N.J. Admin. Code § 11:4-34.7

Current through Register Vol. 56, No. 24, December 18, 2024

Section 11:4-34.7 - Required disclosure of rating practices to consumers

(a) This section applies to any long-term care policy or certificate issued on or after December 19, 2005.

(b) Other than policies for which no applicable premium rate or rate schedule increases can be made, carriers shall provide all of the information listed in this subsection to the applicant at the time of application or enrollment, unless the method of application does not allow for delivery at that time. In such a case, a carrier shall provide all of the information listed below to the applicant no later than at the time of delivery of the policy or certificate.

1. A statement that the policy or certificate may be subject to rate increases in the future, including the circumstances that might lead to a rate increase. The description of circumstances shall include those factors that pose significant risk of rate increases to policyholders or certificate holders;

2. An explanation of potential premium rate revisions, and the policyholder's or certificate holder's option(s) in the event of a premium rate revision, including a description of any contingent benefits or other benefits upon lapse;

3. The premium rate or rate schedule applicable to the applicant that will be in effect until a request is made for an increase;

4. A general explanation for applying premium rate or rate schedule adjustments that shall include:

i. A description of when premium rate or rate schedule adjustments will be effective (for example, next anniversary date, next billing date, etc.); and

ii. A statement that a copy of the revised premium rate or rate schedule as provided in (b)3 above, will be provided if the premium rate or rate schedule is changed; and

5. Information regarding each premium rate increase on this policy or certificate form or similar policy or certificate forms over the past 10 years for this State and any other state.

i. Such information will identify:

(1) The form numbers and marketing names of the policy and certificate forms for which premium rates have been increased;

(2) The calendar years when the form was available for purchase; and

(3) The amount and percentage of each increase. The percentage may be expressed as a percentage of the premium rate prior to the increase, and may also be expressed as minimum and maximum percentages if the rate increase is variable by rating characteristics.

ii. The carrier may, in a fair manner, provide additional explanatory information related to the rate increases.

iii. A carrier shall have the right to exclude from the disclosure information to be provided premium rate increases that only apply to blocks of business acquired from other nonaffiliated carriers or the long-term care policies acquired from other nonaffiliated carriers when those increases occurred prior to the acquisition.

iv. If an acquiring carrier files for a rate increase on a long-term care policy form acquired from nonaffiliated carriers or a block of policy forms acquired from nonaffiliated carriers on or before the later of December 19, 2005 or the end of a 24-month period following the acquisition of the block or policies, the acquiring carrier may exclude that rate increase from the disclosure information. However, the nonaffiliated selling carrier shall include that rate increase in its disclosure information in accordance with (b)5i above.

v. If the acquiring carrier in (b)5iv above files for a subsequent rate increase, even within the 24-month period, on the same policy form or block of policy forms acquired from nonaffiliated carriers referenced in (b)5iv above, the acquiring carrier shall make all disclosures required by this paragraph, including disclosure of the earlier rate increase referenced in (b)5iv above.

(c) An applicant shall sign an acknowledgement at the time of application, unless the method of application does not allow for signature at that time, that the carrier made the disclosure required under (b)1 and 5 above. If, due to the method of application, the applicant cannot sign an acknowledgement at the time of application, the applicant shall sign such an acknowledgement no later than at the time of delivery of the policy or certificate.

(d) A carrier shall use the forms in subchapter Appendices B and F, incorporated herein by reference, to comply with the requirements of (b) and (c) above.

(e) A carrier shall provide notice of an upcoming premium rate schedule increase to all policyholders and certificateholders, if applicable, at least 45 days prior to the implementation of the premium rate schedule increase by the carrier. The notice shall include the information required by (b) above when the rate increase is implemented.

(f) In the case of a policy providing long-term care benefits in combination with other benefits, a description of how premiums paid for the policy are allocated between long-term care and other benefits shall be disclosed in the policy and certificate.

N.J. Admin. Code § 11:4-34.7