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WAC 284-83-415

Agency filings affecting this section

Long-term care partnership policy exchange or replacement.

(1) Within one year of the date that an issuer begins to advertise, market, offer, or sell policies that qualify under the Washington state long-term care partnership program, the issuer must offer to all of its current policyholders and certificate holders the opportunity to exchange their existing long-term policy for a policy that is intended to qualify under the state's long-term care partnership program provided that:
(a) The existing long-term care policy was issued on or after February 8, 2006; and
(b) The existing long-term care policy is the type certified by the issuer for purposes of the state long-term care partnership program.
(2) In making an offer to exchange, an issuer must comply with the following requirements:
(a) The offer must be made on a nondiscriminatory basis without regard to the age or health status of the insured; and
(b) The offer must remain open for a minimum of ninety days from the date of mailing by the issuer.
(3) An exchange occurs when an issuer offers a policyholder or certificate holder (hereinafter "insured") the option to replace an existing long-term care insurance policy with a policy that qualifies as a long-term care partnership policy, and the insured accepts the offer to terminate the existing policy and accepts the new policy.
(4) Notwithstanding subsections (1), (2), and (3) of this section:
(a) An offer to exchange may be deferred for any insured who is currently eligible for benefits under an existing policy or who is subject to an elimination period on a claim, but such deferral shall continue only as long as such eligibility or elimination period exists; and
(b) An offer to exchange does not have to be made if the insured would be required to purchase additional benefits to qualify for the state long-term care partnership program and the insured is not eligible to purchase the additional benefits under the issuer's long-term care underwriting guidelines.
(5) If the partnership policy has an actuarial value of benefits equal to or lesser than the actuarial value of benefits of the existing policy, then the following requirements apply:
(a) The partnership policy must not be underwritten; and
(b) The rate charged for the partnership policy shall be determined using the original issue age and risk class of the insured that was used to determine the rate of the existing policy.
(6) If the partnership policy has an actuarial value of benefits exceeding the actuarial value of the benefits of the existing policy, then the following requirements apply:
(a) The issuer must apply its long-term care underwriting guidelines to the increased benefits only; and
(b) The rate charged for the partnership policy must be determined using the method set forth in subsection (5)(b) of this section for the existing benefits, increased by the rate for the increased benefits using the then current attained age and risk class of the insured for the increased benefits only.
(7) The partnership policy offered in an exchange must be on a form that is currently offered for sale by the issuer in the general market.
(8) In the event of an exchange, the insured must not lose any rights, benefits, or built-up value that has accrued under the original policy with respect to the benefits provided under the original policy including, but not limited to, rights established because of the lapse of time related to preexisting condition exclusions, elimination periods, or incontestability clauses.
(9) Issuers may complete an exchange by either issuing a new policy or by amending an existing policy with an endorsement or rider. An issuer must file such endorsement or rider for approval prior to issue.
(10) For those insureds with long-term care policies issued before February 8, 2006, an issuer may offer an insured the option to exchange an existing policy for a policy that qualifies as a Washington state long-term partnership policy. The requirements set forth in subsections (2) through (9) of this section apply to any such exchange.
(11) Policies issued pursuant to this section shall be considered exchanges and not replacements and are not subject to WAC 284-83-060 through 284-83-070.
[Statutory Authority: RCW 48.02.060 and 48.85.030. WSR 11-22-068 (Matter No. R 2011-08), ยง 284-83-415, filed 10/31/11, effective 12/1/11.]