Md. Code Regs. 31.14.01.35

Current through Register Vol. 51, No. 24, December 2, 2024

Section 31.14.01.35 - Availability of New Services or Providers

A. Notice Requirement.

(1) Except as provided in §B of this regulation, an insurer shall notify policyholders and certificate holders of the availability of a new long-term care insurance policy series that provides coverage for new long-term care services or providers, material in nature, and not previously available through the insurer to the general public.

(2) The notice required by §A(1) of this regulation shall be provided within 12 months of the date the new policy series is made available for sale in Maryland.

B. The notification described in §A of this regulation is not required to be provided:

(1) For any policy issued prior to the effective date of this regulation; or

(2) To any policyholder or certificate holder who:

(a) Is currently eligible for benefits within an elimination period or on a claim;

(b) Previously had been in claim status; or

(c) Would not be eligible to apply for coverage due to issue age limitations under the new policy.

C. The insurer may require that policyholders or certificate holders meet all eligibility requirements, including underwriting and payment of the required premium, to add the new services or providers described in §A of this regulation.

D. The insurer shall make the new coverage available in one of the following ways:

(1) By adding a rider to the existing policy and charging a separate premium for the new rider based on the insured's attained age;

(2) By exchanging the existing policy or certificate for one with an issue age based on the present age of the insured and recognizing past insured status by granting premium credits toward the premiums for the new policy or certificate;

(3) By exchanging the existing policy or certificate for a new policy or certificate in which consideration for past insured status shall be recognized by setting the premium for the new policy or certificate at the issue age of the policy or certificate being exchanged; or

(4) By an alternative program developed by the insurer that meets the intent of this regulation, if the program is filed with and approved by the Commissioner.

E. The premium credits described in §D(2) of this regulation shall be based on premiums paid or reserves held for the prior policy or certificate.

F. The cost for the new policy or certificate described in §D(3) of this regulation may recognize the difference in reserves between the new policy or certificate and the original policy or certificate.

G. Notification When New Policies Used in Limited Distribution Channels.

(1) An insurer is not required to notify policyholders or certificate holders of a new proprietary policy series created and filed for use in a limited distribution channel.

(2) Policyholders or certificate holders that purchased the new proprietary policy described in §G(1) of this regulation shall be notified when a new long-term care policy series that provides coverage for new long-term care services or providers, material in nature, is made available to that limited distribution channel.

H. Exchanges.

(1) Policies issued pursuant to this regulation shall be considered exchanges and not replacements.

(2) Exchanges made under this regulation are not subject to:

(a) The requirements of Regulations .06 and .25 of this chapter; and

(b) The reporting requirements of §§A-F of Regulation .24 of this chapter.

I. Notices for Group Policies.

(1) Except as provided in §I(2) of this regulation, if the policy is offered through an employer, labor organization, professional, trade or occupational association, the required notification in §A of this regulation shall be made to the offering entity.

(2) If the policy is issued to a group not listed in Insurance Article, § 15-302(b)(2), (c)(2), or (d)(2), Annotated Code of Maryland, the notification required by §A of this regulation shall be provided to each certificate holder.

J. Right to Purchase New Benefits.

(1) This regulation does not prohibit an insurer from offering any policy, rider, certificate, or coverage change to any policyholder or certificate holder.

(2) Upon request, any policyholder or certificate holder may apply for currently available coverage that includes the new services or providers.

(3) The insurer may require that policyholders or certificate holders meet all eligibility requirements, including underwriting and payment of the required premium to add the new services or providers.

K. This regulation does not apply to life insurance policies or riders containing accelerated death benefit long-term care benefits.

L. This regulation shall become effective on September 10, 2007.

Md. Code Regs. 31.14.01.35