Ins 3.46(23)(e)2.
2. The insurer shall file with the office of the commissioner of insurance all of the following material:
Ins 3.46(23)(e)3.
3. The association shall disclose in any long-term care insurance solicitation the following:
Ins 3.46(23)(e)3.a.
a. The specific nature and amount of the compensation arrangements, including all fees, commissions, administrative fees and other forms of financial support, that the association receives from endorsement or sale of the policy or certificate to its members.
Ins 3.46(23)(e)3.b.
b. A brief description of the process under which the policies and the insurer issuing the policies were selected.
Ins 3.46(23)(e)4.
4. If the association and the insurer have interlocking directorates or trustee arrangements, the association shall disclose that fact to its members.
Ins 3.46(23)(e)5.
5. The board of directors of associations selling or endorsing long-term care insurance policies or certificates shall review and approve the insurance policies as well as the compensation arrangements made with the insurer.
Ins 3.46(23)(e)6.a.
a. Conduct an examination of its policies, including benefits, features, and rates and subsequently update the examination in the event of material change at the time of the association's decision to endorse or engage the services of a person with expertise in long-term care insurance not affiliated with the insurer.
Ins 3.46(23)(e)6.b.
b. Actively monitor the marketing efforts of the insurer and its intermediaries.
Ins 3.46(23)(e)6.c.
c. Review and approve all marketing materials or other insurance communications used to promote sales or sent to members regarding the policies or certificates.
Ins 3.46(23)(e)7.
7. No group long-term care insurance policy may be issued to an association unless the insurer files with the office of the commissioner of insurance the information required in this subsection.
Ins 3.46(23)(e)8.
8. An insurer may not issue a long-term care policy or certificate to an association or continue to market such a policy or certificate unless the insurer certifies annually that the association has complied with the requirements set forth in this subsection.
Ins 3.46(23)(e)9.
9. Failure to comply with the filing and certification requirements of this section constitutes an unfair trade practice in violation of s.
628.34 (11), Stats.
Ins 3.46(24)
(24)
Availability of new services or providers. Ins 3.46(24)(a)
(a) An insurer shall notify policyholders of the availability of a new long-term care policy series that provides coverage for new long-term care services or providers material in nature and not previously available through the insurer to the general public. The notice shall be provided within 12 months of the date the new policy series is made available for sale in this state.
Ins 3.46(24)(b)
(b) Notwithstanding par.
(a), notification is not required for any policy issued prior to the effective date of this section or to any policyholder or certificateholder who is eligible for benefits, is within an elimination period or is receiving benefits, or who previously received benefits under the terms of the policy, 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 meet all eligibility requirements, including underwriting and payment of the required premium to add such new services or providers.
Ins 3.46(24)(c)
(c) The insurer shall make the new coverage available in one of the following ways:
Ins 3.46(24)(c)1.
1. By adding a rider to the existing policy and charging a separate premium for the new rider based on the insured's attained age.
Ins 3.46(24)(c)2.
2. By exchanging the existing policy or certificate for one with an issue age based on the present age of the insured and recognizing past insured status by granting premium credits toward the premiums for the new policy or certificate. The premium credits shall be based on premiums paid or reserves held for the prior policy or certificate.
Ins 3.46(24)(c)3.
3. By exchanging the existing policy or certificate for a new policy or certificate in which consideration for past insured status shall be recognized by setting the premium for the new policy or certificate at the issue age of the policy or certificate being exchanged. The cost for the new policy or certificate may recognize the difference in reserves between the new policy or certificate and the original policy or certificate.
Ins 3.46(24)(d)
(d) An insurer is not required to notify policyholders of a new proprietary policy series created and filed for use in a limited distribution channel. For purposes of this paragraph, “limited distribution channel" means through a discrete entity, such as a financial institution or brokerage, for which specialized products are available that are not available for sale to the general public. Policyholders that purchased such a proprietary policy shall be notified when a new long-term care policy series that provides coverage for new long-term care services or providers material in nature is made available to that limited distribution channel.
Ins 3.46(24)(e)
(e) Policies issued pursuant to this subsection may not be considered replacements.
