2008).