Ala. Admin. Code r. 482-1-091-.04

Current through Register Vol. 43, No. 02, November 27, 2024

Section 482-1-091-.04 - Definitions

For the purpose of this chapter, the terms "long-term care insurance," "qualified long-term care insurance," "group long-term care insurance," "commissioner," "applicant," "policy" and "certificate" shall have the meanings set forth in Section 27-19-103, Code of Ala. 1975. In addition, the following definitions apply.

(a)

1. "Exceptional increase" means only those increases filed by an insurer as exceptional for which the commissioner determines the need for the premium rate increase is justified:

(i) Due to changes in laws or regulations applicable to long-term care coverage in this state; or

(ii) Due to increased and unexpected utilization that affects the majority of insurers of similar products.

2. Except as provided in Rule 482-1-091-.30, exceptional increases are subject to the same requirements as other premium rate schedule increases.

3. The commissioner may request a review by an independent actuary or a professional actuarial body of the basis for a request that an increase be considered an exceptional increase.

4. The commissioner, in determining that the necessary basis for any exceptional increase exists, shall also determine any potential offsets to higher claims costs.

(b) "Incidental", as used in Rule 482-1-091-.30(10), means that the value of the long-term care benefits provided is less than ten percent (10%) of the total value of the benefits provided over the life of the policy. These values shall be measured as of the date of issue.

(c) "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

(d) "Similar policy forms" means all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered. Certificates of groups that meet the definition in Section 27-19-103(4), Code of Ala. 1975, are not considered similar to certificates or policies otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications. For purposes of determining similar policy forms, long-term care benefit classifications are defined as follows: institutional long-term care benefits only, non-institutional long-term care benefits only, or comprehensive long-term care benefits.

Author: Reyn Norman, Associate Counsel

Ala. Admin. Code r. 482-1-091-.04

New Rule: June 14, 1991; effective October 1, 1991. Revised: August 16, 2000; effective January 1, 2001. Filed for codification in the Alabama Administrative Code by the Department of Insurance on January 17, 2003, pursuant to the Code of Ala. 1975, § 27-7-43. Revised: December 21, 2005; effective July 1, 2006. Filed with LRS December 21, 2005. Rule is not subject to the Alabama Administrative Procedure Act.

Statutory Authority:Code of Ala. 1975, §§ 27-2-17, 27-19-100, etseq.