Ins 3.455(8)(a)3.n. n. Availability of eligible facilities,

Ins 3.455(8)(a)3.o. o. Margins in claim costs,

Ins 3.455(8)(a)3.p. p. Optional nature of benefit,

Ins 3.455(8)(a)3.q. q. Delay in eligibility for benefit,

Ins 3.455(8)(a)3.r. r. Inflation protection provisions, and

Ins 3.455(8)(a)3.s. s. Guaranteed insurability option.

Ins 3.455(8)(a)4. 4. Any applicable valuation morbidity table shall be certified as appropriate as a statutory valuation table by a member of the American academy of actuaries.

Ins 3.455(8)(b) (b) Reserves for long-term care policies shall be determined in accordance with s. Ins 3.17 (8) (b) using tables established for reserve purposes by a qualified actuary meeting the requirements of s. Ins 6.12 and acceptable to the commissioner.

Ins 3.455(9) (9) Long-term care rate increase standards.

Ins 3.455(9)(a) (a) The initial premium rate schedule provided an insured covered by a long-term care policy may not increase during the initial 3 years in which the policy is in force.

Ins 3.455(9)(b) (b) Except as provided in par. (d), any increase in the premium rate schedule provided an insured after the initial 3-year period is subject to the following:

Ins 3.455(9)(b)1. 1. Any premium rate increase after the initial 3-year period is guaranteed for at least 2 years after its effective date;

Ins 3.455(9)(b)2. 2. For those insureds age 75 or above and whose long term care policy(s) has been in force for at least 10 years, no rate increase shall exceed 10%;

Ins 3.455(9)(b)3. 3. If an insurer of any long-term care policy increases rates for a policy by more than 50% in any 3-year period, the insurer shall discontinue issuing all long-term care policies in this state for a period of 2 years from the effective date of such rate increase.

Ins 3.455(9)(b)3.a. a. If an insurer issues both individual and group long-term care policies, the insurer shall discontinue issuing the type of coverage (individual and/or group) for which rates were increased more than 50% in a 3-year period.

Ins 3.455(9)(b)3.b. b. All rate filings subject to this requirement shall include a past history of all previous rate increases and a certification of the maximum rate increase over the last thirty-five months including the current rate increase as a percent of the premium in the first month of the 35 month period.

Ins 3.455(9)(b)3.c. c. This provision shall also apply to any replacing insurer which purchases or otherwise assumes a block of long-term care policies from a prior insurer. For purposes of this provision, any rate increases of the prior insurer shall apply to the replacing insurer.

Ins 3.455(9)(b)4. 4. The premium charged to an insured may not increase due to either:

Ins 3.455(9)(b)4.a. a. The increasing age of the insured at ages beyond 65; or

Ins 3.455(9)(b)4.b. b. The duration the insured has been covered under the policy.

Ins 3.455(9)(c) (c) Long-term care policies which provide for inflation protection shall be subject to the restrictions contained in pars. (a) and (b). However, the purchase of additional coverage may not be considered a premium rate increase for purposes of determining compliance with par. (b) at the time additional coverage is purchased. The premium charged for the purchase of additional coverage shall be subject to par. (b) for any subsequent premium rate increases.

Ins 3.455(9)(d) (d) The commissioner may institute future rulemaking proceedings to amend the provisions in par. (b) in appropriate circumstances, including the following:

Ins 3.455(9)(d)1. 1. Applicable state or federal law is enacted which materially affects the insured risk.

Ins 3.455(9)(d)2. 2. Unforeseen changes occur in long-term care delivery, insured morbidity or insured mortality.

Ins 3.455(9)(d)3. 3. Judicial interpretations or rulings are rendered regarding policy benefits or benefit triggers resulting in unforeseen claim liabilities.

Ins 3.455(9)(e) (e) Except as provided in par. (f) the provisions of this subsection apply only to long-term care insurance policies and certificates issued from August 1, 1996 to December 31, 2001.

Ins 3.455(9)(f) (f) The provisions of this subsection do not apply to any group long-term care insurance policy or certificate issued to any labor organization or to any trust or trustee of a fund established by any employer or labor organization for members or former members if the group policy was in force prior to August 1, 1996.

Ins 3.455(9m) (9m) Premium rate schedule increases, requesting and determining exceptional rate increases.

Ins 3.455(9m)(a) (a) An insurer shall provide notice of a pending premium rate schedule increase, including an exceptional increase, to the commissioner at least 60 days prior to the notice to the policyholders and shall include all of the following: