HTML has links - PDF has Authentication
284-83-190  <<  284-83-195 >>   284-83-210

PDFWAC 284-83-195

Form for reporting replacement and lapse of long-term care insurance policies.

The following form must be used in this state to report replacements and lapses of long-term care insurance.
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 issuer must maintain records for each [agent] [insurance producer] on that [agent's] [insurance producer's] amount of long-term care insurance replacement sales as a percent of the [agent's] [insurance producer's] total annual sales and the amount of lapses of long-term care insurance policies sold by the [agent] [insurance producer] as a percent of the [agent's] [insurance producer's] total annual sales. The tables below should be used to report the ten percent of the issuer's [agents] [insurance producers] with the greatest percentages of replacements and lapses.
Listing of the 10% of [Agents] [Insurance Producers] with the Greatest Percentage of Replacements
[Agent's] [Insurance Producer's] Name
Number of Policies Sold by This [Agent] [Insurance Producer]
Number of Policies Replaced by This [Agent] [Insurance Producer]
Number of Replacements as % of Number Sold by This [Agent] [Insurance Producer]
Listing of the 10% of [Agents] [Insurance Producers] with the Greatest Percentage of Lapses
[Agent's] [Insurance Producer's] Name
Number of Policies Sold by This [Agent] [Insurance Producer]
Number of Policies Lapsed by This [Agent] [Insurance Producer]
Number of Lapses as % of Number Sold by This [Agent] [Insurance Producer]
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)      %
[Statutory Authority: RCW 48.02.060, 48.83.070, 48.83.110, 48.83.120, 48.83.130(1), and 48.83.140 (4)(a). WSR 08-24-019 (Matter No. R 2008-09), § 284-83-195, filed 11/24/08, effective 12/25/08.]
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.
Site Contents
Selected content listed in alphabetical order under each group