Ill. Admin. Code tit. 50, § 2012.EXHIBIT K
Long-Term Care Insurance
Replacement and Lapse Reporting Form
| For the State of | ||
| 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 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 Replacements As % of Number Sold By This Agent |
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 As % of 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) | % | |
(Source: Added at 32 Ill. Reg. 7600, effective May 5, 2008)