Ins 3.46(24)(f)
(f) Where the policy is offered through an employer, labor organization, or professional, trade or occupational association, the required notification in par.
(a) shall be made to the offering entity.
Ins 3.46(24)(g)
(g) Nothing in this subsection shall prohibit an insurer from offering any policy, rider, certificate or coverage change to any policyholder or certificateholder. However, upon request any policyholder may apply for available coverage that includes the new services or providers. The insurer may require that policyholders meet all eligibility requirements, including underwriting and payment of the required premium to add such new services or providers.
Ins 3.46(24)(h)
(h) This subsection does not apply to life insurance policies or riders containing accelerated long-term care benefits.
Ins 3.46(25)
(25)
Right to reduce coverage and lower premiums. Ins 3.46(25)(a)1.1. Every long-term care insurance policy and certificate shall include a provision that allows the policyholder or certificateholder to reduce coverage and lower the policy or certificate premium in at least one of the following ways:
Ins 3.46(25)(a)2.
2. The insurer may also offer other reduction options that are consistent with the policy or certificate design or the insurer's administrative processes.
Ins 3.46(25)(b)
(b) The provision shall include a description of the ways in which coverage may be reduced and the process for requesting and implementing a reduction in coverage.
Ins 3.46(25)(c)
(c) The age to determine the premium for the reduced coverage shall be based on the age used to determine the premiums for the existing coverage.
Ins 3.46(25)(d)
(d) The insurer may limit any reduction in coverage to plans or options available for that policy form and to those for which benefits will be available after consideration of claims paid or payable.
Ins 3.46(25)(e)
(e) If a policy or certificate is due to lapse, the insurer shall provide a written reminder to the policyholder or certificateholder of his or her right to reduce coverage and premiums in the notice required by sub.
(15) (e).
Ins 3.46(25)(f)
(f) This subsection does not apply to life insurance policies or riders containing accelerated long-term care benefits.
Ins 3.46(26)
(26)
Insurance intermediary training requirements. This section applies to all insurance intermediaries that sell, solicit or negotiate long-term care insurance products in this state. For purposes of this paragraph, an hour of training means a period of study consisting of no less than 50 minutes. The requirements of this paragraph do not supersede any other intermediary education requirements contained in chs.
Ins 26 and
28.
Ins 3.46(26)(a)
(a) No insurance intermediary may sell, solicit or negotiate long-term care insurance in this state unless the intermediary is duly licensed and appointed by an insurer and has completed the initial training and ongoing training every 24 months as specified in s.
628.348 (1), Stats. The insurer shall be able to verify compliance with the training requirements as specified in this paragraph and s.
628.348 (2), Stats. The training shall meet the requirements set forth in this paragraph to par.
(d).
Ins 3.46(26)(a)1.a.a. Initial training. The initial training required shall be no less than 8 hours, of which 2 hours shall contain Wisconsin specific Medicaid and long-term care information. Training shall be completed in one six-hour course for non-Wisconsin specific Medicaid and long-term care information training and one two-hour course for Wisconsin specific Medicaid and long-term care information or one eight-hour course that includes the two-hours of training containing specific Medicaid and long-term care information.
Ins 3.46(26)(a)1.b.
b. Ongoing training. After completion of the initial 8 hours of training, all insurance intermediaries shall complete one 4-hour of training course specific to long-term care insurance and shall incorporate updates to the state partnership program as is available from the department's website. Training shall be completed as specified in par.
(b) 2. Ins 3.46(26)(a)2.
2. The training specified in this subsection may not include training that is insurer or company product specific or that includes any sales or marketing information, materials, or training, other than those required by state or federal law.
Ins 3.46(26)(a)3.
3. The training required by this subsection shall be submitted and approved and may be approved as continuing education courses under ch.
Ins 28.
Ins 3.46(26)(a)4.
4. The training required by this subsection shall consist of topics related to long-term care insurance, long-term care services and the state partnership program. The training shall include, but not be limited to, all of the following:
Ins 3.46(26)(a)4.a.
a. State and federal regulations and requirements and the relationship between qualified state long-term care partnership plan policies and other public and private coverage of long-term care services, including Medicaid programs in this state.
