Ins 3.465(6)(a)1.1. An insurer or its intermediary shall provide to each prospective applicant all of the following:
Ins 3.465(6)(a)1.a.
a. Qualifying partnership policy notices in the format contained in Appendix 1 and 2.
Ins 3.465(6)(a)2.
2. No insurer or intermediary shall be responsible for providing applicants the revised guides until 90 days after the insurer or intermediary has been given notice that the revised guides are available.
Ins 3.465(6)(b)
(b) For a qualifying partnership policy issued to a group when an outline of coverage is not delivered, the insurer or intermediary shall deliver copies of the qualifying partnership policy disclosure notice, The Guide to Long-term Care booklet, and The Wisconsin Long-term Care Programs guide.
Ins 3.465(6)(c)
(c) For a life insurance policy that offers long-term care insurance as a provision in the policy or in a rider that is intended to qualify an insured under the state's partnership program, the insurer or intermediary at the time of solicitation shall deliver the disclosure notice (Appendix 1), the Guide to Long-term Care booklet, and the Wisconsin Long-term Care Programs guide.
Ins 3.465(7)(a)(a) When an insurer is made aware that the insured or certificateholder initiated a policy change request or declined a benefit increase that will result in the loss of the status as a qualifying partnership policy, the insurer shall provide, in writing, an explanation of how such action impacts the insured. The insurer shall also advise the insured or certificateholder of how to retain the policy as a qualified partnership policy, if requested.
Ins 3.465(7)(b)
(b) If a qualifying partnership policy no longer meets the requirements of the state's partnership program, the insurer shall explain, in writing, to the policyholder or certificateholder the reason for the loss of status.
Ins 3.465(7)(c)
(c) The insurer shall provide a completed qualifying partnership policy summary document in the format of OCI No. 26-114, when requested by the insured or the insured's authorized representative.
Ins 3.465(8)
(8)
Exchange of long-term care insurance policy to a qualifying partnership policy. Ins 3.465(8)(a)1.1. Insurers offering long-term care policies that are intended to qualify an insured under the state's partnership program are subject to s.
Ins 3.455 (9m).
Ins 3.465(8)(a)2.
2. Insurers issuing an automatic exchange shall comply with all of the following:
Ins 3.465(8)(a)2.a.
a. Only a policy that requires no modifications or additions is eligible for an automatic exchange.
Ins 3.465(8)(a)2.c.
c. The rate used in determining the premium charged for the new policy shall be determined using the original issue age and risk class of the insured that was used to determine the rate of the existing policy and may not contemplate that the new policy is a qualified partnership policy.
Ins 3.465(8)(a)2.d.
d. Insurers issuing automatic exchanges shall provide insureds, at the time of notice of the automatic exchange, a copy of Appendix 1, the Guide to Long-Term Care booklet and the Wisconsin Long-Term Care Programs guide. After issuance of the notice for automatic exchange, if the insured does not decline the offer, the insurer shall provide the insured a copy of Appendix 2.
Ins 3.465(8)(a)2.e.
e. Insurers issuing an automatic exchange shall offer to the insured, at the time of notice of the automatic exchange, the option to decline the automatic exchange and retain the existing policy if the insured responds within a period of time not less than 120 days.
Ins 3.465(8)(a)3.
3. An insurer offering an exchange as to a qualifying partnership policy with an actuarial value of benefits exceeding the actuarial value of benefits of the existing policy shall be subject to all of the following:
Ins 3.465(8)(a)3.b.
b. The insurer shall apply its new business long-term care underwriting guidelines to the increased benefits only.
Ins 3.465(8)(a)3.c.
c. The premium charged for the new policy shall be determined using the method in subd.
3. for existing benefits and the rate for the additional benefits using the then current age and risk class of the insured for the additional benefits only.
Ins 3.465(8)(a)4.
4. An insurer shall maintain documentation of the actuarial value analysis determination and shall provide the analysis to the commissioner upon request.
Ins 3.465(8)(b)
(b) Offer of exchange. An insurer that submits and receives approval to offer a long-term care insurance policy that is intended to be a qualifying partnership policy in this state may, subject to the following requirements, offer an exchange:
Ins 3.465(8)(b)1.
1. Within one year from the date the insurer begins to advertise, market, offer, sell, or issue policies that are intended to be qualifying partnership policies, on a one-time basis in writing, offer to all existing policyholders or certificateholders that were issued long-term care coverage by the insurer with an issue date on or after February 8, 2006, the option to exchange their existing long-term care policy for a qualifying partnership policy. Insurers may offer the exchange option to policyholders or certificateholders with long-term care policies issued prior to February 8, 2006, pursuant to a plan filed with the commissioner.
