Effective 1/01/08

Long-Term Care Insurance (Group and Individual)

LTCO2G
LTCO2I
LTCO3G
LTCO3I
LTCO4G
LTCO4I
LTCO5G
LTCO5I
LTCO6
LTCO5.2G
LTCO5.2I

Long-Term Care Policies

LTCO2G.001
LTCO2G.002
LTCO2G.003
LTCO2I.001
LTCO2I.002
LTCO2I.003
LTCO3G.001
LTCO3G.002
LTCO3G.003
LTCO3I.001
LTCO3I.002
LTCO3I.003
LTCO4G.001
LTCO4G.002
LTCO4I.001
LTCO4I.002
LTCO4I.003
LTCO5G.001
LTCO5G.002
LTCO5G.003
LTCO5I.001
LTCO5I.002
LTCO5I.003
LTCO5.2G.001
LTCO5.2G.002
LTCO5.2G.003
LTCO5.2G.001
LTCO5.2G.002
LTCO5.2G.003
LTCO6.000

Each filing must include a completed Review Requirements Checklist that must contain a completed “Location of Standard in Filing” column for each required element of the filing. Please indicate the proper page # and form # for each entry. The checklists may be found at this link.

50 IL Adm. Code 1405.20 (e)
50 IL Adm. Code 2001.30 (a) (3)

In addition to referencing any previously approved form number(s) as required by 50 IL Adm. Code 1405.20(e), those references must also include the filing number and SERFF tracking number (if applicable and available) for the referenced forms.

Periodic payments must be made within 60 days of insured's selection of a provider or effective date of selection, whichever is later. In case of retrospective enrollment only 30 days after notice by employer to insurer. Subsequent payments must be in monthly periodic cycle. Penalty payment of 9% per year.

Payments other than periodic must be made within 30 days after receipt of due proof of loss. Same penalty provisions.

Group traditional long-term care insurance issued on or after February 1, 1994 must provide insureds with a basis for continuation or conversion of coverage.

An application for a converted policy must be made within 31 days after termination of the group policy and must be effective on the day after termination. It must be issued on a guaranteed renewable basis.

A policy may not be non-renewed or terminated due to age or the deterioration of the mental or physical health of the insured.

A policy may not contain a provision establishing a new waiting period in the event existing coverage is converted or replaced by a new or other form unless the insured individual or policyholder voluntarily chooses an increase in benefits.

A policy may not provide coverage for skilled nursing care only, or contain a provision providing significantly more coverage for skilled care in a facility than for coverage at lower levels of care.

An insurer may not issue a policy unless it includes a written offer to include nonforfeiture benefits to the defaulting policyholder or certificate holder.

This section does not apply to life insurance policies or riders containing accelerated traditional long-term care benefits.

There must be a disclosure for an accelerated life product policy. It must include an explanation of how the long-term care benefit interacts with other components of the policy, as well as an illustration regarding benefits. Additional details are provided.

The disclosure must appear on the policy summary and outline of coverage.

The terms "guaranteed renewable" and "noncancellable" shall not be used in any group and individual direct response or individual traditional long-term care policy or certificate without explanatory language.

Individual policies must contain a renewability provision on the first page of the policy and must state that the policy is guaranteed renewable or noncancellable.

No policy issued on other than a group basis may use a definition of "pre-existing condition" which is more restrictive than: Preexisting condition means the existence of symptoms which would cause an ordinarily prudent person to seek diagnosis, care or treatment, or a condition for which medical advice or treatment was recommended by, or received from a provider of health care services, within 6 months preceding the effective date of coverage for an insured person.

The provision must appear as a separate paragraph in the policy or certificate and be captioned as "Preexisting Condition Limitations".

These disclosure requirements apply to any traditional long-term insurance policy issued on or after January 1, 2003. For a group traditional long-term policy issued on or after July 1, 2002, which was in force prior to that date, these requirements are applicable on the next policy anniversary following July 1, 2003.

An insurer must provide at least 45 days notice to all policyholders or certificate holders prior to implementing a premium rate increase. The notification must include the information required by 50 IL Adm. Code 2012.62 b).

An insurer must provide notice of a pending premium rate increase to the Division at least 30 days prior to the notice to the policyholder and must include the information required by 50 IL Adm. Code 2012.62 as well as certification by an actuary as stated.

These requirements apply to any traditional long-term insurance policy issued on or after January 1, 2003. For a group traditional long-term policy issued on or after July 1, 2002, which was in force prior to that date, these requirements are applicable on the next policy anniversary following July 1, 2003.

No individual long-term care policy shall be issued until the insurer receives from the applicant a written designation of at least one other individual who is to receive notice of termination of the policy for nonpayment of premium. A written waiver of this provision is permissible.

Reinstatement is required if proof of cognitive impairment or loss of functional capacity is provided.

An insurer shall maintain at its home or principal office a complete file containing every printed, published or prepared advertisement of its individual policies and typical printed, published or prepared advertisements of its blanket, franchise and group policies.

The Division does not require advertisements be filed for information or approval.

This section requires insurers of traditional long-term care policies to develop and use suitable standards for determining whether the purchase or replacement of coverage is appropriate. It does not apply to life insurance policies that accelerate benefits for traditional long-term care.

This section also provides additional details regarding the personal worksheet.

815 ILCS 505 2QQ

215 ILCS 138/15

The focus of HB 4712 is on any card required for an individual to access products or services, while SB 2545 is more limited in that it just focuses on insurance cards.

HB 4712 prevents a person from:

· Publicly posting or displaying an individual's SSN;

· Printing an individual's SSN on any card required for the individual to access products or services, however, an entity providing an insurance card must print on the card a unique identification number as required by 215 ILCS 138/15.

· Being required to transmit an SSN over the Internet to access a web site unless the connection is secure or the SSN is encrypted;

· Requiring the individual to use his/her SSN to access a web site unless a PIN number or other authentication device is also used; and,

· Printing an individual's SSN on any materials mailed to an individual unless required by state or federal law.

Insurers are required to comply with both provisions.