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.b.b. The new policy may not be underwritten.
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.a.a. The insurer shall treat the exchange as a replacement and comply with s. Ins 3.46, including suitability.
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)(c) Exchanged policy requirements.
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)(d) Exceptions and exemptions.
Ins 3.465(8)(d)1.1. Insurers offering group long-term care policies are exempt from subs. (5) to (7) and (8) (a) to (c), if they comply with all of the following:
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.e.e. The policy meets the requirements of subs. (3) and (4).
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.