Ins 3.465(8)(b)2.
2. The offer shall be made on a nondiscriminatory basis without regard to the age or health status of the insured.
Ins 3.465(8)(b)3.
3. The offer shall remain open for a minimum of 120 days from the date of the mailing by the insurer.
Ins 3.465(8)(b)4.
4. The effective date of the partnership plan policy shall be the date of the exchanged policy.
Ins 3.465(8)(b)5.
5. In the event of an exchange, the insured may not lose any rights that have accrued under the original policy including, but not limited to, rights established because of the lapse of time related to pre-existing condition exclusions, elimination periods, or incontestability clauses.
Ins 3.465(8)(b)6.
6. The written offer to exchange shall include the disclosure form contained in Appendix 2 and also shall include the Guide to Long-Term Care booklet and the Wisconsin Long-Term Care Programs guide. The insurer shall file with the commissioner, prior to use and for informational purposes, the exchange letter to be used in the exchange offer.
Ins 3.465(8)(c)1.1. The new policy offered in an exchange or automatic exchange shall be of a form that is offered for sale by the insurer in the general market at the time of exchange.
Ins 3.465(8)(c)2.
2. A policy received in an exchange on or after January 1, 2009, is treated as newly issued and thus is eligible for partnership program status. For purposes of applying the Medicaid rules relating to the state partnership program, the addition of a rider, endorsement, or change in schedule page for a policy may be treated as giving rise to an exchange.
Ins 3.465(8)(d)1.a.
a. The policy is issued to a local, municipal, county, or state public employee group.
Ins 3.465(8)(d)1.b.
b. The group coverage was negotiated as part of a collective bargaining agreement.
Ins 3.465(8)(d)1.c.
c. The group coverage is provided to all eligible employees on a guaranteed issue basis.
Ins 3.465(8)(d)1.d.
d. The policy provides insureds with at least 5% compound annualized inflation protection.
Ins 3.465(8)(d)1.f.
f. No later than one year from the date the insurer begins to advertise, market, offer, sell, or issue policies that are intended to be qualifying partnership policies, the insurer shall provide notice that the policy meets the requirements of a qualifying partnership plan and shall provide the insureds with Appendix 1, the Guide to Long-Term Care booklet and the Wisconsin Long-Term Care Programs guide. The insurer shall file with the commissioner, prior to use and for informational purposes, the exchange letter to be used in the exchange offer.
Ins 3.465(8)(d)1.g.
g. To accomplish an automatic exchange the insurer shall apply the exchange to all group members.
Ins 3.465(8)(d)1.h.
h. The effective date of the qualifying partnership policy shall be the date of the exchanged policy.
Ins 3.465(8)(d)1.i.
i. In the event of an exchange, the insured and its certificateholders may not lose any rights that have accrued under the original policy including, but not limited to, rights established because of the lapse of time related to pre-existing condition exclusions, elimination periods, or incontestability clauses.
Ins 3.465(8)(d)2.
2. Notwithstanding par.
(b), an insurer is not required to offer an exchange to an individual who is eligible for benefits or within an elimination period or who is, or who has been in, claim status on or after January 1, 2009, or who would not be eligible to apply for coverage due to issue age limitations under the new policy. The insurer may require that policyholders or certificateholders meet all eligibility requirements, including plan design, underwriting, if applicable, and payment of the required premium.
Ins 3.465 History
History: EmR0817: emerg. cr. eff. 6-3-08;
CR 08-032: cr.
Register October 2008 No. 634, eff. 11-1-08.
Ins 3.465 Note
Note:
CR 08-032 first applies to policies or certificates issued on or after January 1, 2009 or on the first renewal date on or after January 1, 2009, but no later than January 1, 2010 for collectively bargained policies or certificates.
Ins 3.465 APPENDIX 1
PARTNERSHIP POLICY STATUS DISCLOSURE NOTICE
Important Notice Regarding Your Policy's Long-Term
Care Insurance Partnership Plan Status
(Please Keep This Notice With Your Policy or Certificate)
The Wisconsin Long-Term Care Insurance Partnership Program (Wisconsin Partnership Program) is a partnership between the State of Wisconsin and private insurers of long-term care insurance policies [certificates]. The Wisconsin Partnership Program became effective on January 1, 2009. This Notice explains the Medicaid asset protection that you may receive being insured under a Partnership Policy [Certificate].
