| Old | New | Differences | |
|---|---|---|---|
| 1 | 1 | ||
| 2 | 2 | ||
| 3 | + | LCO 4598 \\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046-R01- | |
| 4 | + | SB.docx | |
| 5 | + | 1 of 20 | |
| 3 | 6 | ||
| 4 | - | Senate Bill No. 1046 | |
| 7 | + | General Assembly Raised Bill No. 1046 | |
| 8 | + | January Session, 2021 | |
| 9 | + | LCO No. 4598 | |
| 5 | 10 | ||
| 6 | - | Public Act No. 21-150 | |
| 11 | + | ||
| 12 | + | Referred to Committee on INSURANCE AND REAL ESTATE | |
| 13 | + | ||
| 14 | + | ||
| 15 | + | Introduced by: | |
| 16 | + | (INS) | |
| 17 | + | ||
| 7 | 18 | ||
| 8 | 19 | ||
| 9 | 20 | AN ACT CONCERNING LO NG-TERM CARE INSURANCE. | |
| 10 | 21 | Be it enacted by the Senate and House of Representatives in General | |
| 11 | 22 | Assembly convened: | |
| 12 | 23 | ||
| 13 | - | Section 1. Section 38a-1 of the general statutes is repealed and the | |
| 14 | - | following is substituted in lieu thereof (Effective January 1, 2022): | |
| 15 | - | Terms used in this title and section 2 of this act, unless it appears from | |
| 16 | - | the context to the contrary, shall have a scope and meaning as set forth | |
| 17 | - | in this section. | |
| 18 | - | (1) "Affiliate" or "affiliated" means a person that directly, or indirectly | |
| 19 | - | through one or more intermediaries, controls, is controlled by or is | |
| 20 | - | under common control with another person. | |
| 21 | - | (2) "Alien insurer" means any insurer that has been chartered by or | |
| 22 | - | organized or constituted within or under the laws of any jurisdiction or | |
| 23 | - | country without the United States. | |
| 24 | - | (3) "Annuities" means all agreements to make periodical payments | |
| 25 | - | where the making or continuance of all or some of the series of the | |
| 26 | - | payments, or the amount of the payment, is dependent upon the | |
| 27 | - | continuance of human life or is for a specified term of years. This | |
| 28 | - | definition does not apply to payments made under a policy of life | |
| 29 | - | insurance. Senate Bill No. 1046 | |
| 24 | + | Section 1. Section 38a-1 of the general statutes is repealed and the 1 | |
| 25 | + | following is substituted in lieu thereof (Effective January 1, 2022): 2 | |
| 26 | + | Terms used in this title and section 2 of this act, unless it appears from 3 | |
| 27 | + | the context to the contrary, shall have a scope and meaning as set forth 4 | |
| 28 | + | in this section. 5 | |
| 29 | + | (1) "Affiliate" or "affiliated" means a person that directly, or indirectly 6 | |
| 30 | + | through one or more intermediaries, controls, is controlled by or is 7 | |
| 31 | + | under common control with another person. 8 | |
| 32 | + | (2) "Alien insurer" means any insurer that has been chartered by or 9 | |
| 33 | + | organized or constituted within or under the laws of any jurisdiction or 10 | |
| 34 | + | country without the United States. 11 | |
| 35 | + | (3) "Annuities" means all agreements to make periodical payments 12 | |
| 36 | + | where the making or continuance of all or some of the series of the 13 | |
| 37 | + | payments, or the amount of the payment, is dependent upon the 14 Raised Bill No. 1046 | |
| 30 | 38 | ||
| 31 | - | Public Act No. 21-150 2 of 20 | |
| 32 | 39 | ||
| 33 | - | (4) "Commissioner" means the Insurance Commissioner. | |
| 34 | - | (5) "Control", "controlled by" or "under common control with" means | |
| 35 | - | the possession, direct or indirect, of the power to direct or cause the | |
| 36 | - | direction of the management and policies of a person, whether through | |
| 37 | - | the ownership of voting securities, by contract other than a commercial | |
| 38 | - | contract for goods or nonmanagement services, or otherwise, unless the | |
| 39 | - | power is the result of an official position with the person. | |
| 40 | - | (6) "Domestic insurer" means any insurer that has been chartered by, | |
| 41 | - | incorporated, organized or constituted within or under the laws of this | |
| 42 | - | state. | |
| 43 | - | (7) "Domestic surplus lines insurer" means any domestic insurer that | |
| 44 | - | has been authorized by the commissioner to write surplus lines | |
| 45 | - | insurance. | |
| 46 | - | (8) "Foreign country" means any jurisdiction not in any state, district | |
| 47 | - | or territory of the United States. | |
| 48 | - | (9) "Foreign insurer" means any insurer that has been chartered by or | |
| 49 | - | organized or constituted within or under the laws of another state or a | |
| 50 | - | territory of the United States. | |
| 51 | - | (10) "Insolvency" or "insolvent" means, for any insurer, that it is | |
| 52 | - | unable to pay its obligations when they are due, or when its admitted | |
| 53 | - | assets do not exceed its liabilities plus the greater of: (A) Capital and | |
| 54 | - | surplus required by law for its organization and continued operation; | |
| 55 | - | or (B) the total par or stated value of its authorized and issued capital | |
| 56 | - | stock. For purposes of this subdivision "liabilities" shall include but not | |
| 57 | - | be limited to reserves required by statute or by regulations adopted by | |
| 58 | - | the commissioner in accordance with the provisions of chapter 54 or | |
| 59 | - | specific requirements imposed by the commissioner upon a subject | |
| 60 | - | company at the time of admission or subsequent thereto. Senate Bill No. 1046 | |
| 40 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 41 | + | R01-SB.docx } | |
| 42 | + | 2 of 20 | |
| 61 | 43 | ||
| 62 | - | Public Act No. 21-150 3 of 20 | |
| 44 | + | continuance of human life or is for a specified term of years. This 15 | |
| 45 | + | definition does not apply to payments made under a policy of life 16 | |
| 46 | + | insurance. 17 | |
| 47 | + | (4) "Commissioner" means the Insurance Commissioner. 18 | |
| 48 | + | (5) "Control", "controlled by" or "under common control with" means 19 | |
| 49 | + | the possession, direct or indirect, of the power to direct or cause the 20 | |
| 50 | + | direction of the management and policies of a person, whether through 21 | |
| 51 | + | the ownership of voting securities, by contract other than a commercial 22 | |
| 52 | + | contract for goods or nonmanagement services, or otherwise, unless the 23 | |
| 53 | + | power is the result of an official position with the person. 24 | |
| 54 | + | (6) "Domestic insurer" means any insurer that has been chartered by, 25 | |
| 55 | + | incorporated, organized or constituted within or under the laws of this 26 | |
| 56 | + | state. 27 | |
| 57 | + | (7) "Domestic surplus lines insurer" means any domestic insurer that 28 | |
| 58 | + | has been authorized by the commissioner to write surplus lines 29 | |
| 59 | + | insurance. 30 | |
| 60 | + | (8) "Foreign country" means any jurisdiction not in any state, district 31 | |
| 61 | + | or territory of the United States. 32 | |
| 62 | + | (9) "Foreign insurer" means any insurer that has been chartered by or 33 | |
| 63 | + | organized or constituted within or under the laws of another state or a 34 | |
| 64 | + | territory of the United States. 35 | |
| 65 | + | (10) "Insolvency" or "insolvent" means, for any insurer, that it is 36 | |
| 66 | + | unable to pay its obligations when they are due, or when its admitted 37 | |
| 67 | + | assets do not exceed its liabilities plus the greater of: (A) Capital and 38 | |
| 68 | + | surplus required by law for its organization and continued operation; 39 | |
| 69 | + | or (B) the total par or stated value of its authorized and issued capital 40 | |
| 70 | + | stock. For purposes of this subdivision "liabilities" shall include but not 41 | |
| 71 | + | be limited to reserves required by statute or by regulations adopted by 42 | |
| 72 | + | the commissioner in accordance with the provisions of chapter 54 or 43 | |
| 73 | + | specific requirements imposed by the commissioner upon a subject 44 Raised Bill No. 1046 | |
| 63 | 74 | ||
| 64 | - | (11) "Insurance" means any agreement to pay a sum of money, | |
| 65 | - | provide services or any other thing of value on the happening of a | |
| 66 | - | particular event or contingency or to provide indemnity for loss in | |
| 67 | - | respect to a specified subject by specified perils in return for a | |
| 68 | - | consideration. In any contract of insurance, an insured shall have an | |
| 69 | - | interest which is subject to a risk of loss through destruction or | |
| 70 | - | impairment of that interest, which risk is assumed by the insurer and | |
| 71 | - | such assumption shall be part of a general scheme to distribute losses | |
| 72 | - | among a large group of persons bearing similar risks in return for a | |
| 73 | - | ratable contribution or other consideration. | |
| 74 | - | (12) "Insurer" or "insurance company" includes any person or | |
| 75 | - | combination of persons doing any kind or form of insurance business | |
| 76 | - | other than a fraternal benefit society, and shall include a receiver of any | |
| 77 | - | insurer when the context reasonably permits. | |
| 78 | - | (13) "Insured" means a person to whom or for whose benefit an | |
| 79 | - | insurer makes a promise in an insurance policy. The term includes | |
| 80 | - | policyholders, subscribers, members and beneficiaries. This definition | |
| 81 | - | applies only to the provisions of this title and does not define the | |
| 82 | - | meaning of this word as used in insurance policies or certificates. | |
| 83 | - | (14) "Life insurance" means insurance on human lives and insurances | |
| 84 | - | pertaining to or connected with human life. The business of life | |
| 85 | - | insurance includes granting endowment benefits, granting additional | |
| 86 | - | benefits in the event of death by accident or accidental means, granting | |
| 87 | - | additional benefits in the event of the total and permanent disability of | |
| 88 | - | the insured, and providing optional methods of settlement of proceeds. | |
| 89 | - | Life insurance includes burial contracts to the extent provided by | |
| 90 | - | section 38a-464. | |
| 91 | - | (15) "Mutual insurer" means any insurer without capital stock, the | |
| 92 | - | managing directors or officers of which are elected by its members. Senate Bill No. 1046 | |
| 93 | 75 | ||
| 94 | - | Public Act No. 21-150 4 of 20 | |
| 76 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 77 | + | R01-SB.docx } | |
| 78 | + | 3 of 20 | |
| 95 | 79 | ||
| 96 | - | (16) "Person" means an individual, a corporation, a partnership, a | |
| 97 | - | limited liability company, an association, a joint stock company, a | |
| 98 | - | business trust, an unincorporated organization or other legal entity. | |
| 99 | - | (17) "Policy" means any document, including attached endorsements | |
| 100 | - | and riders, purporting to be an enforceable contract, which | |
| 101 | - | memorializes in writing some or all of the terms of an insurance | |
| 102 | - | contract. | |
| 103 | - | (18) "State" means any state, district, or territory of the United States. | |
| 104 | - | (19) "Subsidiary" of a specified person means an affiliate controlled | |
| 105 | - | by the person directly, or indirectly through one or more intermediaries. | |
| 106 | - | (20) "Unauthorized insurer" or "nonadmitted insurer" means an | |
| 107 | - | insurer that has not been granted a certificate of authority by the | |
| 108 | - | commissioner to transact the business of insurance in this state or an | |
| 109 | - | insurer transacting business not authorized by a valid certificate. | |
| 110 | - | (21) "United States" means the United States of America, its territories | |
| 111 | - | and possessions, the Commonwealth of Puerto Rico and the District of | |
| 112 | - | Columbia. | |
| 113 | - | Sec. 2. (NEW) (Effective January 1, 2022) (a) For the purposes of this | |
| 114 | - | section, "long-term care policy" has the same meaning as provided in | |
| 115 | - | section 38a-501 of the general statutes, as amended by this act, or section | |
| 116 | - | 38a-528 of the general statutes, as amended by this act, as applicable. | |
| 117 | - | (b) The commissioner shall, after consulting with other state | |
| 118 | - | governments and conducting a nation-wide review, develop and | |
| 119 | - | prescribe a minimum set of affordable benefit options to be offered by | |
| 120 | - | an insurance company, fraternal benefit society, hospital service | |
| 121 | - | corporation, medical service corporation or health care center that files | |
