| 16 | | - | Section 1. Subsection (c) of section 38a-501 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011): |
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| 28 | + | Section 1. Subsections (a) to (c), inclusive, of section 38a-501 of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2011): |
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| 29 | + | |
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| 30 | + | (a) (1) As used in this section, "long-term care policy" means any individual health insurance policy, delivered or issued for delivery to any resident of this state on or after July 1, 1986, which is designed to provide, within the terms and conditions of the policy, benefits on an expense-incurred, indemnity or prepaid basis for necessary care or treatment of an injury, illness or loss of functional capacity provided by a certified or licensed health care provider in a setting other than an acute care hospital, for at least one year after an elimination period (A) not to exceed one hundred days of confinement, or (B) of over one hundred days but not to exceed two years of confinement, provided such period is covered by an irrevocable trust in an amount estimated to be sufficient to furnish coverage to the grantor of the trust for the duration of the elimination period. Such trust shall create an unconditional duty to pay the full amount held in trust exclusively to cover the costs of confinement during the elimination period, subject only to taxes and any trustee's charges allowed by law. Payment shall be made directly to the provider. The duty of the trustee may be enforced by the state, the grantor or any person acting on behalf of the grantor. A long-term care policy shall provide benefits for confinement in a nursing home or confinement in the insured's own home or both. Any additional benefits provided shall be related to long-term treatment of an injury, illness or loss of functional capacity. "Long-term care policy" shall not include any such policy which is offered primarily to provide basic Medicare supplement coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified accident coverage or limited benefit health coverage. |
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| 31 | + | |
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| 32 | + | (2) (A) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center delivering, issuing for delivery, renewing, continuing or amending any long-term care policy in this state may refuse to accept or make reimbursement pursuant to a claim for benefits submitted by or prepared with the assistance of a managed residential community, as defined in section 19a-693, in accordance with subdivision (7) of subsection (a) of section 19a-694 solely because such claim for benefits was submitted by or prepared with the assistance of a managed residential community. |
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| 33 | + | |
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| 34 | + | (B) Each insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center delivering, issuing for delivery, renewing, continuing or amending any long-term care policy in this state shall, upon receipt of a written authorization executed by the insured, (i) disclose information to a managed residential community for the purpose of determining such insured's eligibility for an insurance benefit or payment, and (ii) provide a copy of the initial acceptance or declination of a claim for benefits to the managed residential community at the same time such acceptance or declination is made to the insured. |
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| 35 | + | |
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| 36 | + | (b) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center may deliver or issue for delivery any long-term care policy which has a loss ratio of less than sixty per cent for any individual long-term care policy. An issuer shall not use or change premium rates for a long-term care insurance policy unless the rates have been filed with and approved by the Insurance Commissioner. Any rate filings or rate revisions shall demonstrate that anticipated claims in relation to premiums when combined with actual experience to date can be expected to comply with the loss ratio requirement of this section. A rate filing shall include the factors and methodology used to estimate irrevocable trust values if the policy includes an option for the elimination period specified in subdivision (2) of subsection (a) of this section. |
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| 22 | | - | (i) A statement that the policy may be subject to rate increases in the future; |
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| 23 | | - | |
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| 24 | | - | (ii) An explanation of potential future premium rate revisions and the policyholder's option in the event of a premium rate revision; |
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| 25 | | - | |
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| 26 | | - | (iii) The premium rate or rate schedule applicable to the applicant that will be in effect until a request is made by such company, society, corporation or center for an increase in such rate or rate schedule; |
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| 27 | | - | |
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| 28 | | - | (iv) Information regarding each premium rate increase, if any, over the past ten years on such policy form or similar policy forms for this state or any other state, that identifies, at a minimum, (I) the policy forms for which premium rates have been increased, (II) the calendar years when each such policy form was available for purchase, and (III) the amount or percentage of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase or as minimum and maximum percentages if the rate increase is variable by rating characteristics; and |
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| 29 | | - | |
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| 30 | | - | (v) A completed copy of Appendix F of Volume IV, Model 641-1 of the National Association of Insurance Commissioners' Long-Term Care Insurance Model Regulation. |
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| 31 | | - | |
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| 32 | | - | (B) At the time such policy is executed, the policyholder shall initial a copy of the disclosure and the company, society, corporation or center shall retain such copy. |
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| 42 | + | (B) At the time such policy is executed, the insured shall initial a copy of the statement specified in subdivision (1) of this section and the company, society, corporation or center shall retain such copy. |
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| 36 | | - | Sec. 2. Subsection (c) of section 38a-528 of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2011): |
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| 46 | + | Sec. 2. Subsections (a) to (c), inclusive, of section 38a-528 of the general statutes are repealed and the following is substituted in lieu thereof (Effective October 1, 2011): |
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| 47 | + | |
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| 48 | + | (a) (1) As used in this section, "long-term care policy" means any group health insurance policy or certificate delivered or issued for delivery to any resident of this state on or after July 1, 1986, which is designed to provide, within the terms and conditions of the policy or certificate, benefits on an expense-incurred, indemnity or prepaid basis for necessary care or treatment of an injury, illness or loss of functional capacity provided by a certified or licensed health care provider in a setting other than an acute care hospital, for at least one year after a reasonable elimination period. A long-term care policy shall provide benefits for confinement in a nursing home or confinement in the insured's own home or both. Any additional benefits provided shall be related to long-term treatment of an injury, illness or loss of functional capacity. "Long-term care policy" shall not include any such policy or certificate which is offered primarily to provide basic Medicare supplement coverage, basic medical-surgical expense coverage, hospital confinement indemnity coverage, major medical expense coverage, disability income protection coverage, accident only coverage, specified accident coverage or limited benefit health coverage. |
