Idaho Admin. Code r. 18.04.11.019

Current through September 2, 2024
Section 18.04.11.019 - REPORTING REQUIREMENTS
01.Maintenance of Producer Records. Every insurer maintains records for each producer of that producer's amount of replacement sales as a percent of the producer's total annual sales and the number of lapses of long-term care insurance policies sold by the producer as a percent of the producer's total annual sales, in the format of Appendix G.
02.Producers Experiencing Lapses and Replacements. Every insurer reports annually by June 30 the ten percent (10%) of its producers with the greatest percentages of lapses and replacements as measured by Subsection 019.01.
03.Purpose of Reports. Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely producer activities regarding the sale of long-term care insurance.
04.Lapsed Policies. Every insurer reports annually by June 30 the number of lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year.
05.Replacement Policies. Every insurer reports annually by June 30 the number of replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the preceding calendar year.
06.Claims Denied. Every insurer reports annually by June 30, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied, other than claims denied for failure to meet the waiting period or because of an applicable preexisting condition, in the format of Appendix E.
07.Policies and Reports. For purposes of Section 019, "policy" means only long-term care insurance and "report" means on a statewide basis.
a. Policy means only long-term care insurance;
b. Claim means any request for payment of benefits under a policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;
c. Denied means the insurer refused to pay a claim for any reason; and
d. Report means on a statewide basis.
08.Filing. Reports prescribed under Section 019 are filed with the Director.

Idaho Admin. Code r. 18.04.11.019

Effective March 31, 2022