| 122 | - | a rate filing under section 38a-501 of the general statutes, as amended | |
| 123 | - | by this act, or section 38a-528 of the general statutes, as amended by this Senate Bill No. 1046 | |
| 80 | + | company at the time of admission or subsequent thereto. 45 | |
| 81 | + | (11) "Insurance" means any agreement to pay a sum of money, 46 | |
| 82 | + | provide services or any other thing of value on the happening of a 47 | |
| 83 | + | particular event or contingency or to provide indemnity for loss in 48 | |
| 84 | + | respect to a specified subject by specified perils in return for a 49 | |
| 85 | + | consideration. In any contract of insurance, an insured shall have an 50 | |
| 86 | + | interest which is subject to a risk of loss through destruction or 51 | |
| 87 | + | impairment of that interest, which risk is assumed by the insurer and 52 | |
| 88 | + | such assumption shall be part of a general scheme to distribute losses 53 | |
| 89 | + | among a large group of persons bearing similar risks in return for a 54 | |
| 90 | + | ratable contribution or other consideration. 55 | |
| 91 | + | (12) "Insurer" or "insurance company" includes any person or 56 | |
| 92 | + | combination of persons doing any kind or form of insurance business 57 | |
| 93 | + | other than a fraternal benefit society, and shall include a receiver of any 58 | |
| 94 | + | insurer when the context reasonably permits. 59 | |
| 95 | + | (13) "Insured" means a person to whom or for whose benefit an 60 | |
| 96 | + | insurer makes a promise in an insurance policy. The term includes 61 | |
| 97 | + | policyholders, subscribers, members and beneficiaries. This definition 62 | |
| 98 | + | applies only to the provisions of this title and does not define the 63 | |
| 99 | + | meaning of this word as used in insurance policies or certificates. 64 | |
| 100 | + | (14) "Life insurance" means insurance on human lives and insurances 65 | |
| 101 | + | pertaining to or connected with human life. The business of life 66 | |
| 102 | + | insurance includes granting endowment benefits, granting additional 67 | |
| 103 | + | benefits in the event of death by accident or accidental means, granting 68 | |
| 104 | + | additional benefits in the event of the total and permanent disability of 69 | |
| 105 | + | the insured, and providing optional methods of settlement of proceeds. 70 | |
| 106 | + | Life insurance includes burial contracts to the extent provided by 71 | |
| 107 | + | section 38a-464. 72 | |
| 108 | + | (15) "Mutual insurer" means any insurer without capital stock, the 73 | |
| 109 | + | managing directors or officers of which are elected by its members. 74 | |
| 110 | + | (16) "Person" means an individual, a corporation, a partnership, a 75 Raised Bill No. 1046 | |
| 124 | 111 | ||
| 125 | - | Public Act No. 21-150 5 of 20 | |
| 126 | 112 | ||
| 127 | - | act, for an increase in premium rates for a long-term care policy that is | |
| 128 | - | for twenty per cent or more. The commissioner shall send to each | |
| 129 | - | insurance company, fraternal benefit society, hospital service | |
| 130 | - | corporation, medical service corporation or health care center that files | |
| 131 | - | such a rate filing a notice disclosing such minimum set of affordable | |
| 132 | - | benefit options. | |
| 133 | - | (c) The commissioner may adopt regulations, in accordance with the | |
| 134 | - | provisions of chapter 54 of the general statutes, to carry out the purposes | |
| 135 | - | of this section. | |
| 136 | - | Sec. 3. Section 38a-501 of the general statutes is repealed and the | |
| 137 | - | following is substituted in lieu thereof (Effective January 1, 2022): | |
| 138 | - | (a) (1) As used in this section and section 2 of this act, "long-term care | |
| 139 | - | policy" means any individual health insurance policy delivered or | |
| 140 | - | issued for delivery to any resident of this state on or after July 1, 1986, | |
| 141 | - | that is designed to provide, within the terms and conditions of the | |
| 142 | - | policy, benefits on an expense-incurred, indemnity or prepaid basis for | |
| 143 | - | necessary care or treatment of an injury, illness or loss of functional | |
| 144 | - | capacity provided by a certified or licensed health care provider in a | |
| 145 | - | setting other than an acute care hospital, for at least one year after an | |
| 146 | - | elimination period (A) not to exceed one hundred days of confinement, | |
| 147 | - | or (B) of over one hundred days but not to exceed two years of | |
| 148 | - | confinement, provided such period is covered by an irrevocable trust in | |
| 149 | - | an amount estimated to be sufficient to furnish coverage to the grantor | |
| 150 | - | of the trust for the duration of the elimination period. Such trust shall | |
| 151 | - | create an unconditional duty to pay the full amount held in trust | |
| 152 | - | exclusively to cover the costs of confinement during the elimination | |
| 153 | - | period, subject only to taxes and any trustee's charges allowed by law. | |
| 154 | - | Payment shall be made directly to the provider. The duty of the trustee | |
| 155 | - | may be enforced by the state, the grantor or any person acting on behalf | |
| 156 | - | of the grantor. A long-term care policy shall provide benefits for | |
| 157 | - | confinement in a nursing home or confinement in the insured's own Senate Bill No. 1046 | |
| 113 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 114 | + | R01-SB.docx } | |
| 115 | + | 4 of 20 | |
| 158 | 116 | ||
| 159 | - | Public Act No. 21-150 6 of 20 | |
| 117 | + | limited liability company, an association, a joint stock company, a 76 | |
| 118 | + | business trust, an unincorporated organization or other legal entity. 77 | |
| 119 | + | (17) "Policy" means any document, including attached endorsements 78 | |
| 120 | + | and riders, purporting to be an enforceable contract, which 79 | |
| 121 | + | memorializes in writing some or all of the terms of an insurance 80 | |
| 122 | + | contract. 81 | |
| 123 | + | (18) "State" means any state, district, or territory of the United States. 82 | |
| 124 | + | (19) "Subsidiary" of a specified person means an affiliate controlled 83 | |
| 125 | + | by the person directly, or indirectly through one or more intermediaries. 84 | |
| 126 | + | (20) "Unauthorized insurer" or "nonadmitted insurer" means an 85 | |
| 127 | + | insurer that has not been granted a certificate of authority by the 86 | |
| 128 | + | commissioner to transact the business of insurance in this state or an 87 | |
| 129 | + | insurer transacting business not authorized by a valid certificate. 88 | |
| 130 | + | (21) "United States" means the United States of America, its territories 89 | |
| 131 | + | and possessions, the Commonwealth of Puerto Rico and the District of 90 | |
| 132 | + | Columbia. 91 | |
| 133 | + | Sec. 2. (NEW) (Effective January 1, 2022) (a) For the purposes of this 92 | |
| 134 | + | section, "long-term care policy" has the same meaning as provided in 93 | |
| 135 | + | section 38a-501 of the general statutes, as amended by this act, or section 94 | |
| 136 | + | 38a-528 of the general statutes, as amended by this act, as applicable. 95 | |
| 137 | + | (b) The commissioner shall, after consulting with other state 96 | |
| 138 | + | governments and conducting a nation-wide review, develop and 97 | |
| 139 | + | prescribe a minimum set of affordable benefit options to be offered by 98 | |
| 140 | + | an insurance company, fraternal benefit society, hospital service 99 | |
| 141 | + | corporation, medical service corporation or health care center that files 100 | |
| 142 | + | a rate filing under section 38a-501 of the general statutes, as amended 101 | |
| 143 | + | by this act, or section 38a-528 of the general statutes, as amended by this 102 | |
| 144 | + | act, for an increase in premium rates for a long-term care policy that is 103 | |
| 145 | + | for twenty per cent or more. The commissioner shall send to each 104 | |
| 146 | + | insurance company, fraternal benefit society, hospital service 105 Raised Bill No. 1046 | |
| 160 | 147 | ||
| 161 | - | home or both. Any additional benefits provided shall be related to long- | |
| 162 | - | term treatment of an injury, illness or loss of functional capacity. "Long- | |
| 163 | - | term care policy" does not include any such policy that is offered | |
| 164 | - | primarily to provide basic Medicare supplement coverage, basic | |
| 165 | - | medical-surgical expense coverage, hospital confinement indemnity | |
| 166 | - | coverage, major medical expense coverage, disability income protection | |
| 167 | - | coverage, accident only coverage, specified accident coverage or limited | |
| 168 | - | benefit health coverage. | |
| 169 | - | (2) (A) Notwithstanding any provision of the general statutes, no | |
| 170 | - | insurance company, fraternal benefit society, hospital service | |
| 171 | - | corporation, medical service corporation or health care center may | |
| 172 | - | deliver, issue for delivery, renew, continue or amend any long-term care | |
| 173 | - | policy in this state on or after January 1, 2022, unless the insurance | |
| 174 | - | company, fraternal benefit society, hospital service corporation, medical | |
| 175 | - | service corporation or health care center is authorized or licensed to sell | |
| 176 | - | long-term care insurance and at least one other line of insurance in this | |
| 177 | - | state. | |
| 178 | - | [(2) (A)] (B) No insurance company, fraternal benefit society, hospital | |
| 179 | - | service corporation, medical service corporation or health care center | |
| 180 | - | delivering, issuing for delivery, renewing, continuing or amending any | |
| 181 | - | long-term care policy in this state may refuse to accept, or refuse to make | |
| 182 | - | reimbursement pursuant to, a claim for benefits submitted by or | |
| 183 | - | prepared with the assistance of a managed residential community, as | |
| 184 | - | defined in section 19a-693, in accordance with subdivision (7) of | |
| 185 | - | subsection (a) of section 19a-694, solely because such claim for benefits | |
| 186 | - | was submitted by or prepared with the assistance of a managed | |
| 187 | - | residential community. | |
| 188 | - | [(B)] (C) Each insurance company, fraternal benefit society, hospital | |
| 189 | - | service corporation, medical service corporation or health care center | |
| 190 | - | delivering, issuing for delivery, renewing, continuing or amending any | |
| 191 | - | long-term care policy in this state shall, upon receipt of a written Senate Bill No. 1046 | |
| 192 | 148 | ||
| 193 | - | Public Act No. 21-150 7 of 20 | |
| 149 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 150 | + | R01-SB.docx } | |
| 151 | + | 5 of 20 | |
| 194 | 152 | ||
| 195 | - | authorization executed by the insured, (i) disclose information to a | |
| 196 | - | managed residential community for the purpose of determining such | |
| 197 | - | insured's eligibility for an insurance benefit or payment, and (ii) provide | |
| 198 | - | a copy of the initial acceptance or declination of a claim for benefits to | |
| 199 | - | the managed residential community at the same time such acceptance | |
| 200 | - | or declination is made to the insured. | |
| 201 | - | (b) (1) No insurance company, fraternal benefit society, hospital | |
| 202 | - | service corporation, medical service corporation or health care center | |
| 203 | - | may deliver or issue for delivery any long-term care policy that has a | |
| 204 | - | loss ratio of less than sixty per cent for any individual long-term care | |
| 205 | - | policy. An issuer shall not use or change premium rates for a long-term | |
| 206 | - | care policy unless the rates have been filed with and approved by the | |
| 207 | - | [Insurance Commissioner] commissioner. Any rate filings or rate | |
| 208 | - | revisions shall demonstrate that anticipated claims in relation to | |
| 209 | - | premiums when combined with actual experience to date can be | |
| 210 | - | expected to comply with the loss ratio requirement of this section. A rate | |
| 211 | - | filing shall include the factors and methodology used to estimate | |
| 212 | - | irrevocable trust values if the policy includes an option for the | |
| 213 | - | elimination period specified in subdivision (1) of subsection (a) of this | |
| 214 | - | section. | |
| 215 | - | (2) (A) Any insurance company, fraternal benefit society, hospital | |
| 216 | - | service corporation, medical service corporation or health care center | |