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| 49 | + | |
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| 50 | + | (2) (A) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center delivering, issuing for delivery, renewing, continuing or amending any long-term care policy in this state may refuse to accept or make reimbursement pursuant to a claim for benefits submitted by or prepared with the assistance of a managed residential community, as defined in section 19a-693, in accordance with subdivision (7) of subsection (a) of section 19a-694 solely because such claim for benefits was submitted by or prepared with the assistance of a managed residential community. |
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| 51 | + | |
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| 52 | + | (B) Each insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center delivering, issuing for delivery, renewing, continuing or amending any long-term care policy in this state shall, upon receipt of a written authorization executed by the insured, (i) disclose information to a managed residential community for the purpose of determining such insured's eligibility for an insurance benefit or payment, and (ii) provide a copy of the initial acceptance or declination of a claim for benefits to the managed residential community at the same time such acceptance or declination is made to the insured. |
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| 53 | + | |
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| 54 | + | (b) No insurance company, fraternal benefit society, hospital service corporation, medical service corporation or health care center may deliver or issue for delivery any long-term care policy or certificate which has a loss ratio of less than sixty-five per cent for any group long-term care policy. An issuer shall not use or change premium rates for a long-term care insurance policy or certificate unless the rates have been filed with the Insurance Commissioner. Deviations in rates to reflect policyholder experience shall be permitted, provided each policy form shall meet the loss ratio requirement of this section. Any rate filings or rate revisions shall demonstrate that anticipated claims in relation to premiums when combined with actual experience to date can be expected to comply with the loss ratio requirement of this section. On an annual basis, an insurer shall submit to the Insurance Commissioner an actuarial certification of the insurer's continuing compliance with the loss ratio requirement of this section. Any rate or rate revision may be disapproved if the commissioner determines that the loss ratio requirement will not be met over the lifetime of the policy form using reasonable assumptions. |
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| 44 | | - | (ii) An explanation of potential future premium rate revisions and the policyholder's or certificate holder's option in the event of a premium rate revision; |
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| 45 | | - | |
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| 46 | | - | (iii) The premium rate or rate schedule applicable to the applicant that will be in effect until a request is made by such company, society, corporation or center for an increase in such rate or rate schedule; |
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| 47 | | - | |
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| 48 | | - | (iv) Information regarding each premium rate increase, if any, over the past ten years on such policy form or similar policy forms for this state or any other state, that identifies, at a minimum (I) the policy forms for which premium rates have been increased, (II) the calendar years when each such policy form was available for purchase, and (III) the amount or percentage of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase or as minimum and maximum percentages if the rate increase is variable by rating characteristics; and |
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| 49 | | - | |
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| 50 | | - | (v) A completed copy of Appendix F of Volume IV, Model 641-1 of the National Association of Insurance Commissioners' Long-Term Care Insurance Model Regulation. |
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| 51 | | - | |
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| 52 | | - | (B) At the time such policy is executed, the policyholder shall initial a copy of the disclosure and the company, society, corporation or center shall retain such copy. |
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| 53 | | - | |
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| 54 | | - | (C) The policyholder shall provide to each eligible individual a copy of the disclosure. |
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| 62 | + | (C) The policyholder shall provide to each eligible individual the disclosure required under this subdivision. |
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| 60 | | - | (NEW) (e) Any life insurance policy with long-term care benefits issued pursuant to this section shall comply with the disclosure requirements set forth in subdivision (1) of subsection (c) of section 38a-501, as amended by this act. |
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| 68 | + | (a) On and after June 16, 1989, any life insurance company doing business in this state may issue life insurance policies or certificates, or riders or endorsements thereto, which provide, within the terms and conditions of the policy or certificate, long-term care benefits as described in section 38a-501, as amended by this act, provided such company is licensed for both life and health insurance in this state. The Insurance Commissioner may adopt regulations, in accordance with chapter 54, to implement the provisions of this section. Prior to the effective date of such regulations, any such policy, certificate, rider or endorsement may be filed with the commissioner and may be approved at the commissioner's discretion. |
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| 69 | + | |
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| 70 | + | (b) Long-term care benefits provided pursuant to subsection (a) of this section shall not be subject to the requirements of subsection (b) of section 38a-501, as amended by this act, or subsection (b) of section 38a-528, as amended by this act. |
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| 71 | + | |
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| 72 | + | (c) No insurance producer shall sell any such policy, certificate, rider or endorsement unless the producer is licensed to sell both life and health insurance in this state. |
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| 73 | + | |
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| 74 | + | (d) A life insurance policy with long-term care benefits issued pursuant to this section may include a rider that provides long-term care benefits that become payable upon exhaustion of benefits under the life insurance policy. The elimination period limitations shall apply only to the life insurance policy to which the rider is attached. Such rider shall not contain an additional elimination period and may calculate the waiver of premium from the time benefits are payable under such rider. |
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| 75 | + | |
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| 76 | + | (e) Any life insurance policy with long-term care benefits issued pursuant to this section shall comply with the disclosure requirements set forth in subdivision (1) of subsection (c) of section 38a-501, as amended by this act. |
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