18 Del. Admin. Code § 1404-13.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1404-13.0 - Requirement to Offer Inflation Protection

13.1 No insurer may offer a long-term care insurance policy unless the insurer also offers to the policyholder the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations which are meaningful to account for reasonably anticipated increases in the costs of long-term services covered by the policy. Insurers must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than one of the following:

13.1.1 Increases benefit levels annually in a manner so that the increases are compounded annually at a rate not less than 5%. However, if the insured individual shall reject the inflation protection offer as provided for in Section 13.0 of this regulation, the insurer may offer other or alternate forms of inflation protection;

13.1.2 Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability or health status so long as the option for the previous period has not been declined. The amount of additional benefit shall be no less than the difference between the existing policy benefit and that benefit compounded annually at a rate of at least 5% for the period beginning with the purchase of the existing benefit and extended until the year in which the offer is made; or

13.1.3 Covers a specific percentage of actual or reasonable charges and does not include a maximum specified indemnity amount of limit.

13.2 Where the policy is issued to a group, the required offer in subsection 13.1 of this regulation shall be made to the group policyholder; except, if the policy is issued to a group defined in 18 Del.C. § 7103(4), other than to a continuing care retirement community, the offering shall be made to each proposed certificate holder.

13.3 The offer in subsection 13.1 of this regulation shall not be required of life insurance policies or riders containing accelerated long-term care benefits.

13.4 Insurers shall include the following information in or with the outline of coverage:

13.4.1 A graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20 year period.

13.4.2 Any expected premium increases or additional premiums to pay for automatic or optional benefit increases. An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.

13.5 Inflation protection benefit increases under a policy which contains such benefits shall continue without regard to an insured's age, claim status or claim history, or the length of time the person has been insured under the policy.

13.6 An offer of inflation protection which provides for automatic benefit increases shall include an offer of a premium which the insurer expects to remain constant. Such offer shall disclose in a conspicuous manner that the premium may change in the future unless the premium is guaranteed to remain constant.

13.7 Inflation protection as provided in subsection 13.1.1 of this regulation shall be included in a long-term care insurance policy unless an insurer obtains a rejection of inflation protection signed by the policyholder as required in subsection 13.7 of this regulation.

13.7.1 The rejection shall be considered part of the application and shall state:

I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans __________ and I reject inflation protection.

18 Del. Admin. Code § 1404-13.0

14 DE Reg. 316 (10/01/10)
25 DE Reg. 714 (1/1/2022)
26 DE Reg. 767 (3/1/2023) (Final)