Md. Code Regs. 31.14.03.08

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

Section 31.14.03.08 - Required Provision of Information Regarding A Partnership Policy

A. Except as provided in §C of this regulation, at the request of the insured or a representative of the Department on behalf of an insured, a carrier shall provide a completed Long-Term Care Partnership Program Policy Summary in the form set forth in §D of this regulation.

B. The completed Long-Term Care Partnership Program Policy Summary required by §A of this regulation shall be:

(1) Provided within 14 days after the date the carrier receives the request from the insured or the representative of the Department on behalf of the insured; and

(2) Given to:

(a) The insured, if the request for the Long-Term Care Partnership Program Policy Summary was received from the insured; or

(b) The insured and the representative of the Department, if the request for the Long-Term Care Partnership Program Policy Summary was received from a representative of the Department on behalf of the insured.

C. A carrier may develop its own partnership policy summary to provide the information found in the Long-Term Care Partnership Program Policy Summary form in §D of this regulation, if the carrier's policy summary includes all of the information and content found in the Long-Term Care Partnership Program Policy Summary form in §D of this regulation.

D. The format and required text of the Long-Term Care Partnership Program Policy Summary referred to in §A of this regulation shall read as follows:

LONG TERM CARE PARTNERSHIP PROGRAM POLICY SUMMARY

1. Name of insured __________________________

2. Insured's Social Security # ______________

3. Insured's Date of Birth __________________

4. Policy/certificate number _______________

5. Effective date of coverage ______________

6. The policy/certificate was issued in the state of: _______________

7. Issue age of the insured at the time the coverage was issued _______________

8. The policy/certificate was issued With Without inflation coverage

9. The inflation coverage is:

[ ] Simple Inflation with an annual percentage rate of __________

[ ] Compound Inflation with an annual percentage rate of __________

[ ] Compound annual inflation protection benefit at an interest rate equal to the annual increase in the Consumer Price Index-All Urban Consumers, U.S. City Average, and All Items.

[ ] None

10. The inflation coverage is currently in effect [ ] Yes [ ] No

11. If the answer to item 10 is no, the date inflation coverage ceased:__________

12. The policy meets the standards of a tax qualified long-term care insurance policy [ ] Yes [ ] No

13. The cumulative dollar amount of long-term care insurance benefits paid: $__________

(Note: The indicated amount does not include any payments for cash surrender, return of premium death benefits, or waiver of premium, and if joint coverage, the amount is for the indicated insured only.)

14. The total dollar amount of long-term care insurance benefits remaining available under the policy $ __________ as of the date this form was completed __________.

15. The name, phone number, and email address of the person completing this form

Name _______________________

Phone Number _______________________

Email Address _______________________

I hereby certify that the above information is true and accurate and that the coverage

[ ] meets [ ] does not meet partnership policy status in Maryland at the time of this certification.

Signature ________________________ Date _______________________

E. A carrier shall provide to the Department within 45 days after issuance of a partnership policy, the following information:

(1) Name of the insured;

(2) Insured's Social Security number;

(3) Insured's date of birth; and

(4) Policy or certificate number.

F. A carrier shall provide reports to the Centers for Medicare and Medicaid Services in accordance with federal regulations developed, including any information that is deemed appropriate according to federal requirements.

Md. Code Regs. 31.14.03.08