| 217 | - | that files a rate filing for an increase in premium rates for a long-term | |
| 218 | - | care policy that is for twenty per cent or more shall spread the increase | |
| 219 | - | over a period of not less than three years and not file a rate filing for an | |
| 220 | - | increase in premium rates for the long-term care policy during the | |
| 221 | - | period chosen. Such company, society, corporation or center shall use a | |
| 222 | - | periodic rate increase that is actuarially equivalent to a single rate | |
| 223 | - | increase and a current interest rate for the period chosen. | |
| 224 | - | (B) Prior to implementing a premium rate increase, each such | |
| 225 | - | company, society, corporation or center shall: Senate Bill No. 1046 | |
| 153 | + | corporation, medical service corporation or health care center that files 106 | |
| 154 | + | such a rate filing a notice disclosing such minimum set of affordable 107 | |
| 155 | + | benefit options. 108 | |
| 156 | + | (c) The commissioner may adopt regulations, in accordance with the 109 | |
| 157 | + | provisions of chapter 54 of the general statutes, to carry out the purposes 110 | |
| 158 | + | of this section. 111 | |
| 159 | + | Sec. 3. Section 38a-501 of the general statutes is repealed and the 112 | |
| 160 | + | following is substituted in lieu thereof (Effective January 1, 2022): 113 | |
| 161 | + | (a) (1) As used in this section and section 2 of this act, "long-term care 114 | |
| 162 | + | policy" means any individual health insurance policy delivered or 115 | |
| 163 | + | issued for delivery to any resident of this state on or after July 1, 1986, 116 | |
| 164 | + | that is designed to provide, within the terms and conditions of the 117 | |
| 165 | + | policy, benefits on an expense-incurred, indemnity or prepaid basis for 118 | |
| 166 | + | necessary care or treatment of an injury, illness or loss of functional 119 | |
| 167 | + | capacity provided by a certified or licensed health care provider in a 120 | |
| 168 | + | setting other than an acute care hospital, for at least one year after an 121 | |
| 169 | + | elimination period (A) not to exceed one hundred days of confinement, 122 | |
| 170 | + | or (B) of over one hundred days but not to exceed two years of 123 | |
| 171 | + | confinement, provided such period is covered by an irrevocable trust in 124 | |
| 172 | + | an amount estimated to be sufficient to furnish coverage to the grantor 125 | |
| 173 | + | of the trust for the duration of the elimination period. Such trust shall 126 | |
| 174 | + | create an unconditional duty to pay the full amount held in trust 127 | |
| 175 | + | exclusively to cover the costs of confinement during the elimination 128 | |
| 176 | + | period, subject only to taxes and any trustee's charges allowed by law. 129 | |
| 177 | + | Payment shall be made directly to the provider. The duty of the trustee 130 | |
| 178 | + | may be enforced by the state, the grantor or any person acting on behalf 131 | |
| 179 | + | of the grantor. A long-term care policy shall provide benefits for 132 | |
| 180 | + | confinement in a nursing home or confinement in the insured's own 133 | |
| 181 | + | home or both. Any additional benefits provided shall be related to long-134 | |
| 182 | + | term treatment of an injury, illness or loss of functional capacity. "Long-135 | |
| 183 | + | term care policy" does not include any such policy that is offered 136 | |
| 184 | + | primarily to provide basic Medicare supplement coverage, basic 137 | |
| 185 | + | medical-surgical expense coverage, hospital confinement indemnity 138 Raised Bill No. 1046 | |
| 226 | 186 | ||
| 227 | - | Public Act No. 21-150 8 of 20 | |
| 228 | 187 | ||
| 229 | - | (i) Notify its policyholders of such premium rate increase and make | |
| 230 | - | available to such policyholders the additional choice of reducing the | |
| 231 | - | policy benefits to reduce the premium rate or electing coverage that | |
| 232 | - | reflects the minimum set of affordable benefit options developed by the | |
| 233 | - | commissioner pursuant to section 2 of this act. Such notice shall include | |
| 234 | - | a description of such policy benefit reductions and minimum set of | |
| 235 | - | affordable benefit options. The premium rates for any benefit reductions | |
| 236 | - | shall be based on the new premium rate schedule; | |
| 237 | - | (ii) Provide policyholders not less than thirty calendar days to elect a | |
| 238 | - | reduction in policy benefits or coverage that reflects the minimum set of | |
| 239 | - | affordable benefit options developed by the commissioner pursuant to | |
| 240 | - | section 2 of this act; and | |
| 241 | - | (iii) Include a statement in such notice that if a policyholder fails to | |
| 242 | - | elect a reduction in policy benefits or coverage that reflects the | |
| 243 | - | minimum set of affordable benefit options developed by the | |
| 244 | - | commissioner pursuant to section 2 of this act by the end of the notice | |
| 245 | - | period and has not cancelled the policy, the policyholder will be deemed | |
| 246 | - | to have elected to retain the existing policy benefits. | |
| 247 | - | (c) (1) No such company, society, corporation or center may deliver | |
| 248 | - | or issue for delivery any long-term care policy without providing, at the | |
| 249 | - | time of solicitation or application for purchase or sale of such coverage, | |
| 250 | - | full and fair written disclosure of the benefits and limitations of the | |
| 251 | - | policy. | |
| 252 | - | (2) (A) The applicant shall sign an acknowledgment at the time of | |
| 253 | - | application for such policy that the company, society, corporation or | |
| 254 | - | center has provided the written disclosure required under this | |
| 255 | - | subsection to the applicant. If the method of application does not allow | |
| 256 | - | for such signature at the time of application, the applicant shall sign | |
| 257 | - | such acknowledgment not later than at the time of delivery of such | |
| 258 | - | policy. Senate Bill No. 1046 | |
| 188 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 189 | + | R01-SB.docx } | |
| 190 | + | 6 of 20 | |
| 259 | 191 | ||
| 260 | - | Public Act No. 21-150 9 of 20 | |
| 192 | + | coverage, major medical expense coverage, disability income protection 139 | |
| 193 | + | coverage, accident only coverage, specified accident coverage or limited 140 | |
| 194 | + | benefit health coverage. 141 | |
| 195 | + | (2) (A) Notwithstanding any provision of the general statutes, no 142 | |
| 196 | + | insurance company, fraternal benefit society, hospital service 143 | |
| 197 | + | corporation, medical service corporation or health care center may 144 | |
| 198 | + | deliver, issue for delivery, renew, continue or amend any long-term care 145 | |
| 199 | + | policy in this state on or after January 1, 2022, unless the insurance 146 | |
| 200 | + | company, fraternal benefit society, hospital service corporation, medical 147 | |
| 201 | + | service corporation or health care center is authorized or licensed to sell 148 | |
| 202 | + | long-term care insurance and at least one other line of insurance in this 149 | |
| 203 | + | state. 150 | |
| 204 | + | [(2) (A)] (B) No insurance company, fraternal benefit society, hospital 151 | |
| 205 | + | service corporation, medical service corporation or health care center 152 | |
| 206 | + | delivering, issuing for delivery, renewing, continuing or amending any 153 | |
| 207 | + | long-term care policy in this state may refuse to accept, or refuse to make 154 | |
| 208 | + | reimbursement pursuant to, a claim for benefits submitted by or 155 | |
| 209 | + | prepared with the assistance of a managed residential community, as 156 | |
| 210 | + | defined in section 19a-693, in accordance with subdivision (7) of 157 | |
| 211 | + | subsection (a) of section 19a-694, solely because such claim for benefits 158 | |
| 212 | + | was submitted by or prepared with the assistance of a managed 159 | |
| 213 | + | residential community. 160 | |
| 214 | + | [(B)] (C) Each insurance company, fraternal benefit society, hospital 161 | |
| 215 | + | service corporation, medical service corporation or health care center 162 | |
| 216 | + | delivering, issuing for delivery, renewing, continuing or amending any 163 | |
| 217 | + | long-term care policy in this state shall, upon receipt of a written 164 | |
| 218 | + | authorization executed by the insured, (i) disclose information to a 165 | |
| 219 | + | managed residential community for the purpose of determining such 166 | |
| 220 | + | insured's eligibility for an insurance benefit or payment, and (ii) provide 167 | |
| 221 | + | a copy of the initial acceptance or declination of a claim for benefits to 168 | |
| 222 | + | the managed residential community at the same time such acceptance 169 | |
| 223 | + | or declination is made to the insured. 170 Raised Bill No. 1046 | |
| 261 | 224 | ||
| 262 | - | (B) Except for a long-term care policy for which no applicable | |
| 263 | - | premium rate revision or rate schedule increases can be made or as | |
| 264 | - | otherwise provided in subdivision (3) of this subsection, such disclosure | |
| 265 | - | shall include: | |
| 266 | - | (i) A statement that the policy may be subject to rate increases in the | |
| 267 | - | future; | |
| 268 | - | (ii) An explanation of potential future premium rate revisions and the | |
| 269 | - | policyholder's option in the event of a premium rate revision; | |
| 270 | - | (iii) The premium rate or rate schedule applicable to the applicant | |
| 271 | - | that will be in effect until such company, society, corporation or center | |
| 272 | - | files a request with the [Insurance Commissioner] commissioner for a | |
| 273 | - | revision to such premium rate or rate schedule; | |
| 274 | - | (iv) An explanation of how a premium rate or rate schedule revision | |
| 275 | - | will be applied that includes a description of when such rate or rate | |
| 276 | - | schedule revision will be effective; and | |
| 277 | - | (v) Information regarding each premium rate increase, if any, over | |
| 278 | - | the past ten years on such policy form or similar policy forms for this | |
| 279 | - | state or any other state, that identifies, at a minimum, (I) the policy forms | |
| 280 | - | for which premium rates have been increased, (II) the calendar years | |
| 281 | - | when each such policy form was available for purchase, and (III) the | |
| 282 | - | amount or percentage of each increase. The percentage may be | |
| 283 | - | expressed as a percentage of the premium rate prior to the increase or | |
| 284 | - | as minimum and maximum percentages if the rate increase is variable | |
| 285 | - | by rating characteristics. | |
| 286 | - | (C) The company, society, corporation or center may provide, in a fair | |
| 287 | - | manner, any additional explanatory information related to a premium | |
| 288 | - | rate or rate schedule revision. | |
| 289 | - | (3) (A) Any such company, society, corporation or center may Senate Bill No. 1046 | |
| 290 | 225 | ||
| 291 | - | Public Act No. 21-150 10 of 20 | |
| 226 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 227 | + | R01-SB.docx } | |
| 228 | + | 7 of 20 | |
| 292 | 229 | ||
| 293 | - | exclude from the disclosure required under subparagraph (B) of | |
| 294 | - | subdivision (2) of this subsection premium rate increases that only | |
| 295 | - | apply to blocks of business or long-term care policies acquired from a | |
| 296 | - | nonaffiliated company, society, corporation or center and that occurred | |
| 297 | - | prior to the acquisition. | |
| 298 | - | (B) If an acquiring company, society, corporation or center files a | |
| 299 | - | request for a premium rate increase on or before January 1, 2015, or the | |
| 300 | - | end of a twenty-four-month period after the acquisition, whichever is | |
| 301 | - | later, for a block of policy forms or long-term care policies acquired from | |
| 302 | - | a nonaffiliated company, society, corporation or center, such acquiring | |
| 303 | - | company, society, corporation or center may exclude from the | |
| 304 | - | disclosure required under subparagraph (B) of subdivision (2) of this | |
| 305 | - | subsection such premium rate increase, except that the nonaffiliated | |
| 306 | - | company, society, corporation or center selling such block of policy | |
| 307 | - | forms or long-term care policies shall include such premium rate | |
| 308 | - | increase in such disclosure. | |
