14 Va. Admin. Code § 5-200-205

Current through Register Vol. 40, No. 22, June 17, 2024

Section 14VAC5-200-205 - State Long-Term Care Insurance Partnership Program

A. In accordance with § 6021 of the Deficit Reduction Act of 2005 ( Pub.L. 109-171 ) and § 32.1-325 of the Code of Virginia, in addition to the applicable provisions of this chapter, the provisions of this section shall apply to any qualified state long-term care insurance partnership policy.

B. "Qualified state long-term care insurance partnership policy" or "partnership policy" means an insurance policy that meets all the requirements specified in 12VAC30-40-290 and meets the following requirements:

1. The policy covers an insured who was a resident of the Commonwealth of Virginia (a Partnership State) when coverage first became effective under the policy.

2. The policy is a qualified long-term care insurance policy as defined in § 7702B(b) of the Internal Revenue Code of 1986 and was issued no earlier than September 1, 2007.

3. The policy meets all the applicable requirements of this chapter and the requirements of the National Association of Insurance Commissioners long-term care insurance model act and model regulation as those requirements are set forth in § 1917(b)(5)(A) of the Social Security Act ( 42 USC § 1396p(b)(5)(A) ).

4. The policy provides the following inflation protections:

a. If the policy is sold to an individual who has not attained age 61 as of the date of purchase, the policy shall provide a compound annual inflation protection feature at least equivalent to the provisions of 14VAC5-200-100;

b. If the policy is sold to an individual who has attained age 61 but has not attained age 76 as of the date of purchase, the policy shall provide an inflation protection feature at least equivalent to the provisions of 14VAC5-200-100;

c. If the policy is sold to an individual who has attained age 76 as of the date of purchase, the policy may provide inflation protection, but shall at least comply with the provisions of 14VAC5-200-100.

1. An insurer or its agent, soliciting or offering to sell a policy that is intended to qualify as a partnership policy, shall provide to each prospective applicant a Partnership Program Notice (Form 200-A), outlining the requirements and benefits of a partnership policy. A similar notice may be used for this purpose if filed and approved by the commission. The Partnership Program Notice shall be provided with the required Outline of Coverage.

2. A partnership policy issued or issued for delivery in the Commonwealth of Virginia shall include a Partnership Disclosure Notice (Form 200-B) explaining the benefits associated with a partnership policy and indicating that at the time issued, the policy is a qualified state long-term care insurance partnership policy. A similar notice may be used if filed and approved by the commission. The Partnership Disclosure Notice shall also include a statement indicating that by purchasing this partnership policy, the insured does not automatically qualify for Medicaid.

1. A partnership policy shall not be issued or issued for delivery in this Commonwealth unless filed with and approved by the commission in accordance with the procedures set forth in § 38.2-316 of the Code of Virginia. Any policy submitted for approval as a partnership policy shall be accompanied by a Partnership Certification Form (Form 200-C), or a similar form filed and approved by the commission.

2. Insurers requesting to make use of a previously approved policy form as a qualified state long-term care partnership policy shall submit to the commission a Partnership Certification Form signed by an officer of the company. The Partnership Certification Form shall be accompanied by a copy of the policy or certificate form listed, the approval date, and a bookmark for each of the requirements listed in sections II and III of the form. A Partnership Certification Form shall be required for each policy form submitted for partnership qualification.

E. Agent training requirements. An individual may not sell, solicit or negotiate a partnership policy unless the individual is a licensed and appointed insurance agent in accordance with provisions of Chapter 18 (§ 38.2-1800 et seq.) of Title 38.2 of the Code of Virginia and has completed an initial training component and ongoing training every 24 months thereafter. The training shall meet the following requirements:

1. All training shall be approved as continuing education by the Insurance Continuing Education Board in accordance with § 38.2-1867 of the Code of Virginia.

2. The initial training required by this subsection shall be no less than eight hours, and the on-going training required by this subsection shall be no less than four hours.

3. The training required under subdivision 2 of this subsection shall consist of topics related to long-term care insurance, long-term care services, and qualified state long-term care insurance partnership programs, including, but not limited to:

a. State and federal regulations and requirements and the relationship between qualified state long-term care insurance partnership programs and other public and private coverage of long-term care services, including Medicaid;

b. Available long-term care services and providers;

c. Changes or improvements in long-term care services or providers;

d. Alternatives to the purchase of private long-term care insurance;

e. The effect of inflation on benefits and the importance of inflation protection; and

f. Consumer suitability standards and guidelines.

F. Insurers offering a partnership policy shall obtain verification that an agent has received the training required by subsection E of this section before the agent is permitted to sell, solicit or negotiate the insurer's partnership policy.

G. Each insurer shall maintain records with respect to the training of its agents qualified to sell, solicit or negotiate partnership policies, to include training received and that the agent has demonstrated an understanding of the partnership policies and their relationship to public and private coverage of long-term care, including Medicaid, in this Commonwealth. These records shall be maintained for a period of not less than five years and shall be made available to the commission upon request.

H. Each insurer issuing a partnership policy shall provide regular reports to the United States Secretary of Health and Human Services in accordance with regulations of the Secretary that include notification of the date benefits were paid, the amount paid, the date the policy terminates, and such other information as the Secretary determines may be appropriate to the administration of partnerships.

14 Va. Admin. Code § 5-200-205

Derived from Virginia Register Volume 23, Issue 17, eff. September 1, 2007.

Statutory Authority

§§ 12.1-13 and 38.2-223 of the Code of Virginia.