Ins 3.46(12)(a)(a) No insurer may advertise, market or offer a long-term care policy or certificate, or life insurance-long-term care coverage with an elimination period exceeding 180 days unless the insurer has a form approved under s. 631.20, Stats., providing the identical coverage, but with an elimination period of 180 days or less.
Ins 3.46(12)(b)(b) No insurer may file a form for a long-term care policy or certificate or life insurance-long-term care coverage containing an elimination period in excess of 180 days, unless the application form contains a clear and conspicuous disclosure of the offer required under par. (c).
Ins 3.46(12)(c)(c) No insurer or intermediary may contact any person to solicit the sale of a long-term care policy or certificate or life insurance-long-term care coverage with an elimination period in excess of 180 days unless, at the time of the contact, the intermediary or insurer makes a clear and conspicuous offer to the person to provide the policy, certificate or coverage with an elimination period of 180 days or less.
Ins 3.46(12)(d)(d) No insurer or intermediary may accept an application for a long-term care policy or certificate, or life insurance-long-term care coverage, unless it is signed by the applicant and has indicated acceptance or rejection of the offer required under par. (c) on the application.
Ins 3.46(12)(e)(e) If a policy or coverage is a group policy or coverage, the applicant for the purpose of par. (d) is the proposed certificate holder.
Ins 3.46(12)(f)(f) This subsection does not require an insurer to accept an applicant for a policy, certificate or coverage with a 180-day or less elimination period if the applicant would be rejected for the same policy, certificate or coverage with the elimination period in excess of 180 days.
Ins 3.46(13)(13)Commission limits for long-term care, nursing home and home health care policies.
Ins 3.46(13)(a)(a) An insurer may provide compensation to an intermediary, and an intermediary may accept compensation for the sale of a long-term care policy or certificate only if the compensation provided in the 2nd year or period and subsequent years is the same and is provided for at least 5 renewal years.
Ins 3.46(13)(b)(b) Except as provided in par. (c), no person may provide compensation to an intermediary, and no intermediary may accept compensation, relating to the replacement of a long-term care policy or certificate which is greater than the renewal compensation provided by the replacing insurer for the replacing policy or certificate. Long-term care policies this paragraph and par. (c) apply to include, but are not limited to, long-term care policies, nursing home policies and home health care policies issued prior to June 1, 1991.
Ins 3.46(13)(c)(c) A person may provide to an intermediary, and an intermediary may accept, compensation relating to the replacement of a long-term care policy or certificate; which compensation is no greater than the first-year compensation provided by the replacing insurer for the replacing policy or certificate if, in addition to requirements contained in sub. (14), all of the following criteria are satisfied:
Ins 3.46(13)(c)1.1. The replacing insurer has established reasonable standards for which first-year compensation is appropriate for the replacement.
Ins 3.46(13)(c)2.2. The standards referenced in subd. 1. include all of the following standards:
Ins 3.46(13)(c)2.a.a. The replacing policy is suitable for the applicant.
Ins 3.46(13)(c)2.b.b. The replacing policy materially improves the position of the applicant, including, but not limited to, the coverage, price, premium stability, or financial strength ratings of the insurer.
Ins 3.46(13)(c)2.c.c. The intermediary has done an assessment of the replacement transaction justifying the replacement according to the insurer’s replacement standards and this subd. 2. c. and submits that assessment to the insurer as part of the application for replacement.
Ins 3.46(13)(c)2.d.d. The insurer evaluates each replacement and affirmatively approves or denies the replacement’s qualification for first-year compensation of the replacing policy.
Ins 3.46(13)(c)2.e.e. The standards and methodology are subject to review by the office of the commissioner of insurance.
Ins 3.46(13)(c)3.3. The replacing insurer has established an auditable methodology for evaluating replacements that qualify for first-year compensation.
Ins 3.46(14)(14)Replacement; long-term care, nursing home and home health care policies.
Ins 3.46(14)(a)(a) If a long-term care policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods and probationary periods in the new long-term care policy for similar benefits to the extent that similar exclusions have been satisfied under the original policy.
Ins 3.46(14)(b)(b) If a group long-term care policy is replaced by another group long-term care policy purchased by the same policyholder, the succeeding insurer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new group policy may not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.
Ins 3.46(14)(c)(c)
Ins 3.46(14)(c)1.1. Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or certificate is intended to replace any other accident and sickness or long-term care policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent, except where the coverage is sold without an agent, containing the following questions may be used:
Ins 3.46(14)(c)1.a.a. Do you have another long-term care insurance policy or certificate in force (including a health care service contract or health maintenance organization contract)?
Ins 3.46(14)(c)1.b.b. Did you have another long-term care insurance policy or certificate in force during the last 12 months?
Ins 3.46(14)(c)1.c.c. If so, with which [company or insurer]?
Ins 3.46(14)(c)1.d.d. If that policy lapsed, when did it lapse?
Ins 3.46(14)(c)1.e.e. Are you covered by Medicaid?
Ins 3.46(14)(c)1.f.f. Do you intend to replace any of your medical or health insurance coverage with this policy [certificate]?