Tenn. Comp. R. & Regs. 0780, 0780-01, ch. 0780-01-61, app L
IMPORTANT INFORMATION REGARDING YOUR [POLICY'S] [CERTIFICATE'S] LONG-TERM CARE INSURANCE PARTNERSHIP STATUS
This disclosure notice is issued in conjunction with your long-term care policy:
Some long-term care insurance [policies] [certificates] sold in Tennessee qualify for the Tennessee Long-Term Care Insurance 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. Long-term care insurance [policies] [certificates] that qualify as Partnership [Policies] [Certificates] may be entitled to special treatment, and in particular an "Asset Disregard," under Tennessee's Medicaid program.
Asset Disregard means that an amount of the [policyholder's] [certificateholder's] assets equal to the amount of long-term care insurance benefits received under a qualified Partnership [Policy] [Certificate] will be disregarded for the purpose of determining the insured's eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a qualified Partnership [Policy] [Certificate] without affecting the person's eligibility for Medicaid. All other Medicaid eligibility criteria will apply and special rules may apply to persons whose home equity exceeds $[500,000]. Asset Disregard is not available under a long-term care insurance [policy] [certificate] that is not a Partnership [Policy] [Certificate]. The purchase of this Partnership Policy does not automatically qualify you for Medicaid.
Partnership [Policy] [Certificate] Status . Your long-term care insurance [policy] [certificate] is intended to qualify as a Partnership [Policy] [Certificate] under the Tennessee Long-Term Care Partnership Program as of your [Policy's] [Certificate's] effective date.
What Could Disqualify Your [Policy] [Certificate] as a Partnership Policy. If you make any changes to your [policy] [certificate], such changes could affect whether your [policy] [certificate] continues to be a Partnership Policy. Before you make any changes, you should consult with [insert name of carrier] to determine the effect of a proposed change. In addition, if you move to a State that does not maintain a Partnership Program or does not recognize your [policy] [certificate] as a Partnership [Policy] [Certificate], you would not receive beneficial treatment of your [policy] [certificate] under the Medicaid program of that State. The information contained in this Notice is based on current State and Federal laws. These laws may be subject to change. Any change in law could reduce or eliminate the beneficial treatment of your [policy] [certificate] under Tennessee's Medicaid program.
Additional Information. If you have questions regarding your insurance [policy] [certificate] please contact [insert name of carrier.] If you have questions regarding current laws governing Medicaid eligibility, you should contact the Bureau of TennCare.
Tenn. Comp. R. & Regs. 0780, 0780-01, ch. 0780-01-61, app L