N.H. Admin. Code § Ins 3602.06

Current through Register No. 50, December 12, 2024

Section Ins 3602.06 - Standards and Reporting Requirements for Approved Long-Term Care Partnership Policies and Certificates

(a) The following standards shall apply to all insurers that issue or deliver New Hampshire partnership policies or certificates:

(1) In addition to the required filing and approval pursuant to this part, any policy or certificate marketed or represented to be a New Hampshire partnership policy or certificate shall comply with the following requirements:

a. The insured individual shall be a resident of New Hampshire when coverage first becomes effective under the policy. If the policy or certificate is exchanged pursuant to Ins 3602.05, the individual shall have been a resident of New Hampshire when coverage first became effective under the original policy;

b. The coverage shall be intended to be a qualified long-term care insurance coverage under the provisions of Ins 3601.05(a)(5); and

c. The policy or certificate shall be issued with and shall retain inflation coverage that meets the inflation standards specified in Ins 3601.12;

(2) The following notices shall be required:

a. A disclosure notice that explains the benefits associated with the policy or certificate and indicates that, at the time issued, the policy qualified as a New Hampshire partnership policy. The required disclosure notice shall appear verbatim as follows:

"Partnership Status Disclosure Notice for Long-Term Care Partnership Policies/Certificates

IMPORTANT INFORMATION REGARDING THE NEW HAMPSHIRE

LONG-TERM CARE PARTNERSHIP PROGRAM

Note: It is very important that you keep this Disclosure Notice with your Long-Term Care Insurance Policy or Certificate.

Insured Name: ___________________________________________

Policy Name: ____________________________________________

Date of Issue: ____________________________________________

The long-term care insurance policy/certificate that you have purchased currently qualifies for the New Hampshire Long-Term Care Partnership Program.

Insurance companies voluntarily agree to participate in the Partnership Program by offering long-term care insurance coverage that meets certain State and Federal requirements. Policies that qualify as Partnership Policies protect your assets through a feature known as an "asset disregard" under the New Hampshire Medicaid program.

Asset Disregard "Asset Disregard" means that an amount of your assets equal to the amount of long-term care insurance benefits you have received under your Partnership Policy will not be counted for the purpose of determining your eligibility for Medicaid. This generally allows you to keep additional assets equal to the insurance benefits received under your Partnership Policy without affecting your eligibility for Medicaid. All other Medicaid eligibility criteria will still apply. This "Asset Disregard" is only available if you have a Partnership Policy. The purchase of a Partnership Policy guarantees that if you qualify for the Medicaid program, you can retain additional assets as described above. However, the purchase of a Partnership Policy does not automatically qualify you for the Medicaid program.

Partnership Policy/Certificate Status. Your long-term care insurance policy is a Partnership Policy under the New Hampshire Long-Term Care Partnership Program as of your policy's effective date.

What Could Disqualify Your Policy from the Partnership Program. If you make any changes to your policy/certificate, such changes could affect whether your policy continues to be a Partnership Policy. Before you make any changes, you should consult with [name of insurance company] to determine the effect of the proposed change. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy as a Partnership Policy, you may not receive beneficial treatment such as asset disregard under the Medicaid program in that state.

THE INFORMATION CONTAINED IN THIS NOTICE IS BASED ON NEW HAMPSHIRE AND FEDERAL LAWS IN EFFECT THE DATE YOUR POLICY WAS ISSUED. THESE LAWS ARE SUBJECT TO CHANGE.

Additional Information. If you have any questions regarding your insurance policy/certificate please contact [insert name of insurer]. If you have questions regarding current laws governing Medicaid eligibility, you should contact the:

New Hampshire Department of Health and Human Services

Division of Family Assistance

Brown Building, 129 Pleasant Street, Concord, NH (street address)

129 Pleasant Street, Concord, NH 03301-3857 (mailing address)

Telephone: 603-271-9700 or 800-852-3345, ext. 9700"

b. The following requirements and procedures shall apply to (2)a. above:

1. The insurer shall provide the insured's name, the policy name, and the date of issue in the spaces provided in the disclosure notice;

2. The text in the notice shall be in at least 12-point type and shall follow the order of the information presented in (2)a.; and

3. An insurer may modify the format but shall not change the order of the mandated text from that specified in (2)a., if the insurer files the form for review and approval by the commissioner in compliance with Ins 401.13;

c. When an insurer is made aware that a policyholder or certificateholder has initiated action that will result in the loss of partnership status, the insurer shall provide an explanation of how such action impacts the insured in writing. The insurer shall also advise the policyholder or certificateholder on how to retain partnership status if possible;

d. If a partnership policy subsequently loses partnership status, the insurer shall explain to the policyholders or certificate holders in writing within 60 calendar days of the loss the reason for the loss of status;

e. All insurers shall provide upon request and without charge to any insured under a New Hampshire partnership policy or certificate, or to any New Hampshire resident insured under a long-term care insurance policy or certificate that is afforded reciprocity pursuant to the standards established under 42 U.S.C. § 1396p(b)(1)(C)(iii), a written summary of policy information that shall include the following:

1. The name of the insured;

2. The policy or certificate number;

3. The effective date of coverage;

4. The state in which the policy or certificate was issued;

5. The age of the insured at the time the coverage was issued;

6. In regard to any inflation coverage, the following information:

(i) Whether the policy was issued with or without inflation coverage;

(ii) A description of any inflation coverage currently in effect; and

(iii) Whether any inflation coverage provided is simple inflation coverage or compound inflation coverage;

f. Whether the policy is intended to meet the standards of a tax qualified long-term care policy;

g. The cumulative dollar amount of insurance benefits paid to the insured only, excluding any payments for cash surrender, return of premium death benefit, or waiver of premium. The date such cumulative dollar amount was calculated shall also be provided;

h. The total dollar amount of insurance benefits remaining available under the policy, and the date such total remaining benefits were calculated;

i. The date the form was completed; and

j. The name, address, telephone, and email address of the person completing the form; and

(3) Under §1917(b)(5)(B)(iii) of the Social Security Act 42 U.S.C. § 1396p(b)(5)(B)(iii), the commissioner, in implementing the New Hampshire long-term care partnership program, shall certify that long-term care insurance policies and certificates covered under the partnership program meet certain consumer protection requirements, and policies. The consumer protection requirements shall be as set forth in §1917(b)(5)(A) of the Social Security Act and principally include certain specified provisions of the National Association of Insurance Commissioners long-term care model act 640 and model regulation 641, as updated in 2017 and available as referenced in Appendix II. In providing this certification, the commissioner shall require the certification by insurers made in accordance with Appendix III Long-Term Care Partnership Program Insurer Certification Form.

(b) In accordance with §1917(b)(1)(C)(iii)(VI) and (v) of the Social Security Act, all issuers of partnership policies or certificates shall provide regular reports to the secretary of the Federal Department of Health and Human Services (secretary) in accordance with 45 CFR Part 144, Subpart B.

(c) Such information shall include, but not be limited to, the following:

(1) Notification regarding when insurance benefits provided under partnership policies or certificates have been paid and the amount of such benefits paid; and

(2) Notification regarding when such policies or certificates otherwise terminate.

N.H. Admin. Code § Ins 3602.06

#9654, eff 2-16-10

Amended by Volume XXXVIII Number 06, Filed February 8, 2018, Proposed by #12472, Effective 2/16/2018, Expires 2/16/2028.