| 309 | - | (C) If an acquiring company, society, corporation or center under | |
| 310 | - | subparagraph (B) of this subdivision files a subsequent request, even | |
| 311 | - | within the twenty-four-month period specified in said subparagraph, | |
| 312 | - | for a premium rate increase on the same block of policy forms or long- | |
| 313 | - | term care policies set forth in said subparagraph, the acquiring | |
| 314 | - | company, society, corporation or center shall include in the disclosure | |
| 315 | - | required under subparagraph (B) of subdivision (2) of this subsection | |
| 316 | - | such premium rate increase and any premium rate increase filed and | |
| 317 | - | approved pursuant to subparagraph (B) of this subdivision. | |
| 318 | - | (4) If the offering for any long-term care policy includes an option for | |
| 319 | - | the elimination period specified in subdivision (1) of subsection (a) of | |
| 320 | - | this section, the application form for such policy and the face page of | |
| 321 | - | such policy shall contain a clear and conspicuous disclosure that the | |
| 322 | - | irrevocable trust may not be sufficient to cover all costs during the | |
| 323 | - | elimination period. Senate Bill No. 1046 | |
| 230 | + | (b) (1) No insurance company, fraternal benefit society, hospital 171 | |
| 231 | + | service corporation, medical service corporation or health care center 172 | |
| 232 | + | may deliver or issue for delivery any long-term care policy that has a 173 | |
| 233 | + | loss ratio of less than sixty per cent for any individual long-term care 174 | |
| 234 | + | policy. An issuer shall not use or change premium rates for a long-term 175 | |
| 235 | + | care policy unless the rates have been filed with and approved by the 176 | |
| 236 | + | [Insurance Commissioner] commissioner. Any rate filings or rate 177 | |
| 237 | + | revisions shall demonstrate that anticipated claims in relation to 178 | |
| 238 | + | premiums when combined with actual experience to date can be 179 | |
| 239 | + | expected to comply with the loss ratio requirement of this section. A rate 180 | |
| 240 | + | filing shall include the factors and methodology used to estimate 181 | |
| 241 | + | irrevocable trust values if the policy includes an option for the 182 | |
| 242 | + | elimination period specified in subdivision (1) of subsection (a) of this 183 | |
| 243 | + | section. If the commissioner determines, in the commissioner's 184 | |
| 244 | + | discretion, that an insurance company, fraternal benefit society, hospital 185 | |
| 245 | + | service corporation, medical service corporation or health care center 186 | |
| 246 | + | deliberately or recklessly included a misstatement of fact in, or 187 | |
| 247 | + | deliberately or recklessly omitted a statement of fact from, a rate filing 188 | |
| 248 | + | filed on or after January 1, 2022, that caused a long-term care policy to 189 | |
| 249 | + | be underpriced by at least fifty per cent, the commissioner shall refer 190 | |
| 250 | + | such rate filing to the Attorney General for an investigation pursuant to 191 | |
| 251 | + | section 5 of this act. 192 | |
| 252 | + | (2) (A) Any insurance company, fraternal benefit society, hospital 193 | |
| 253 | + | service corporation, medical service corporation or health care center 194 | |
| 254 | + | that files a rate filing for an increase in premium rates for a long-term 195 | |
| 255 | + | care policy that is for twenty per cent or more shall spread the increase 196 | |
| 256 | + | over a period of not less than three years and not file a rate filing for an 197 | |
| 257 | + | increase in premium rates for the long-term care policy during the 198 | |
| 258 | + | period chosen. Such company, society, corporation or center shall use a 199 | |
| 259 | + | periodic rate increase that is actuarially equivalent to a single rate 200 | |
| 260 | + | increase and a current interest rate for the period chosen. 201 | |
| 261 | + | (B) Prior to implementing a premium rate increase, each such 202 | |
| 262 | + | company, society, corporation or center shall: 203 Raised Bill No. 1046 | |
| 324 | 263 | ||
| 325 | - | Public Act No. 21-150 11 of 20 | |
| 326 | 264 | ||
| 327 | - | (d) No such company, society, corporation or center may deliver or | |
| 328 | - | issue for delivery any long-term care policy on or after July 1, 2008, | |
| 329 | - | without offering, at the time of solicitation or application for purchase | |
| 330 | - | or sale of such coverage, an option to purchase a policy that includes a | |
| 331 | - | nonforfeiture benefit. Such offer of a nonforfeiture benefit may be in the | |
| 332 | - | form of a rider attached to such policy. In the event the nonforfeiture | |
| 333 | - | benefit is declined, such company, society, corporation or center shall | |
| 334 | - | provide a contingent benefit upon lapse that shall be available for a | |
| 335 | - | specified period of time following a substantial increase in premium | |
| 336 | - | rates. Not later than July 1, 2008, the [Insurance Commissioner] | |
| 337 | - | commissioner shall adopt regulations, in accordance with chapter 54, to | |
| 338 | - | implement the provisions of this subsection. Such regulations shall | |
| 339 | - | specify the type of nonforfeiture benefit that may be offered, the | |
| 340 | - | standards for such benefit, the period of time during which a contingent | |
| 341 | - | benefit upon lapse will be available and the substantial increase in | |
| 342 | - | premium rates that trigger a contingent benefit upon lapse in | |
| 343 | - | accordance with the Long-Term Care Insurance Model Regulation | |
| 344 | - | adopted by the National Association of Insurance Commissioners. | |
| 345 | - | (e) The [Insurance Commissioner] commissioner shall adopt | |
| 346 | - | regulations, in accordance with chapter 54, that address (1) the insured's | |
| 347 | - | right to information prior to the insured replacing an accident and | |
| 348 | - | sickness policy with a long-term care policy, (2) the insured's right to | |
| 349 | - | return a long-term care policy to the insurer, within a specified period | |
| 350 | - | of time after delivery, for cancellation, and (3) the insured's right to | |
| 351 | - | accept by the insured's signature, and prior to it becoming effective, any | |
| 352 | - | rider or endorsement added to a long-term care policy after the issuance | |
| 353 | - | date of such policy. The [Insurance Commissioner] commissioner shall | |
| 354 | - | adopt such additional regulations as the commissioner deems necessary | |
| 355 | - | in accordance with chapter 54 to carry out the purpose of this section. | |
| 356 | - | (f) The [Insurance Commissioner] commissioner may, upon written | |
| 357 | - | request by any such company, society, corporation or center, issue an Senate Bill No. 1046 | |
| 265 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 266 | + | R01-SB.docx } | |
| 267 | + | 8 of 20 | |
| 358 | 268 | ||
| 359 | - | Public Act No. 21-150 12 of 20 | |
| 269 | + | (i) Notify its policyholders of such premium rate increase and make 204 | |
| 270 | + | available to such policyholders the additional choice of reducing the 205 | |
| 271 | + | policy benefits to reduce the premium rate or electing coverage that 206 | |
| 272 | + | reflects the minimum set of affordable benefit options developed by the 207 | |
| 273 | + | commissioner pursuant to section 2 of this act. Such notice shall include 208 | |
| 274 | + | a description of such policy benefit reductions and minimum set of 209 | |
| 275 | + | affordable benefit options. The premium rates for any benefit reductions 210 | |
| 276 | + | shall be based on the new premium rate schedule; 211 | |
| 277 | + | (ii) Provide policyholders not less than thirty calendar days to elect a 212 | |
| 278 | + | reduction in policy benefits or coverage that reflects the minimum set of 213 | |
| 279 | + | affordable benefit options developed by the commissioner pursuant to 214 | |
| 280 | + | section 2 of this act; and 215 | |
| 281 | + | (iii) Include a statement in such notice that if a policyholder fails to 216 | |
| 282 | + | elect a reduction in policy benefits or coverage that reflects the 217 | |
| 283 | + | minimum set of affordable benefit options developed by the 218 | |
| 284 | + | commissioner pursuant to section 2 of this act by the end of the notice 219 | |
| 285 | + | period and has not cancelled the policy, the policyholder will be deemed 220 | |
| 286 | + | to have elected to retain the existing policy benefits. 221 | |
| 287 | + | (c) (1) No such company, society, corporation or center may deliver 222 | |
| 288 | + | or issue for delivery any long-term care policy without providing, at the 223 | |
| 289 | + | time of solicitation or application for purchase or sale of such coverage, 224 | |
| 290 | + | full and fair written disclosure of the benefits and limitations of the 225 | |
| 291 | + | policy. 226 | |
| 292 | + | (2) (A) The applicant shall sign an acknowledgment at the time of 227 | |
| 293 | + | application for such policy that the company, society, corporation or 228 | |
| 294 | + | center has provided the written disclosure required under this 229 | |
| 295 | + | subsection to the applicant. If the method of application does not allow 230 | |
| 296 | + | for such signature at the time of application, the applicant shall sign 231 | |
| 297 | + | such acknowledgment not later than at the time of delivery of such 232 | |
| 298 | + | policy. 233 | |
| 299 | + | (B) Except for a long-term care policy for which no applicable 234 Raised Bill No. 1046 | |
| 360 | 300 | ||
| 361 | - | order to modify or suspend a specific provision of this section or any | |
| 362 | - | regulation adopted pursuant thereto with respect to a specific long-term | |
| 363 | - | care policy upon a written finding that: (1) The modification or | |
| 364 | - | suspension would be in the best interest of the insureds; (2) the purposes | |
| 365 | - | to be achieved could not be effectively or efficiently achieved without | |
| 366 | - | such modification or suspension; and (3) (A) the modification or | |
| 367 | - | suspension is necessary to the development of an innovative and | |
| 368 | - | reasonable approach for insuring long-term care, (B) the policy is to be | |
| 369 | - | issued to residents of a life care or continuing care retirement | |
| 370 | - | community or other residential community for the elderly and the | |
| 371 | - | modification or suspension is reasonably related to the special needs or | |
| 372 | - | nature of such community, or (C) the modification or suspension is | |
| 373 | - | necessary to permit long-term care policies to be sold as part of, or in | |
| 374 | - | conjunction with, another insurance product. Whenever the | |
| 375 | - | commissioner decides not to issue such an order, the commissioner shall | |
| 376 | - | provide written notice of such decision to the requesting party in a | |
| 377 | - | timely manner. | |
| 378 | - | (g) Upon written request by any such company, society, corporation | |
| 379 | - | or center, the [Insurance Commissioner] commissioner may issue an | |
| 380 | - | order to extend the preexisting condition exclusion period, as | |
| 381 | - | established by regulations adopted pursuant to this section, for | |
| 382 | - | purposes of specific age group categories in a specific long-term care | |
| 383 | - | policy form whenever the commissioner makes a written finding that | |
| 384 | - | such an extension is in the best interest to the public. Whenever the | |
| 385 | - | commissioner decides not to issue such an order, the commissioner shall | |
| 386 | - | provide written notice of such decision to the requesting party in a | |
| 387 | - | timely manner. | |
| 388 | - | (h) The provisions of section 38a-19 shall be applicable to any such | |
| 389 | - | requesting party aggrieved by any order or decision of the | |
| 390 | - | commissioner made pursuant to subsections (f) and (g) of this section. | |
| 391 | - | Sec. 4. Section 38a-528 of the general statutes is repealed and the Senate Bill No. 1046 | |
| 392 | 301 | ||
| 393 | - | Public Act No. 21-150 13 of 20 | |
| 302 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 303 | + | R01-SB.docx } | |
| 304 | + | 9 of 20 | |
| 394 | 305 | ||
| 395 | - | following is substituted in lieu thereof (Effective January 1, 2022): | |
| 396 | - | (a) (1) As used in this section and section 2 of this act, "long-term care | |
| 397 | - | policy" means any group health insurance policy or certificate delivered | |
