Section 58053 - Conversion of Policies or Certificates(a) Conversion of Non-Partnership Policies or Certificates to Partnership Policies. Each participating Issuer which has previously sold non-Partnership long-term care insurance policies or certificates shall make the following provisions for its policy or certificate holders who are not in benefit status or in the process of satisfying the policy or certificate elimination period;
(1) Individual policy holders who hold non-Partnership policies on the date when the participating Issuer's Policy is first available for purchase shall have a right to convert to a Partnership Policy at any time during the period the Issuer is a participating Issuer. However, the policy holder's right to convert may be limited to one-time only if the Issuer elects to provide written notification to each individual policy holder of the right to convert to a Partnership Policy within twelve months (12) of the date the participating Issuer is approved and allows the policy holder a minimum window of at least sixty (60) days to convert to a Partnership Policy.(2) Each holder of a non-Partnership certificate shall be afforded the right to convert to a Partnership Certificate if the employer or entity who holds the group policy elects to make available a Partnership Certificate to any of its employees or members. If the employer or entity so elects, the holders of non-Partnership certificates shall be provided written notification and allowed, at minimum, a window of at least sixty (60) days to convert to a Partnership Certificate.(3) Except as provided in (4) below, participating Issuers shall allow current policy or certificate holders to convert to a Partnership Policy or Certificate based upon full underwriting criteria no more stringent than if the policy or certificate holder were applying for coverage under a certified Policy or Certificate.(4) Participating Issuers shall allow current policy or certificate holders with policies or certificates in effect for less than twenty-four (24) months to convert to a Partnership Policy or Certificate based on underwriting criteria no more stringent than specified in (5) below if either of the following conditions are met: (A) the current policy or certificate converts nursing home care only and the policy or certificate holder is converting to a Partnership Nursing Facility and Residential Care Facility Only Policy or Certificate with a lifetime maximum benefit that is no greater than the lifetime maximum benefit of the current policy or certificate; or(B) the current policy or certificate covers home and community-based care and nursing home benefits and the policy or certificate holder is converting to a Partnership Comprehensive Policy or Certificate with a lifetime maximum benefit no greater than the lifetime maximum benefit of the current policy or certificate.(5) Participating Issuers shall allow current policy or certificate holders who meet the conditions of (4) above to convert to a Partnership Policy or Certificate based on either no underwriting or underwriting that only disqualifies the policy or certificate holder from converting to a Partnership Policy or Certificate if he or she is: (A) currently in benefit status or satisfying an elimination period; and/or(B) currently receiving Formal or Informal Long-Term Care Services which would reasonably indicate that the policy or certificate holder would meet or shortly meet (within 1 year) the Insured Event criteria were the policy or certificate holder to be assessed; and/or(C) currently using ambulation devices or medical equipment that would reasonably indicate that the policy or certificate holder would meet or shortly meet (within 1 year) the Insured Event criteria were he or she to be assessed.(6) When a participating Issuer replaces the current policy or certificate of its policy or certificate holder with a Partnership Policy or Certificate, the Issuer shall acknowledge the prior coverage by granting a premium credit for each full year the original policy or certificate was in force toward all subsequent premium payments for the replacement Policy or Certificate as specified in Section 58066(b).(b) Conversion of Partnership Policies and Certificates to Non-Partnership Status. The prospective Issuer of a non-Partnership policy or certificate to a holder of a current Partnership Policy or Certificate shall require the applicant to sign a form stating that he/she recognizes that the new policy or certificate does not conform to certification standards and that the Medi-Cal Property Exemption feature will no longer apply. This provision shall apply regardless of whether the original Partnership Policy or Certificate was issued by the Issuer of the new non-Partnership policy or certificate.(c) Conversion of Non-tax-qualified Partnership Policies or Certificates to Tax Qualified Partnership Policies or Certificate. Each participating Issuer which sold Non-tax qualified Partnership long-term care insurance Policies or Certificates after January 1, 1997 shall make the following provision for its policy or certificate holders:
(1) Notify each Policy or Certificate holder of the availability of a Tax-Qualified Partnership Policy or Certificate within ninety (90) days after such a Policy of Certificate first becomes available; and(2) Allow each Policy or Certificate holder a minimum window of at least sixty (60) days to convert to a Tax-Qualified Partnership Policy or Certificate with similar coverage, a premium based on original issue age, and without new underwriting.Cal. Code Regs. Tit. 22, § 58053
1. New section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36). Submitted for printing only pursuant to section 22009, Welfare and Institutions Code.
2. Certificate of Compliance as to 8-30-93 order, including amendment of subsections (a)(5)(A) and (a)(6), transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of section heading and section filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 10-1-98 order transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No. 12). Note: Authority cited: Section 22009(a), Welfare and Institutions Code. Reference: Section 22005, Welfare and Institutions Code.
1. New section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36). Submitted for printing only pursuant to section 22009, Welfare and Institutions Code.
2. Certificate of Compliance as to 8-30-93 order, including amendment of subsections (a)(5)(A) and (a)(6), transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No. 4).
3. Amendment of section heading and section filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and Institutions Code section 22009(d) (Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL by 1-29-99 or emergency language will be repealed by operation of law on the following day.
4. Certificate of Compliance as to 10-1-98 order transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No. 12).