2626 REPORTING REQUIREMENTS

2600

2601

2602

2603

2604

2605

2606

2607

2608

2609

2610

2611

2612

2613

2614

2615

2616

2617

2618

2619

2620

2621

2622

2623

2624

2625

2626

2626.1 An insurer shall maintain records for each agent of the agent's amount of 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.

2626.2 An insurer shall report annually by June 30 the ten percent (10%) of its agents with the greatest percents of lapses and replacements as measured under subsection 2626.1. The report shall be provided on a form conforming with Appendix G.

2626.3 Reported replacement and lapse rates shall not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports shall be for the purpose of reviewing more closely agent activities regarding the sale of long-term care insurance.

2626.4 An 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. The report shall be provided on a form conforming with Appendix G.

2626.5 An 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. The report shall be provided on a form conforming with Appendix G.

2626.6 An 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. The report shall be provided on a form conforming with Appendix E.

2626.7 The information in the reports required under this section shall be provided on a District of Columbia-wide basis.

2626.8 Reports required by this section shall be filed with the Commissioner.

2626.9 For the purposes of this section, the word:

(a) “Policy” means only long-term care insurance;

(b) “Claim” means, subject to paragraph (c) of this subsection, 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; and

(c) “Denied” means the insurer refuses to pay a claim for a reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition.

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