| 398 | - | or issued for delivery to any resident of this state on or after July 1, 1986, | |
| 399 | - | that is designed to provide, within the terms and conditions of the policy | |
| 400 | - | or certificate, benefits on an expense-incurred, indemnity or prepaid | |
| 401 | - | basis for necessary care or treatment of an injury, illness or loss of | |
| 402 | - | functional capacity provided by a certified or licensed health care | |
| 403 | - | provider in a setting other than an acute care hospital, for at least one | |
| 404 | - | year after a reasonable elimination period. A long-term care policy shall | |
| 405 | - | provide benefits for confinement in a nursing home or confinement in | |
| 406 | - | the insured's own home or both. Any additional benefits provided shall | |
| 407 | - | be related to long-term treatment of an injury, illness or loss of | |
| 408 | - | functional capacity. "Long-term care policy" does not include any such | |
| 409 | - | policy or certificate that is offered primarily to provide basic Medicare | |
| 410 | - | supplement coverage, basic medical-surgical expense coverage, hospital | |
| 411 | - | confinement indemnity coverage, major medical expense coverage, | |
| 412 | - | disability income protection coverage, accident only coverage, specified | |
| 413 | - | accident coverage or limited benefit health coverage. | |
| 414 | - | (2) (A) Notwithstanding any provision of the general statutes, no | |
| 415 | - | insurance company, fraternal benefit society, hospital service | |
| 416 | - | corporation, medical service corporation or health care center may | |
| 417 | - | deliver, issue for delivery, renew, continue or amend any long-term care | |
| 418 | - | policy in this state on or after January 1, 2022, unless the insurance | |
| 419 | - | company, fraternal benefit society, hospital service corporation, medical | |
| 420 | - | service corporation or health care center is authorized or licensed to sell | |
| 421 | - | long-term care insurance and at least one other line of insurance in this | |
| 422 | - | state. | |
| 423 | - | [(2) (A)] (B) No insurance company, fraternal benefit society, hospital | |
| 424 | - | service corporation, medical service corporation or health care center | |
| 425 | - | delivering, issuing for delivery, renewing, continuing or amending any Senate Bill No. 1046 | |
| 306 | + | premium rate revision or rate schedule increases can be made or as 235 | |
| 307 | + | otherwise provided in subdivision (3) of this subsection, such disclosure 236 | |
| 308 | + | shall include: 237 | |
| 309 | + | (i) A statement that the policy may be subject to rate increases in the 238 | |
| 310 | + | future; 239 | |
| 311 | + | (ii) An explanation of potential future premium rate revisions and the 240 | |
| 312 | + | policyholder's option in the event of a premium rate revision; 241 | |
| 313 | + | (iii) The premium rate or rate schedule applicable to the applicant 242 | |
| 314 | + | that will be in effect until such company, society, corporation or center 243 | |
| 315 | + | files a request with the [Insurance Commissioner] commissioner for a 244 | |
| 316 | + | revision to such premium rate or rate schedule; 245 | |
| 317 | + | (iv) An explanation of how a premium rate or rate schedule revision 246 | |
| 318 | + | will be applied that includes a description of when such rate or rate 247 | |
| 319 | + | schedule revision will be effective; and 248 | |
| 320 | + | (v) Information regarding each premium rate increase, if any, over 249 | |
| 321 | + | the past ten years on such policy form or similar policy forms for this 250 | |
| 322 | + | state or any other state, that identifies, at a minimum, (I) the policy forms 251 | |
| 323 | + | for which premium rates have been increased, (II) the calendar years 252 | |
| 324 | + | when each such policy form was available for purchase, and (III) the 253 | |
| 325 | + | amount or percentage of each increase. The percentage may be 254 | |
| 326 | + | expressed as a percentage of the premium rate prior to the increase or 255 | |
| 327 | + | as minimum and maximum percentages if the rate increase is variable 256 | |
| 328 | + | by rating characteristics. 257 | |
| 329 | + | (C) The company, society, corporation or center may provide, in a fair 258 | |
| 330 | + | manner, any additional explanatory information related to a premium 259 | |
| 331 | + | rate or rate schedule revision. 260 | |
| 332 | + | (3) (A) Any such company, society, corporation or center may 261 | |
| 333 | + | exclude from the disclosure required under subparagraph (B) of 262 | |
| 334 | + | subdivision (2) of this subsection premium rate increases that only 263 | |
| 335 | + | apply to blocks of business or long-term care policies acquired from a 264 Raised Bill No. 1046 | |
| 426 | 336 | ||
| 427 | - | Public Act No. 21-150 14 of 20 | |
| 428 | 337 | ||
| 429 | - | long-term care policy in this state may refuse to accept, or refuse to make | |
| 430 | - | reimbursement pursuant to, a claim for benefits submitted by or | |
| 431 | - | prepared with the assistance of a managed residential community, as | |
| 432 | - | defined in section 19a-693, in accordance with subdivision (7) of | |
| 433 | - | subsection (a) of section 19a-694, solely because such claim for benefits | |
| 434 | - | was submitted by or prepared with the assistance of a managed | |
| 435 | - | residential community. | |
| 436 | - | [(B)] (C) Each insurance company, fraternal benefit society, hospital | |
| 437 | - | service corporation, medical service corporation or health care center | |
| 438 | - | delivering, issuing for delivery, renewing, continuing or amending any | |
| 439 | - | long-term care policy in this state shall, upon receipt of a written | |
| 440 | - | authorization executed by the insured, (i) disclose information to a | |
| 441 | - | managed residential community for the purpose of determining such | |
| 442 | - | insured's eligibility for an insurance benefit or payment, and (ii) provide | |
| 443 | - | a copy of the initial acceptance or declination of a claim for benefits to | |
| 444 | - | the managed residential community at the same time such acceptance | |
| 445 | - | or declination is made to the insured. | |
| 446 | - | (b) (1) No insurance company, fraternal benefit society, hospital | |
| 447 | - | service corporation, medical service corporation or health care center | |
| 448 | - | may deliver or issue for delivery any long-term care policy or certificate | |
| 449 | - | that has a loss ratio of less than sixty-five per cent for any group long- | |
| 450 | - | term care policy. An issuer shall not use or change premium rates for a | |
| 451 | - | long-term care policy or certificate unless the rates have been filed with | |
| 452 | - | the [Insurance Commissioner] commissioner. Deviations in rates to | |
| 453 | - | reflect policyholder experience shall be permitted, provided each policy | |
| 454 | - | form shall meet the loss ratio requirement of this section. Any rate filings | |
| 455 | - | or rate revisions shall demonstrate that anticipated claims in relation to | |
| 456 | - | premiums when combined with actual experience to date can be | |
| 457 | - | expected to comply with the loss ratio requirement of this section. On | |
| 458 | - | an annual basis, an insurer shall submit to the [Insurance | |
| 459 | - | Commissioner] commissioner an actuarial certification of the insurer's Senate Bill No. 1046 | |
| 338 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 339 | + | R01-SB.docx } | |
| 340 | + | 10 of 20 | |
| 460 | 341 | ||
| 461 | - | Public Act No. 21-150 15 of 20 | |
| 342 | + | nonaffiliated company, society, corporation or center and that occurred 265 | |
| 343 | + | prior to the acquisition. 266 | |
| 344 | + | (B) If an acquiring company, society, corporation or center files a 267 | |
| 345 | + | request for a premium rate increase on or before January 1, 2015, or the 268 | |
| 346 | + | end of a twenty-four-month period after the acquisition, whichever is 269 | |
| 347 | + | later, for a block of policy forms or long-term care policies acquired from 270 | |
| 348 | + | a nonaffiliated company, society, corporation or center, such acquiring 271 | |
| 349 | + | company, society, corporation or center may exclude from the 272 | |
| 350 | + | disclosure required under subparagraph (B) of subdivision (2) of this 273 | |
| 351 | + | subsection such premium rate increase, except that the nonaffiliated 274 | |
| 352 | + | company, society, corporation or center selling such block of policy 275 | |
| 353 | + | forms or long-term care policies shall include such premium rate 276 | |
| 354 | + | increase in such disclosure. 277 | |
| 355 | + | (C) If an acquiring company, society, corporation or center under 278 | |
| 356 | + | subparagraph (B) of this subdivision files a subsequent request, even 279 | |
| 357 | + | within the twenty-four-month period specified in said subparagraph, 280 | |
| 358 | + | for a premium rate increase on the same block of policy forms or long-281 | |
| 359 | + | term care policies set forth in said subparagraph, the acquiring 282 | |
| 360 | + | company, society, corporation or center shall include in the disclosure 283 | |
| 361 | + | required under subparagraph (B) of subdivision (2) of this subsection 284 | |
| 362 | + | such premium rate increase and any premium rate increase filed and 285 | |
| 363 | + | approved pursuant to subparagraph (B) of this subdivision. 286 | |
| 364 | + | (4) If the offering for any long-term care policy includes an option for 287 | |
| 365 | + | the elimination period specified in subdivision (1) of subsection (a) of 288 | |
| 366 | + | this section, the application form for such policy and the face page of 289 | |
| 367 | + | such policy shall contain a clear and conspicuous disclosure that the 290 | |
| 368 | + | irrevocable trust may not be sufficient to cover all costs during the 291 | |
| 369 | + | elimination period. 292 | |
| 370 | + | (d) No such company, society, corporation or center may deliver or 293 | |
| 371 | + | issue for delivery any long-term care policy on or after July 1, 2008, 294 | |
| 372 | + | without offering, at the time of solicitation or application for purchase 295 | |
| 373 | + | or sale of such coverage, an option to purchase a policy that includes a 296 Raised Bill No. 1046 | |
| 462 | 374 | ||
| 463 | - | continuing compliance with the loss ratio requirement of this section. | |
| 464 | - | Any rate or rate revision may be disapproved if the commissioner | |
| 465 | - | determines that the loss ratio requirement will not be met over the | |
| 466 | - | lifetime of the policy form using reasonable assumptions. | |
| 467 | - | (2) (A) Any insurance company, fraternal benefit society, hospital | |
| 468 | - | service corporation, medical service corporation or health care center | |
| 469 | - | that files a rate filing for an increase in premium rates for a long-term | |
| 470 | - | care policy that is for twenty per cent or more shall spread the increase | |
| 471 | - | over a period of not less than three years and not file a rate filing for an | |
| 472 | - | increase in premium rates for the long-term care policy during the | |
| 473 | - | period chosen. Such company, society, corporation or center shall use a | |
| 474 | - | periodic rate increase that is actuarially equivalent to a single rate | |
| 475 | - | increase and a current interest rate for the period chosen. | |
| 476 | - | (B) Prior to implementing a premium rate increase, each such | |
| 477 | - | company, society, corporation or center shall: | |
| 478 | - | (i) Notify its certificate holders of such premium rate increase and | |
| 479 | - | make available to such certificate holders the additional choice of | |
| 480 | - | reducing the policy benefits to reduce the premium rate or electing | |
| 481 | - | coverage that reflects the minimum set of affordable benefit options | |
| 482 | - | developed by the commissioner pursuant to section 2 of this act. Such | |
| 483 | - | notice shall include a description of such policy benefit reductions and | |
| 484 | - | minimum set of affordable benefit options. The premium rates for any | |
| 485 | - | benefit reductions shall be based on the new premium rate schedule; | |
| 486 | - | (ii) Provide certificate holders not less than thirty calendar days to | |
| 487 | - | elect a reduction in policy benefits or coverage that reflects the | |
| 488 | - | minimum set of affordable benefit options developed by the | |