Notice of Partnership Plan Policy Status. Your long-term care insurance policy [certificate] is intended to qualify as a Qualifying Partnership Policy [Certificate] under the Wisconsin Long-Term Care Insurance Partnership Program as of your policy's [certificate's] effective date.
You should also be aware that insurers are required to provide personally identifying information, including your name, to the federal government to be entered into a federal data base to which state Medicaid departments will have access.
Medicaid Asset Protection Provided by the State Medicaid Program. Long-term care insurance is one tool that helps individuals prepare for future long-term care needs. The purchase of a Qualifying Partnership Policy [certificate] does not automatically qualify you for Medicaid.
In particular, such policies [certificates] may permit individuals to protect assets from spend-down requirements under Wisconsin's Medicaid program if assistance under this program is ever needed and you otherwise qualify for Medicaid.
Specifically, the asset eligibility and recovery provisions of the Wisconsin Medicaid program are applied by disregarding the amount of assets equal to the amount of insurance benefits you have received from your Qualifying Partnership Policy [Certificate]. The disregarded assets are also exempt from estate recovery. For example, if you receive $200,000 of insurance benefits from your Qualifying Partnership Policy [Certificate], you generally would be able to retain $200,000 of assets above and beyond the amount of assets normally permitted for Medicaid eligibility.
Other Medicaid eligibility requirements apart from permissible assets shall be met, including special rules that may apply if the equity in your home exceeds [$750,000]. In addition, you shall meet the Medicaid program's income requirements and may be required to contribute some of your income to the costs of your care once you become eligible for Medicaid. Medicaid eligibility requirements may vary by county and may change over time. Medicaid eligibility requirements may also be different from state to state.
Additional Consumer Protections. In addition to providing Medicaid asset protection, your Partnership Policy [Certificate] has other important features. Under the rules governing Wisconsin's Long-Term Care Insurance Partnership Program, your Qualifying Partnership Policy [Certificate] shall be a tax-qualified long-term care insurance contract under Federal tax law, and as such the insurance benefits you receive from the policy generally will not be subject to income tax. (Please note that a policy or certificate can be a qualified long-term care insurance contract under Federal and State income tax law, with the same income tax treatment, even if it is not a Qualifying Partnership Policy [Certificate].) In addition, if you were under age 76 when you purchased your Qualifying Partnership Policy [Certificate], it shall provide inflation protection to help protect against potential future increases in the cost of long-term care. (For older purchasers, only an offer of inflation protection is required.)
What Could Disqualify Your Policy as a Partnership Policy [Certificate]. If you make any changes to your policy or certificate, such changes could affect whether your policy [certificate] continues to be a Qualifying Partnership Policy [Certificate]. Before you make any changes, you should consult with the [carrier's name] to determine the effect of a proposed change. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy as a Qualifying Partnership Policy [Certificate], you would not receive Medicaid asset protection in that state. However, the coverage contained in your policy would not be affected. Also, changes in Federal or State law could modify, reduce or eliminate the Medicaid asset protection available with respect to your Qualifying Partnership Policy [Certificate] after you have purchased the policy.
Additional information. If you would like further information about the Medicaid asset protection provided by your Qualifying Partnership Policy [Certificate] or the Wisconsin's Long-Term Care Insurance Partnership Program, please contact State of Wisconsin Member Services at 1-800-362-3002.
Ins 3.465 APPENDIX 2
PARTNERSHIP PROGRAM NOTICE
Important Consumer Information Regarding the Wisconsin
Long-Term Care Insurance Partnership Program
Some long-term care insurance policies [certificates] sold in Wisconsin may qualify for the Wisconsin Long-Term Care Insurance Partnership Program (the Partnership Program). The Partnership Program is a partnership between state government and private insurance companies to assist individuals in planning their long-term care needs. Insurance companies voluntarily agree to participate in the Partnership Program by offering long-term care insurance coverage that meets certain State and Federal requirements. Long-term care insurance policies [certificates] that qualify as Qualifying Partnership Policies [Certificates] may protect the policyholder's [certificateholder's] assets through a feature known as “Asset Disregard" under Wisconsin's Medicaid program.
Asset Disregard means that amount of the policyholder's [certificateholder's] assets equal to the amount of long-term care insurance benefits received under a Qualifying Partnership Policy [Certificate] will be disregarded for the purpose of determining the insured's eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a Qualifying Partnership Policy [Certificate] without affecting the person's eligibility for Medicaid. The disregarded assets are also exempt from estate recovery. All other Medicaid eligibility criteria will apply and special rules may apply to persons whose home equity exceeds $750,000. Asset Disregard is available under a Qualifying Partnership Policy [Certificate]. Therefore, you should consider if Asset Disregard is important to you, and whether a Qualifying Partnership Policy meets your needs. The purchase of a Qualifying Partnership Policy does not automatically qualify you for Medicaid.
