Section 760 IAC 2-13-1 - Relevant factorsAuthority: IC 27-8-12-7
Affected: IC 27-1-12-7; IC 27-8-12-14.5; IC 27-8-12-14.6
Sec. 1.
(a) Benefits under individual long term care insurance policies shall be deemed reasonable in relation to premiums provided the expected loss ratio is at least sixty percent (60%), calculated in a manner that provides for adequate reserving of the long term care insurance risk. In evaluating the expected loss ratio, due consideration shall be given to all relevant factors, including the following: (1) Statistical credibility of incurred claims experience and earned premiums.(2) The period for which rates are computed to provide coverage.(3) Experienced and projected trends.(4) Concentration of experience within early policy duration.(5) Expected claim fluctuation.(6) Experience refunds, adjustments, or dividends.(7) Renewability features.(8) All appropriate expense factors.(10) Experimental nature of the coverage.(12) Mix of business by risk classification.(13) Product features, such as long elimination periods, high deductibles, and high maximum limits.(b) This section does not apply to life insurance policies that accelerate benefits for long term care. A life insurance policy that funds long term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premium paid, if the policy complies with all of the following provisions:(1) The interest credited internally to determine cash value accumulations, including long term care, if any, is guaranteed to be no less than the minimum guaranteed interest rate for cash value accumulations without long term care set forth in the policy.(2) The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of IC 27-1-12-7.(3) The policy meets the disclosure requirements of IC 27-8-12-14.5 and IC 27-8-12-14.6.(4) Any policy illustrations meet the applicable requirements of 760 IAC 1-62.(5) An actuarial memorandum is filed with the commissioner that includes the following:(A) A description of the basis on which the long term care rates were determined.(B) A description of the basis for the reserves.(C) A summary of the following:(iv) General marketing method.(v) Limits on ages of issuance.(D) A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any.(E) A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives.(F) The estimated average annual premium per policy and the average issue age.(G) A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used, and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs.(H) A description of the effect of the long term care policy provision on the required premiums, nonforfeiture values, and reserves on the underlying life insurance policy, both for active lives and those in long term care claim status.Department of Insurance; 760 IAC 2-13-1; filed Oct 30, 1992, 12:00 p.m.: 16 IR 866; readopted filed Sep 14, 2001, 12:22 p.m.: 25 IR 531; filed Oct 7, 2004, 1:00 p.m.: 28 IR 573; readopted filed Nov 24, 2010, 9:17 a.m.: 20101222-IR-760100633RFAReadopted filed 11/23/2016, 9:47 a.m.: 20161221-IR-760160436RFAReadopted filed 11/30/2022, 11:39 a.m.: 20221228-IR-760220302RFA