| 489 | - | commissioner pursuant to section 2 of this act; and | |
| 490 | - | (iii) Include a statement in such notice that if a certificate holder fails | |
| 491 | - | to elect a reduction in policy benefits or coverage that reflects the Senate Bill No. 1046 | |
| 492 | 375 | ||
| 493 | - | Public Act No. 21-150 16 of 20 | |
| 376 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 377 | + | R01-SB.docx } | |
| 378 | + | 11 of 20 | |
| 494 | 379 | ||
| 495 | - | minimum set of affordable benefit options developed by the | |
| 496 | - | commissioner pursuant to section 2 of this act by the end of the notice | |
| 497 | - | period and has not cancelled the policy, the certificate holder will be | |
| 498 | - | deemed to have elected to retain the existing policy benefits. | |
| 499 | - | (c) (1) No such company, society, corporation or center may deliver | |
| 500 | - | or issue for delivery any long-term care policy without providing, at the | |
| 501 | - | time of solicitation or application for purchase or sale of such coverage, | |
| 502 | - | full and fair written disclosure of the benefits and limitations of the | |
| 503 | - | policy. The provisions of this subsection shall not be applicable to | |
| 504 | - | noncontributory plans. | |
| 505 | - | (2) (A) The applicant shall sign an acknowledgment at the time of | |
| 506 | - | application for such policy that the company, society, corporation or | |
| 507 | - | center has provided the written disclosure required under this | |
| 508 | - | subsection to the applicant. If the method of application does not allow | |
| 509 | - | for such signature at the time of application, the applicant shall sign | |
| 510 | - | such acknowledgment not later than at the time of delivery of such | |
| 511 | - | policy. | |
| 512 | - | (B) The policyholder shall provide a copy of such disclosure to each | |
| 513 | - | eligible individual. | |
| 514 | - | (3) (A) Except for a long-term care policy for which no applicable | |
| 515 | - | premium rate revision or rate schedule increases can be made or as | |
| 516 | - | otherwise provided in subdivision (4) of this subsection, such disclosure | |
| 517 | - | shall include: | |
| 518 | - | (i) A statement that the policy may be subject to rate increases in the | |
| 519 | - | future; | |
| 520 | - | (ii) An explanation of potential future premium rate revisions and the | |
| 521 | - | policyholder's or certificate holder's option in the event of a premium | |
| 522 | - | rate revision; Senate Bill No. 1046 | |
| 380 | + | nonforfeiture benefit. Such offer of a nonforfeiture benefit may be in the 297 | |
| 381 | + | form of a rider attached to such policy. In the event the nonforfeiture 298 | |
| 382 | + | benefit is declined, such company, society, corporation or center shall 299 | |
| 383 | + | provide a contingent benefit upon lapse that shall be available for a 300 | |
| 384 | + | specified period of time following a substantial increase in premium 301 | |
| 385 | + | rates. Not later than July 1, 2008, the [Insurance Commissioner] 302 | |
| 386 | + | commissioner shall adopt regulations, in accordance with chapter 54, to 303 | |
| 387 | + | implement the provisions of this subsection. Such regulations shall 304 | |
| 388 | + | specify the type of nonforfeiture benefit that may be offered, the 305 | |
| 389 | + | standards for such benefit, the period of time during which a contingent 306 | |
| 390 | + | benefit upon lapse will be available and the substantial increase in 307 | |
| 391 | + | premium rates that trigger a contingent benefit upon lapse in 308 | |
| 392 | + | accordance with the Long-Term Care Insurance Model Regulation 309 | |
| 393 | + | adopted by the National Association of Insurance Commissioners. 310 | |
| 394 | + | (e) The [Insurance Commissioner] commissioner shall adopt 311 | |
| 395 | + | regulations, in accordance with chapter 54, that address (1) the insured's 312 | |
| 396 | + | right to information prior to the insured replacing an accident and 313 | |
| 397 | + | sickness policy with a long-term care policy, (2) the insured's right to 314 | |
| 398 | + | return a long-term care policy to the insurer, within a specified period 315 | |
| 399 | + | of time after delivery, for cancellation, and (3) the insured's right to 316 | |
| 400 | + | accept by the insured's signature, and prior to it becoming effective, any 317 | |
| 401 | + | rider or endorsement added to a long-term care policy after the issuance 318 | |
| 402 | + | date of such policy. The [Insurance Commissioner] commissioner shall 319 | |
| 403 | + | adopt such additional regulations as the commissioner deems necessary 320 | |
| 404 | + | in accordance with chapter 54 to carry out the purpose of this section. 321 | |
| 405 | + | (f) The [Insurance Commissioner] commissioner may, upon written 322 | |
| 406 | + | request by any such company, society, corporation or center, issue an 323 | |
| 407 | + | order to modify or suspend a specific provision of this section or any 324 | |
| 408 | + | regulation adopted pursuant thereto with respect to a specific long-term 325 | |
| 409 | + | care policy upon a written finding that: (1) The modification or 326 | |
| 410 | + | suspension would be in the best interest of the insureds; (2) the purposes 327 | |
| 411 | + | to be achieved could not be effectively or efficiently achieved without 328 | |
| 412 | + | such modification or suspension; and (3) (A) the modification or 329 Raised Bill No. 1046 | |
| 523 | 413 | ||
| 524 | - | Public Act No. 21-150 17 of 20 | |
| 525 | 414 | ||
| 526 | - | (iii) The premium rate or rate schedule applicable to the applicant | |
| 527 | - | that will be in effect until such company, society, corporation or center | |
| 528 | - | files a request with the [Insurance Commissioner] commissioner for a | |
| 529 | - | revision to such premium rate or rate schedule; | |
| 530 | - | (iv) An explanation of how a premium rate or rate schedule revision | |
| 531 | - | will be applied that includes a description of when such rate or rate | |
| 532 | - | schedule revision will be effective; and | |
| 533 | - | (v) Information regarding each premium rate increase, if any, over | |
| 534 | - | the past ten years on such policy form or similar policy forms for this | |
| 535 | - | state or any other state, that identifies, at a minimum, (I) the policy forms | |
| 536 | - | for which premium rates have been increased, (II) the calendar years | |
| 537 | - | when each such policy form was available for purchase, and (III) the | |
| 538 | - | amount or percentage of each increase. The percentage may be | |
| 539 | - | expressed as a percentage of the premium rate prior to the increase or | |
| 540 | - | as minimum and maximum percentages if the rate increase is variable | |
| 541 | - | by rating characteristics. | |
| 542 | - | (B) The company, society, corporation or center may provide, in a fair | |
| 543 | - | manner, any additional explanatory information related to a premium | |
| 544 | - | rate or rate schedule revision. | |
| 545 | - | (4) (A) Any such company, society, corporation or center may | |
| 546 | - | exclude from the disclosure required under subdivision (3) of this | |
| 547 | - | subsection premium rate increases that only apply to blocks of business | |
| 548 | - | or long-term care policies acquired from a nonaffiliated company, | |
| 549 | - | society, corporation or center and that occurred prior to the acquisition. | |
| 550 | - | (B) If an acquiring company, society, corporation or center files a | |
| 551 | - | request for a premium rate increase on or before January 1, 2015, or the | |
| 552 | - | end of a twenty-four-month period after the acquisition, whichever is | |
| 553 | - | later, for a block of policy forms or long-term care policies acquired from | |
| 554 | - | a nonaffiliated company, society, corporation or center such acquiring Senate Bill No. 1046 | |
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| 416 | + | R01-SB.docx } | |
| 417 | + | 12 of 20 | |
| 555 | 418 | ||
| 556 | - | Public Act No. 21-150 18 of 20 | |
| 419 | + | suspension is necessary to the development of an innovative and 330 | |
| 420 | + | reasonable approach for insuring long-term care, (B) the policy is to be 331 | |
| 421 | + | issued to residents of a life care or continuing care retirement 332 | |
| 422 | + | community or other residential community for the elderly and the 333 | |
| 423 | + | modification or suspension is reasonably related to the special needs or 334 | |
| 424 | + | nature of such community, or (C) the modification or suspension is 335 | |
| 425 | + | necessary to permit long-term care policies to be sold as part of, or in 336 | |
| 426 | + | conjunction with, another insurance product. Whenever the 337 | |
| 427 | + | commissioner decides not to issue such an order, the commissioner shall 338 | |
| 428 | + | provide written notice of such decision to the requesting party in a 339 | |
| 429 | + | timely manner. 340 | |
| 430 | + | (g) Upon written request by any such company, society, corporation 341 | |
| 431 | + | or center, the [Insurance Commissioner] commissioner may issue an 342 | |
| 432 | + | order to extend the preexisting condition exclusion period, as 343 | |
| 433 | + | established by regulations adopted pursuant to this section, for 344 | |
| 434 | + | purposes of specific age group categories in a specific long-term care 345 | |
| 435 | + | policy form whenever the commissioner makes a written finding that 346 | |
| 436 | + | such an extension is in the best interest to the public. Whenever the 347 | |
| 437 | + | commissioner decides not to issue such an order, the commissioner shall 348 | |
| 438 | + | provide written notice of such decision to the requesting party in a 349 | |
| 439 | + | timely manner. 350 | |
| 440 | + | (h) The provisions of section 38a-19 shall be applicable to any such 351 | |
| 441 | + | requesting party aggrieved by any order or decision of the 352 | |
| 442 | + | commissioner made pursuant to subsections (f) and (g) of this section. 353 | |
| 443 | + | Sec. 4. Section 38a-528 of the general statutes is repealed and the 354 | |
| 444 | + | following is substituted in lieu thereof (Effective January 1, 2022): 355 | |
| 445 | + | (a) (1) As used in this section and section 2 of this act, "long-term care 356 | |
| 446 | + | policy" means any group health insurance policy or certificate delivered 357 | |
| 447 | + | or issued for delivery to any resident of this state on or after July 1, 1986, 358 | |
| 448 | + | that is designed to provide, within the terms and conditions of the policy 359 | |
| 449 | + | or certificate, benefits on an expense-incurred, indemnity or prepaid 360 | |
| 450 | + | basis for necessary care or treatment of an injury, illness or loss of 361 Raised Bill No. 1046 | |
| 557 | 451 | ||
| 558 | - | company, society, corporation or center may exclude from the | |
| 559 | - | disclosure required under subdivision (3) of this subsection such | |
| 560 | - | premium rate increase, except that the nonaffiliated company, society, | |
| 561 | - | corporation or center selling such block of policy forms or long-term | |
| 562 | - | care policies shall include such premium rate increase in such | |
| 563 | - | disclosure. | |
| 564 | - | (C) If an acquiring company, society, corporation or center under | |
| 565 | - | subparagraph (B) of this subdivision files a subsequent request, even | |
| 566 | - | within the twenty-four-month period specified in said subparagraph, | |
| 567 | - | for a premium rate increase on the same block of policy forms or long- | |
| 568 | - | term care policies set forth in said subparagraph, the acquiring | |
| 569 | - | company, society, corporation or center shall include in the disclosure | |
| 570 | - | required under subdivision (3) of this subsection such premium rate | |
| 571 | - | increase and any premium rate increase filed and approved pursuant to | |
| 572 | - | subparagraph (B) of this subdivision. | |
| 573 | - | (d) The [Insurance Commissioner] commissioner shall adopt | |
| 574 | - | regulations, in accordance with chapter 54, that address (1) the insured's | |
| 575 | - | right to information prior to his replacing an accident and sickness | |
| 576 | - | policy with a long-term care policy, (2) the insured's right to return a | |
| 577 | - | long-term care policy to the insurer, within a specified period of time | |
| 578 | - | after delivery, for cancellation, and (3) the insured's right to accept by | |
| 579 | - | the insured's signature, and prior to it becoming effective, any rider or | |
