Md. Code Regs. 31.14.01.32
The following form is to be used for reporting claim denials made by each insurer as required by Regulation .24G of this chapter: For the State of Instructions The purpose of this form is to report all long-term care claim denials under in force long-term care insurance policies. “Denied” means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition. 1 The nationwide data may be viewed as a more representative and credible indicator where the data for claims reported and denied for your state are small in number. 2 Example — home health care claim filed under a nursing home only policy. 3 Example — a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy. 4 Examples — a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care.
| Company Name: __________________________ Due: June 30 annually |
| Company Address: _________________________________________ |
| Company NAIC Number: ____________________________________ |
| Contact Person: _________________ Phone Number: ______________ |
| Line of Business: _____________ Individual ________ Group |
| State Data | Nationwide Data1 | ||
|---|---|---|---|
| 1 | Total Number of Long-Term Care Claims Reported | ||
| 2 | Total Number of Long-Term Care Claims Denied/Not Paid | ||
| 3 | Number of Claims Not Paid due to Preexisting Condition Exclusion | ||
| 4 | Number of Claims Not Paid due to Waiting (Elimination) Period Not Met | ||
| 5 | Net Number of Long-Term Care Claims Denied for Reporting Purposes (Line 2 Minus Line 3 Minus Line 4) | ||
| 6 | Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1) | ||
| 7 | Number of Long-Term Care Claim Denied due to: | ||
| 8 | • Long-Term Care Services Not Covered under the Policy2 | ||
| 9 | • Provider/Facility Not Qualified under the Policy3 | ||
| 10 | • Benefit Eligibility Criteria Not Met4 | ||
| 11 | • Other |
Authority: Health-General Article, §19-705; Insurance Article, §§2-109, 14-124, Title 18, Subtitle 1, and Title 27; Annotated Code of Maryland
Effective date: September 1, 1994 (21:13 Md. R. 1156)
Chapter recodified from COMAR 09.30.88 to COMAR 31.14.01 effective September 7, 1998 (25:18 Md. R. 1439)
Chapter revised effective April 1, 2002 (29:6 Md. R. 570)
Chapter revised effective September 10, 2007 (34:18 Md. R. 1581)
Regulation .01 amended effective September 1, 2014 (41:17 Md. R. 972)
Regulation .13E amended effective February 27, 2017 (44:4 Md. R. 256)
Regulation .24H—J adopted effective February 27, 2017 (44:4 Md. R. 256)
Regulation .36 amended effective February 27, 2017 (44:4 Md. R. 256)