Ariz. Admin. Code § 20-6-1002

Current through Register Vol. 30, No. 45, November 8, 2024

Section R20-6-1002 - Definitions

The definitions in A.R.S. § 20-1691 and the following definitions apply in this Article.

A. "Benefit trigger," for purposes of a tax-qualified long-term care insurance contract, as defined in Section 7702B(b) of the Internal Revenue Code of 1968, as amended, "benefit trigger" shall include a determination by a licensed health care practitioner that an insured is a chronically ill individual.

B. "Exceptional increase" means only those rate increases that an insurer has filed as exceptional and that the Director determines the need for the premium rate increase is justified due to changes in laws or regulations applicable to long-term care coverage in this state; or due to increased and unexpected utilization that affects the majority of insurers of similar products.

1. Except as provided in Sections R20-6-1014 and R20-6-1015, exceptional increases are subject to the same requirements as other premium rate schedule increases.

2. The Director may request independent actuarial review on the issue of whether an increase should be deemed an exceptional increase.

3. The Director may also determine whether there are any potential offsets to higher claims costs.

C. "Incidental," as used in R20-6-1014(L) and R20-6-1015(L), means that the value of the long-term care benefits provided is less than 10% of the total value of the benefits provided over the life of the policy, with value measured as of the date of issue.

D. "Licensed health care professional" means an individual qualified by education and experience in an appropriate field, to determine, by record review, an insured's actual functional or cognitive impairment.

E. "Long-term care benefit classification" means one of the following:

1. Institutional long-term care - benefits only;

2. Non-institutional long-term care - benefits only; or

3. Comprehensive long-term care benefits.

F. "Managed care plan" means a health care or assisted living arrangement designed to coordinate patient care or control costs through utilization review, case management, use of specific provider networks, or a combination of these methods.

G. "Personal information" has the same meaning prescribed in A.R.S. § 20-2102(19).

H. "Privileged information" has the same meaning prescribed in A.R.S. § 20-2102(22).

I. "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

J. "Similar policy forms" means all long-term care insurance policies and certificates that are issued by a particular insurer and that have the same long-term care benefit classification as a policy form being reviewed.

Ariz. Admin. Code § R20-6-1002

Adopted effective August 10, 1992 (Supp. 92-3). R20-6-1002recodified from R4-14-1002 (Supp. 95-1). Amended by final rulemaking at 10 A.A.R. 4661, effective January 3, 2005 (Supp. 04-4). Amended by final exempt rulemaking at 23 A.A.R. 1119, effective 11/10/2017.