| 580 | - | endorsement added to a long-term care policy after the issuance date of | |
| 581 | - | such policy, provided (A) any regulations adopted pursuant to | |
| 582 | - | subdivisions (1) and (2) of this subsection shall not be applicable to (i) | |
| 583 | - | any long-term care policy that is delivered or issued for delivery to one | |
| 584 | - | or more employers or labor organizations, or to a trust or to the trustees | |
| 585 | - | of a fund established by one or more employers or labor organizations, | |
| 586 | - | or a combination thereof or for members or former members or a | |
| 587 | - | combination thereof, of the labor organizations, or (ii) noncontributory | |
| 588 | - | plans, and (B) any regulations adopted pursuant to subdivision (3) of Senate Bill No. 1046 | |
| 589 | 452 | ||
| 590 | - | Public Act No. 21-150 19 of 20 | |
| 453 | + | LCO 4598 {\\PRDFS1\SCOUSERS\FORZANOF\WS\2021SB-01046- | |
| 454 | + | R01-SB.docx } | |
| 455 | + | 13 of 20 | |
| 591 | 456 | ||
| 592 | - | this subsection shall not be applicable to any group long-term care | |
| 593 | - | policy. The [Insurance Commissioner] commissioner shall adopt such | |
| 594 | - | additional regulations as the commissioner deems necessary in | |
| 595 | - | accordance with said chapter 54 to carry out the purpose of this section. | |
| 596 | - | (e) The [Insurance Commissioner] commissioner may, upon written | |
| 597 | - | request by any such company, society, corporation or center, issue an | |
| 598 | - | order to modify or suspend a specific provision of this section or any | |
| 599 | - | regulation adopted pursuant thereto with respect to a specific long-term | |
| 600 | - | care policy upon a written finding that: (1) The modification or | |
| 601 | - | suspension would be in the best interest of the insureds; (2) the purposes | |
| 602 | - | to be achieved could not be effectively or efficiently achieved without | |
| 603 | - | such modification or suspension; and (3) (A) the modification or | |
| 604 | - | suspension is necessary to the development of an innovative and | |
| 605 | - | reasonable approach for insuring long-term care, (B) the policy is to be | |
| 606 | - | issued to residents of a life care or continuing care retirement | |
| 607 | - | community or other residential community for the elderly and the | |
| 608 | - | modification or suspension is reasonably related to the special needs or | |
| 609 | - | nature of such community, or (C) the modification or suspension is | |
| 610 | - | necessary to permit long-term care policies to be sold as part of, or in | |
| 611 | - | conjunction with, another insurance product. Whenever the | |
| 612 | - | commissioner decides not to issue such an order, the commissioner shall | |
| 613 | - | provide written notice of such decision to the requesting party in a | |
| 614 | - | timely manner. | |
| 615 | - | (f) Upon written request by any such company, society, corporation | |
| 616 | - | or center, the [Insurance Commissioner] commissioner may issue an | |
| 617 | - | order to extend the preexisting condition exclusion period, as | |
| 618 | - | established by regulations adopted pursuant to this section, for | |
| 619 | - | purposes of specific age group categories in a specific long-term care | |
| 620 | - | policy form whenever he makes a written finding that such an extension | |
| 621 | - | is in the best interest to the public. Whenever the commissioner decides | |
| 622 | - | not to issue such an order, the commissioner shall provide written notice Senate Bill No. 1046 | |
| 457 | + | functional capacity provided by a certified or licensed health care 362 | |
| 458 | + | provider in a setting other than an acute care hospital, for at least one 363 | |
| 459 | + | year after a reasonable elimination period. A long-term care policy shall 364 | |
| 460 | + | provide benefits for confinement in a nursing home or confinement in 365 | |
| 461 | + | the insured's own home or both. Any additional benefits provided shall 366 | |
| 462 | + | be related to long-term treatment of an injury, illness or loss of 367 | |
| 463 | + | functional capacity. "Long-term care policy" does not include any such 368 | |
| 464 | + | policy or certificate that is offered primarily to provide basic Medicare 369 | |
| 465 | + | supplement coverage, basic medical-surgical expense coverage, hospital 370 | |
| 466 | + | confinement indemnity coverage, major medical expense coverage, 371 | |
| 467 | + | disability income protection coverage, accident only coverage, specified 372 | |
| 468 | + | accident coverage or limited benefit health coverage. 373 | |
| 469 | + | (2) (A) Notwithstanding any provision of the general statutes, no 374 | |
| 470 | + | insurance company, fraternal benefit society, hospital service 375 | |
| 471 | + | corporation, medical service corporation or health care center may 376 | |
| 472 | + | deliver, issue for delivery, renew, continue or amend any long-term care 377 | |
| 473 | + | policy in this state on or after January 1, 2022, unless the insurance 378 | |
| 474 | + | company, fraternal benefit society, hospital service corporation, medical 379 | |
| 475 | + | service corporation or health care center is authorized or licensed to sell 380 | |
| 476 | + | long-term care insurance and at least one other line of insurance in this 381 | |
| 477 | + | state. 382 | |
| 478 | + | [(2) (A)] (B) No insurance company, fraternal benefit society, hospital 383 | |
| 479 | + | service corporation, medical service corporation or health care center 384 | |
| 480 | + | delivering, issuing for delivery, renewing, continuing or amending any 385 | |
| 481 | + | long-term care policy in this state may refuse to accept, or refuse to make 386 | |
| 482 | + | reimbursement pursuant to, a claim for benefits submitted by or 387 | |
| 483 | + | prepared with the assistance of a managed residential community, as 388 | |
| 484 | + | defined in section 19a-693, in accordance with subdivision (7) of 389 | |
| 485 | + | subsection (a) of section 19a-694, solely because such claim for benefits 390 | |
| 486 | + | was submitted by or prepared with the assistance of a managed 391 | |
| 487 | + | residential community. 392 | |
| 488 | + | [(B)] (C) Each insurance company, fraternal benefit society, hospital 393 | |
| 489 | + | service corporation, medical service corporation or health care center 394 Raised Bill No. 1046 | |
| 623 | 490 | ||
| 624 | - | Public Act No. 21-150 20 of 20 | |
| 625 | 491 | ||
| 626 | - | of such decision to the requesting party in a timely manner. | |
| 627 | - | (g) The provisions of section 38a-19 shall be applicable to any such | |
| 628 | - | requesting party aggrieved by any order or decision of the | |
| 629 | - | commissioner made pursuant to subsections (e) and (f) of this section. | |
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| 494 | + | 14 of 20 | |
| 495 | + | ||
| 496 | + | delivering, issuing for delivery, renewing, continuing or amending any 395 | |
| 497 | + | long-term care policy in this state shall, upon receipt of a written 396 | |
| 498 | + | authorization executed by the insured, (i) disclose information to a 397 | |
| 499 | + | managed residential community for the purpose of determining such 398 | |
| 500 | + | insured's eligibility for an insurance benefit or payment, and (ii) provide 399 | |
| 501 | + | a copy of the initial acceptance or declination of a claim for benefits to 400 | |
| 502 | + | the managed residential community at the same time such acceptance 401 | |
| 503 | + | or declination is made to the insured. 402 | |
| 504 | + | (b) (1) No insurance company, fraternal benefit society, hospital 403 | |
| 505 | + | service corporation, medical service corporation or health care center 404 | |
| 506 | + | may deliver or issue for delivery any long-term care policy or certificate 405 | |
| 507 | + | that has a loss ratio of less than sixty-five per cent for any group long-406 | |
| 508 | + | term care policy. An issuer shall not use or change premium rates for a 407 | |
| 509 | + | long-term care policy or certificate unless the rates have been filed with 408 | |
| 510 | + | the [Insurance Commissioner] commissioner. Deviations in rates to 409 | |
| 511 | + | reflect policyholder experience shall be permitted, provided each policy 410 | |
| 512 | + | form shall meet the loss ratio requirement of this section. Any rate filings 411 | |
| 513 | + | or rate revisions shall demonstrate that anticipated claims in relation to 412 | |
| 514 | + | premiums when combined with actual experience to date can be 413 | |
| 515 | + | expected to comply with the loss ratio requirement of this section. On 414 | |
| 516 | + | an annual basis, an insurer shall submit to the [Insurance 415 | |
| 517 | + | Commissioner] commissioner an actuarial certification of the insurer's 416 | |
| 518 | + | continuing compliance with the loss ratio requirement of this section. 417 | |
| 519 | + | Any rate or rate revision may be disapproved if the commissioner 418 | |
| 520 | + | determines that the loss ratio requirement will not be met over the 419 | |
| 521 | + | lifetime of the policy form using reasonable assumptions. If the 420 | |
| 522 | + | commissioner determines, in the commissioner's discretion, that an 421 | |
| 523 | + | insurance company, fraternal benefit society, hospital service 422 | |
| 524 | + | corporation, medical service corporation or health care center 423 | |
| 525 | + | deliberately or recklessly included a misstatement of fact in, or 424 | |
| 526 | + | deliberately or recklessly omitted a statement of fact from, a rate filing 425 | |
| 527 | + | filed on or after January 1, 2022, that caused a long-term care policy to 426 | |
| 528 | + | be underpriced by at least fifty per cent, the commissioner shall refer 427 | |
| 529 | + | such rate filing to the Attorney General for an investigation pursuant to 428 Raised Bill No. 1046 | |
| 530 | + | ||
| 531 | + | ||
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| 534 | + | 15 of 20 | |
| 535 | + | ||
| 536 | + | section 5 of this act. 429 | |
| 537 | + | (2) (A) Any insurance company, fraternal benefit society, hospital 430 | |
| 538 | + | service corporation, medical service corporation or health care center 431 | |
| 539 | + | that files a rate filing for an increase in premium rates for a long-term 432 | |
| 540 | + | care policy that is for twenty per cent or more shall spread the increase 433 | |
| 541 | + | over a period of not less than three years and not file a rate filing for an 434 | |
| 542 | + | increase in premium rates for the long-term care policy during the 435 | |
| 543 | + | period chosen. Such company, society, corporation or center shall use a 436 | |
| 544 | + | periodic rate increase that is actuarially equivalent to a single rate 437 | |
| 545 | + | increase and a current interest rate for the period chosen. 438 | |
| 546 | + | (B) Prior to implementing a premium rate increase, each such 439 | |
| 547 | + | company, society, corporation or center shall: 440 | |
| 548 | + | (i) Notify its certificate holders of such premium rate increase and 441 | |
| 549 | + | make available to such certificate holders the additional choice of 442 | |
| 550 | + | reducing the policy benefits to reduce the premium rate or electing 443 | |
| 551 | + | coverage that reflects the minimum set of affordable benefit options 444 | |
| 552 | + | developed by the commissioner pursuant to section 2 of this act. Such 445 | |
| 553 | + | notice shall include a description of such policy benefit reductions and 446 | |
| 554 | + | minimum set of affordable benefit options. The premium rates for any 447 | |
| 555 | + | benefit reductions shall be based on the new premium rate schedule; 448 | |
| 556 | + | (ii) Provide certificate holders not less than thirty calendar days to 449 | |
| 557 | + | elect a reduction in policy benefits or coverage that reflects the 450 | |
| 558 | + | minimum set of affordable benefit options developed by the 451 | |
| 559 | + | commissioner pursuant to section 2 of this act; and 452 | |
| 560 | + | (iii) Include a statement in such notice that if a certificate holder fails 453 | |
| 561 | + | to elect a reduction in policy benefits or coverage that reflects the 454 | |
| 562 | + | minimum set of affordable benefit options developed by the 455 | |
| 563 | + | commissioner pursuant to section 2 of this act by the end of the notice 456 | |
| 564 | + | period and has not cancelled the policy, the certificate holder will be 457 | |
