Ill. Admin. Code tit. 50, pt. 2012, exh. K
Long-Term Care Insurance
Replacement and Lapse Reporting Form
For the State of ______________________________
Reporting Year of ____________________________
Company Name: ___________________________________Due: June 30 annually
Company Address: _____________________________________________________
Company NAIC Number: _________________________________________________
Contact Person: _______________________________________________________
Phone Number: ________________________________________________________
Instructions
The purpose of this form is to report on a statewide basis information regarding long-term care insurance policy replacements and lapses. Specifically, every insurer shall maintain records for each agent on that agent's amount of long-term care insurance replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales. The tables below should be used to report the 10% of the insurer's agents with the greatest percentages of replacements and lapses.
Listing of the 10% of Agents with the Greatest Percentage of Replacements
Agent's Name | Number of Policies Sold By This Agent | Number of Policies Replaced By This Agent | Number of Replacements As % of Number Sold By This Agent |
Listing of the 10% of Agents with the Greatest Percentage of Lapses
Agent's Name | Number of Policies Sold By This Agent | Number of Policies Lapsed By This Agent | Number of Lapses As % of Number Sold By This Agent |
Company Totals:
Percentage of Replacement Policies Sold to Total Annual Sales | _______% |
Percentage of Replacement Policies Sold to Policies in Force (as of the end of the preceding calendar year) | _______% |
Percentage of Lapsed Policies to Total Annual Sales | _______% |
Percentage of Lapsed Policies to Policies in Force (as of the end of the preceding calendar year) | _______% |
Ill. Admin. Code tit. 50, pt. 2012, exh. K