Ins 3.46(26)(a)4.e.
e. The effect of inflation on benefits and the importance of inflation protection.
Ins 3.46(26)(a)6.
6. Wisconsin specific Medicaid and long-term care training shall consist of the training developed and made available by the department.
Ins 3.46(26)(a)7.
7. Satisfaction of the training requirements in any state shall be deemed to satisfy the training requirements in this state subject to verification and compliance with the training requirements in subd.
1. except for the initial 2 hours of Wisconsin specific Medicaid and long-term care information training.
Ins 3.46(26)(b)1.1. Insurance intermediaries licensed prior to January 1, 2009, shall complete the initial training prior to selling long-term care products on or after January 1, 2009. Completion of initial training courses on or after October 27, 2007, that meet the requirements of par.
(a) 4., may be counted towards completion of the initial 8 hour training requirement.
Ins 3.46(26)(b)2.
2. For purposes of complying with s.
628.348 (1), Stats., compliance with this subsection will comply with s.
628.348 (1), Stats. Insurance intermediaries
who complete initial training by January 1, 2009, are required to complete the required 4 hours of ongoing training by the first complete license renewal cycle as specified in s.
Ins 6.63. Insurance intermediaries completing initial training after January 1, 2009 shall complete the required 4 hours of ongoing training by the date of their next complete license renewal cycle as specified in s.
Ins 6.63.
Ins 3.46(26)(c)
(c) Insurers subject to this section shall obtain and maintain verification that the intermediaries appointed with the insurer received the training required by sub.
(1) and shall make such information available to the commissioner upon request.
Ins 3.46(26)(d)
(d) Insurers offering long-term care insurance intended as a qualifying partnership policy shall maintain records that its authorized insurance intermediaries have demonstrated an understanding of the state partnership program and the relationship of the state partnership program to public and private coverage of long-term care including Wisconsin Medicaid long-term care programs. Information maintained shall be in a form that allows the commissioner to provide assurance to the department that the insurer's intermediaries have received the long-term care insurance training.
Ins 3.46 Note
Note:
The amendment to sub. (4) (g) and creation of sub. (18) first applies to any tax qualified long term policy solicited in Wisconsin after December 31, 1996.
Ins 3.46 History
History: Cr.
Register, June, 1981, No. 305, eff. 11-1-81; cr. (3) (c),
Register, June, 1982, No. 318, eff. 7-1-82; am. (1) and (3) (b),
Register, March, 1985, No. 351, eff. 4-1-85; (6m) deleted under s. 13.93 (2m) (b) 16., Stats.,
Register, March, 1985, No. 351; r. and recr.
Register, December, 1986, No. 372, eff. 1-1-87; r. and recr.,
Register, April, 1991, No. 424, eff. 6-1-91; cr. (3) (cm), (4) (t), (9) (b), (11m), (15), (16), (17), am. (4) (b), (g), renum. (9) (intro.), (a) and (b) to be (9) (a) (intro.), (a) 1. and 2.,
Register, July, 1996, No. 487, eff. 8-1-96; am. (4) (g) and cr. (18),
Register, August, 1997, No. 500, eff. 9-1-97; r. (9) (b),
Register, January, 1999, No. 517, eff. 2-1-99;
CR 00-188: cr. (3) (j), (4) (u), (9) (b) to (j) and (19), am. (5) (b) 5. and 9., r. (11m),
Register July 2001, No. 547 eff. 1-1-02;
EmR0817: emerg. r. (2) (a), am. (2) (d) (intro.), (4) (c), (j) to (n), (r), (5) (a), (b) 9., (16) (b), r. and recr. (3), (14), (19) (c) 4. and (d), cr. (8) (c), (d), (9) (k) to (m), (10) (f) to (j), (11) (a) 4., (19) (j) and (20) to (26), eff. 6-3-08;
CR 08-032: r. (2) (a), am. (2) (d) (intro.), (4) (c), (j) to (n), (r), (5) (a), (b) 9., (16) (b), r. and recr. (3), (14), (19) (c) 4. and (d), cr. (8) (c), (d), (9) (k) to (m), (10) (f) to (j), (11) (a) 4., (h), (19) (j) and (20) to (26)
Register October 2008 No. 634, eff. 11-1-08; corrections in (3) (a), (11) (h) and (20) made under s. 13.92 (4) (b) 1. and 7., Stats.,
Register October 2008 No. 634;
2013 Wis. Act 278: cons. and renum. (13) (a) (intro.) and 2. to (13) (a) and am., r. (13) (a) 1., am. (13) (b), cr. (13) (c)
Register May 2014 No. 701, eff. 6-1-14.