What are the Requirements for a Partnership Policy [Certificate]? In order for a policy [certificate] to qualify as a Qualifying Partnership Policy [Certificate], it shall, among other requirements:
•
Have an effective date on or after January 1, 2009;
•
Be issued to an individual who was a Wisconsin resident when coverage first becomes effective under the policy;
•
Be a tax-qualified policy under s. 7702(B)(b) of the Internal Revenue Code of 1986, as amended;
• Meet certain consumer protection standards; and,
• Meet the following inflation requirements:
• For persons age 60 or younger – provide compound annual inflation protection of at least 3%.
• For persons age 61-75 – provide annual inflation protection of at least 3% not compounded.
• For persons age 76 and older – there are no requirements for purchasing inflation protection.
If you apply and are approved for long-term care insurance coverage, [carrier name] will provide you with written documentation as to whether or not your policy [certificate] is a Qualifying Partnership Policy.
You should also be aware that insurers are required to provide personally identifying information, including your name, to the federal government to be entered into a federal data base to which state Medicaid departments will have access.
What Could Disqualify a Policy [Certificate] from Continuing to be a Qualifying Partnership Policy? Certain types of changes to a Qualifying Partnership Policy [Certificate] could affect whether or not such policy [certificate]continues to be a Qualifying Partnership Policy [Certificate]. If you purchase a Qualifying Partnership Policy [Certificate] and later decide to make a change, you should first consult with [carrier name] to determine the effect of the proposed changes. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy [certificate] as a Qualifying Partnership Policy [Certificate], you would not receive treatment of you policy [certificate] under the Medicaid program of that state. However, the coverage under your policy will not be affected. The information contained in this disclosure is based upon current Wisconsin and Federal laws. These laws may be subject to change. Any change in law could modify, reduce or eliminate the treatment of your policy [certificate] under Wisconsin's Medicaid program.
Additional Information: If you have questions regarding long-term care insurance policies [certificates] please contact [carrier name]. If you have questions regarding current laws governing Wisconsin Medicaid eligibility, you should contact State of Wisconsin Member Services at 1-800-362-3002.
Ins 3.47
Ins 3.47 Cancer insurance solicitation. Ins 3.47(1)(1)
Findings. Information on file in the office of the commissioner of insurance shows that significant misunderstanding exists with respect to cancer insurance. Consumers are not aware of the limitations of cancer insurance and do not know how cancer insurance policies fit in with other health insurance coverage. Many of the sales presentations used in the selling of cancer insurance are confusing, misleading and incomplete and consumers are not getting the information they need to make informed choices. The commissioner of insurance finds that such presentations and sales materials are misleading, deceptive and restrain competition unreasonably as considered by s.
628.34 (12), Stats., and that their continued use without additional information would constitute an unfair trade practice under s.
628.34 (11), Stats., and would result in misrepresentation as defined and prohibited in s.
628.34 (1), Stats.
Ins 3.47(2)
(2)
Purpose. This section interprets s.
628.34 (12), Stats., relating to unfair trade practices. It requires insurers and intermediaries who sell cancer insurance to give all prospective buyers of cancer insurance a shopper's guide prepared by the national association of insurance commissioners.
Ins 3.47(3)
(3)
Scope. This section applies to all individual, group and franchise insurance policies or riders which provide benefits for or are advertised as providing benefits primarily for the treatment of cancer. This section does not apply to solicitations in which the booklet, “Health Insurance Advice for Senior Citizens," is given to applicants as required by s.
Ins 3.39.
Ins 3.47(4)
(4)
Definition. “A Shopper's Guide to Cancer Insurance" means the document which contains the language set forth in Appendix I to this section.
Ins 3.47(5)(a)(a) Each insurer offering a policy or rider described in sub.
(3) shall print, and the insurer and its intermediaries shall provide to all prospective purchasers of any policy or rider subject to this section, a copy of “A Shopper's Guide to Cancer Insurance" at the time the prospect is contacted by the insurer or intermediary with an invitation to apply, as defined in s.
Ins 3.27 (5) (g).
Ins 3.47(5)(b)
(b) “A Shopper's Guide to Cancer Insurance" shall be printed in an easy-to-read type of not less than 12-pt. size.