| 565 | + | deemed to have elected to retain the existing policy benefits. 458 | |
| 566 | + | (c) (1) No such company, society, corporation or center may deliver 459 Raised Bill No. 1046 | |
| 567 | + | ||
| 568 | + | ||
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| 572 | + | ||
| 573 | + | or issue for delivery any long-term care policy without providing, at the 460 | |
| 574 | + | time of solicitation or application for purchase or sale of such coverage, 461 | |
| 575 | + | full and fair written disclosure of the benefits and limitations of the 462 | |
| 576 | + | policy. The provisions of this subsection shall not be applicable to 463 | |
| 577 | + | noncontributory plans. 464 | |
| 578 | + | (2) (A) The applicant shall sign an acknowledgment at the time of 465 | |
| 579 | + | application for such policy that the company, society, corporation or 466 | |
| 580 | + | center has provided the written disclosure required under this 467 | |
| 581 | + | subsection to the applicant. If the method of application does not allow 468 | |
| 582 | + | for such signature at the time of application, the applicant shall sign 469 | |
| 583 | + | such acknowledgment not later than at the time of delivery of such 470 | |
| 584 | + | policy. 471 | |
| 585 | + | (B) The policyholder shall provide a copy of such disclosure to each 472 | |
| 586 | + | eligible individual. 473 | |
| 587 | + | (3) (A) Except for a long-term care policy for which no applicable 474 | |
| 588 | + | premium rate revision or rate schedule increases can be made or as 475 | |
| 589 | + | otherwise provided in subdivision (4) of this subsection, such disclosure 476 | |
| 590 | + | shall include: 477 | |
| 591 | + | (i) A statement that the policy may be subject to rate increases in the 478 | |
| 592 | + | future; 479 | |
| 593 | + | (ii) An explanation of potential future premium rate revisions and the 480 | |
| 594 | + | policyholder's or certificate holder's option in the event of a premium 481 | |
| 595 | + | rate revision; 482 | |
| 596 | + | (iii) The premium rate or rate schedule applicable to the applicant 483 | |
| 597 | + | that will be in effect until such company, society, corporation or center 484 | |
| 598 | + | files a request with the [Insurance Commissioner] commissioner for a 485 | |
| 599 | + | revision to such premium rate or rate schedule; 486 | |
| 600 | + | (iv) An explanation of how a premium rate or rate schedule revision 487 | |
| 601 | + | will be applied that includes a description of when such rate or rate 488 | |
| 602 | + | schedule revision will be effective; and 489 Raised Bill No. 1046 | |
| 603 | + | ||
| 604 | + | ||
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| 608 | + | ||
| 609 | + | (v) Information regarding each premium rate increase, if any, over 490 | |
| 610 | + | the past ten years on such policy form or similar policy forms for this 491 | |
| 611 | + | state or any other state, that identifies, at a minimum, (I) the policy forms 492 | |
| 612 | + | for which premium rates have been increased, (II) the calendar years 493 | |
| 613 | + | when each such policy form was available for purchase, and (III) the 494 | |
| 614 | + | amount or percentage of each increase. The percentage may be 495 | |
| 615 | + | expressed as a percentage of the premium rate prior to the increase or 496 | |
| 616 | + | as minimum and maximum percentages if the rate increase is variable 497 | |
| 617 | + | by rating characteristics. 498 | |
| 618 | + | (B) The company, society, corporation or center may provide, in a fair 499 | |
| 619 | + | manner, any additional explanatory information related to a premium 500 | |
| 620 | + | rate or rate schedule revision. 501 | |
| 621 | + | (4) (A) Any such company, society, corporation or center may 502 | |
| 622 | + | exclude from the disclosure required under subdivision (3) of this 503 | |
| 623 | + | subsection premium rate increases that only apply to blocks of business 504 | |
| 624 | + | or long-term care policies acquired from a nonaffiliated company, 505 | |
| 625 | + | society, corporation or center and that occurred prior to the acquisition. 506 | |
| 626 | + | (B) If an acquiring company, society, corporation or center files a 507 | |
| 627 | + | request for a premium rate increase on or before January 1, 2015, or the 508 | |
| 628 | + | end of a twenty-four-month period after the acquisition, whichever is 509 | |
| 629 | + | later, for a block of policy forms or long-term care policies acquired from 510 | |
| 630 | + | a nonaffiliated company, society, corporation or center such acquiring 511 | |
| 631 | + | company, society, corporation or center may exclude from the 512 | |
| 632 | + | disclosure required under subdivision (3) of this subsection such 513 | |
| 633 | + | premium rate increase, except that the nonaffiliated company, society, 514 | |
| 634 | + | corporation or center selling such block of policy forms or long-term 515 | |
| 635 | + | care policies shall include such premium rate increase in such 516 | |
| 636 | + | disclosure. 517 | |
| 637 | + | (C) If an acquiring company, society, corporation or center under 518 | |
| 638 | + | subparagraph (B) of this subdivision files a subsequent request, even 519 | |
| 639 | + | within the twenty-four-month period specified in said subparagraph, 520 | |
| 640 | + | for a premium rate increase on the same block of policy forms or long-521 Raised Bill No. 1046 | |
| 641 | + | ||
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| 646 | + | ||
| 647 | + | term care policies set forth in said subparagraph, the acquiring 522 | |
| 648 | + | company, society, corporation or center shall include in the disclosure 523 | |
| 649 | + | required under subdivision (3) of this subsection such premium rate 524 | |
| 650 | + | increase and any premium rate increase filed and approved pursuant to 525 | |
| 651 | + | subparagraph (B) of this subdivision. 526 | |
| 652 | + | (d) The [Insurance Commissioner] commissioner shall adopt 527 | |
| 653 | + | regulations, in accordance with chapter 54, that address (1) the insured's 528 | |
| 654 | + | right to information prior to his replacing an accident and sickness 529 | |
| 655 | + | policy with a long-term care policy, (2) the insured's right to return a 530 | |
| 656 | + | long-term care policy to the insurer, within a specified period of time 531 | |
| 657 | + | after delivery, for cancellation, and (3) the insured's right to accept by 532 | |
| 658 | + | the insured's signature, and prior to it becoming effective, any rider or 533 | |
| 659 | + | endorsement added to a long-term care policy after the issuance date of 534 | |
| 660 | + | such policy, provided (A) any regulations adopted pursuant to 535 | |
| 661 | + | subdivisions (1) and (2) of this subsection shall not be applicable to (i) 536 | |
| 662 | + | any long-term care policy that is delivered or issued for delivery to one 537 | |
| 663 | + | or more employers or labor organizations, or to a trust or to the trustees 538 | |
| 664 | + | of a fund established by one or more employers or labor organizations, 539 | |
| 665 | + | or a combination thereof or for members or former members or a 540 | |
| 666 | + | combination thereof, of the labor organizations, or (ii) noncontributory 541 | |
| 667 | + | plans, and (B) any regulations adopted pursuant to subdivision (3) of 542 | |
| 668 | + | this subsection shall not be applicable to any group long-term care 543 | |
| 669 | + | policy. The [Insurance Commissioner] commissioner shall adopt such 544 | |
| 670 | + | additional regulations as the commissioner deems necessary in 545 | |
| 671 | + | accordance with said chapter 54 to carry out the purpose of this section. 546 | |
| 672 | + | (e) The [Insurance Commissioner] commissioner may, upon written 547 | |
| 673 | + | request by any such company, society, corporation or center, issue an 548 | |
| 674 | + | order to modify or suspend a specific provision of this section or any 549 | |
| 675 | + | regulation adopted pursuant thereto with respect to a specific long-term 550 | |
| 676 | + | care policy upon a written finding that: (1) The modification or 551 | |
| 677 | + | suspension would be in the best interest of the insureds; (2) the purposes 552 | |
| 678 | + | to be achieved could not be effectively or efficiently achieved without 553 | |
| 679 | + | such modification or suspension; and (3) (A) the modification or 554 Raised Bill No. 1046 | |
| 680 | + | ||
| 681 | + | ||
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| 685 | + | ||
| 686 | + | suspension is necessary to the development of an innovative and 555 | |
| 687 | + | reasonable approach for insuring long-term care, (B) the policy is to be 556 | |
| 688 | + | issued to residents of a life care or continuing care retirement 557 | |
| 689 | + | community or other residential community for the elderly and the 558 | |
| 690 | + | modification or suspension is reasonably related to the special needs or 559 | |
| 691 | + | nature of such community, or (C) the modification or suspension is 560 | |
| 692 | + | necessary to permit long-term care policies to be sold as part of, or in 561 | |
| 693 | + | conjunction with, another insurance product. Whenever the 562 | |
| 694 | + | commissioner decides not to issue such an order, the commissioner shall 563 | |
| 695 | + | provide written notice of such decision to the requesting party in a 564 | |
| 696 | + | timely manner. 565 | |
| 697 | + | (f) Upon written request by any such company, society, corporation 566 | |
| 698 | + | or center, the [Insurance Commissioner] commissioner may issue an 567 | |
| 699 | + | order to extend the preexisting condition exclusion period, as 568 | |
| 700 | + | established by regulations adopted pursuant to this section, for 569 | |
| 701 | + | purposes of specific age group categories in a specific long-term care 570 | |
| 702 | + | policy form whenever he makes a written finding that such an extension 571 | |
| 703 | + | is in the best interest to the public. Whenever the commissioner decides 572 | |
| 704 | + | not to issue such an order, the commissioner shall provide written notice 573 | |
| 705 | + | of such decision to the requesting party in a timely manner. 574 | |
| 706 | + | (g) The provisions of section 38a-19 shall be applicable to any such 575 | |
| 707 | + | requesting party aggrieved by any order or decision of the 576 | |
| 708 | + | commissioner made pursuant to subsections (e) and (f) of this section. 577 | |
| 709 | + | Sec. 5. (NEW) (Effective January 1, 2022) The Attorney General is 578 | |
| 710 | + | authorized to investigate and, in consultation with the Insurance 579 | |
| 711 | + | Commissioner, take such action as is deemed necessary to protect, and 580 | |
| 712 | + | secure compensation for, an insured under a long-term care policy that 581 | |
| 713 | + | is the subject of a rate filing that the Insurance Commissioner refers to 582 | |
| 714 | + | the Attorney General pursuant to subdivision (1) of subsection (b) of 583 | |
| 715 | + | section 38a-501 of the general statutes, as amended by this act, or 584 | |
| 716 | + | subdivision (1) of subsection (b) of section 38a-528 of the general 585 | |
| 717 | + | statutes, as amended by this act. Such action may include, but need not 586 | |
| 718 | + | be limited to, bringing a civil action to recover damages reflecting 587 Raised Bill No. 1046 | |
| 719 | + | ||
| 720 | + | ||
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| 724 | + | ||
| 725 | + | excessive executive compensation, shareholder contributions and 588 | |
| 726 | + | broker fees paid by the insurance company, fraternal benefit society, 589 | |
| 727 | + | hospital service corporation, medical service corporation or health care 590 | |
| 728 | + | center that filed such rate filing and distributing such damages to the 591 | |
| 729 | + | insured. For the purposes of this section, "long-term care policy" has the 592 | |
| 730 | + | same meaning as provided in section 38a-501 of the general statutes, as 593 | |
| 731 | + | amended by this act, or section 38a-528 of the general statutes, as 594 | |
| 732 | + | amended by this act, as applicable. 595 | |
| 733 | + | This act shall take effect as follows and shall amend the following | |
| 734 | + | sections: | |
| 735 | + | ||
| 736 | + | Section 1 January 1, 2022 38a-1 | |
| 737 | + | Sec. 2 January 1, 2022 New section | |
| 738 | + | Sec. 3 January 1, 2022 38a-501 | |
| 739 | + | Sec. 4 January 1, 2022 38a-528 | |
| 740 | + | Sec. 5 January 1, 2022 New section | |
| 741 | + | ||
| 742 | + | INS Joint Favorable | |
| 630 | 743 |