Ins 3.46 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 3.46 APPENDIX 1
(COMPANY NAME)
OUTLINE OF COVERAGE
(Insert the appropriate caption stated below.)
1. This policy is [an individual policy of insurance]([a group policy] that was issued in the [indicate jurisdiction in which group policy was issued]).
2. PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage provides a very brief description of the important features of the policy. You should compare this outline of coverage to outlines of coverage for other policies available to you. This is not an insurance contract, but only a summary of coverage. Only the individual or group policy contains governing contractual provisions. This means that the policy or group policy sets forth in detail the rights and obligations of both you and the insurance company. Therefore, if you purchase this coverage, or any other coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE) CAREFULLY!
3. FEDERAL TAX CONSEQUENCES.
This [POLICY] [CERTIFICATE] is intended to be a federally tax-qualified long-term care insurance contract under Section
7702B(b) of the Internal Revenue Code of 1986, as amended.
OR
Federal Tax Implications of this [POLICY] [CERTIFICATE]. This [POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified long-term care insurance contract under Section
7702B(b) of the Internal Revenue Code of 1986 as amended. Benefits received under the [POLICY] [CERTIFICATE] may be taxable as income.
4. Terms Under Which the Policy OR Certificate May Be Continued in Force or Discontinued.
(a) [For long-term care insurance policies or certificates describe one of the following permissible policy renewability provisions:
(1) Policies and certificates that are guaranteed renewable shall contain the following statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS GUARANTEED RENEWABLE. This means you have the right, subject to the terms of your policy, [certificate] to continue this policy as long as you pay your premiums on time. [Company Name] cannot change any of the terms of your policy on its own, except that, in the future, IT MAY INCREASE THE PREMIUM YOU PAY.
(2) [Policies and certificates that are noncancellable shall contain the following statement:] RENEWABILITY: THIS POLICY [CERTIFICATE] IS NONCANCELLABLE. This means that you have the right, subject to the terms of your policy, to continue this policy as long as you pay your premiums on time. [Company Name] cannot change any of the terms of your policy on its own and cannot change the premium you currently pay. However, if your policy contains an inflation protection feature where you choose to increase your benefits, [Company Name] may increase your premium at that time for those additional benefits.
(b) [For group coverage, specifically describe continuation/conversion provisions applicable to the certificate and group policy;]
(c) [Describe waiver of premium provisions or state that there are not such provisions.]
5. TERMS UNDER WHICH THE COMPANY MAY CHANGE PREMIUMS.
[In bold type larger than the maximum type required to be used for the other provisions of the outline of coverage, state whether or not the company has a right to change the premium, and if a right exists, describe clearly and concisely each circumstance under which the premium may change.]
6. TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED AND PREMIUM REFUNDED.
(a) [Provide a brief description of the right to return–“free look" provision of the policy.]
(b) [Include a statement that the policy either does or does not contain provisions providing for a refund or partial refund of premium upon the death of an insured or surrender of the policy or certificate. If the policy contains such provisions, include a description of them.]
7. THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide available from the insurance company.
(a) [For agents] Neither [insert company name] nor its agents represent Medicare, the federal government or any state government.
(b) [For direct response] [insert company name] is not representing Medicare, the federal government or any state government.
8. LONG-TERM CARE COVERAGE. Policies of this category are designed to provide coverage for one or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting other than an acute care unit of a hospital, such as in a nursing home, in the community or in the home.
