1. (1) This section applies to all individual long-term care insurance policies except those covered in Sections R590-148-21 and R590-148-24.
2. (2) Benefits under an individual policy are considered reasonable in relation to the premium if the expected loss ratio is at least 60%, calculated in a manner that provides for adequate reserving of the long-term care insurance risk.

3. (3) In evaluating the expected loss ratio, consideration shall be given to each relevant factor, including:

   1. (a) statistical credibility of incurred claims experience and earned premiums;
   2. (b) the period that rates are computed to provide coverage;
   3. (c) experienced and projected trends;
   4. (d) concentration of experience within early policy duration;
   5. (e) expected claim fluctuation;
   6. (f) experience refunds, adjustments, or dividends;
   7. (g) renewability features;

   8. (h) all appropriate expense factors;

      1. (i) interest;
   9. (j) experimental nature of the coverage;

   10. (k) policy reserves;

       1. (l) mix of business by risk classification; and
   11. (m) product features such as long elimination periods, high deductibles, and high maximum limits.

4. (4) The premium charged to an insured may not increase due to:

   1. (a) the increasing age of the insured at an age beyond 65; or
   2. (b) the duration the insured has been covered under the policy.
5. (5) Rate filing documents shall contain the information required in Section R590-85-4.

KEY: insurance

Date of Last Change: October 22, 2024

Notice of Continuation: June 30, 2022

Authorizing, and Implemented or Interpreted Law: 31A-2-201; 31A-22-1404