S.D. Admin. R. 20:06:21 app J
Long-Term Care Insurance
Replacement and Lapse Reporting Form
For the State of _____________________ For the 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 ten percent (10%) of the insurer's agents with the greatest percentage 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) _____%
S.D. Admin. R. 20:06:21 app J