Wash. Admin. Code § 284-83-195
The following form must be used in this state to report replacements and lapses of long-term care insurance.
Long-Term Care Insurance Replacement and Lapse Reporting Form
For the State of For the Reporting Year of
Company Name:
Due: June 30, Annually
Company Address:
Company NAIC Number:
Contact Person: Phone Number:
Instructions
The purpose of this form is to report on a statewide basis information regarding long-term care insurance policy replacements and lapses. Specifically, every issuer must maintain records for each [agent] [insurance producer] on that [agent's] [insurance producer's] amount of long-term care insurance replacement sales as a percent of the [agent's] [insurance producer's] total annual sales and the amount of lapses of long-term care insurance policies sold by the [agent] [insurance producer] as a percent of the [agent's] [insurance producer's] total annual sales. The tables below should be used to report the ten percent of the issuer's [agents] [insurance producers] with the greatest percentages of replacements and lapses.
Listing of the 10% of [Agents] [Insurance Producers] with the Greatest Percentage of Replacements
[Agent's] [Insurance Producer's] Name | Number of Policies Sold by This [Agent] [Insurance Producer] | Number of Policies Replaced by This [Agent] [Insurance Producer] | Number of Replacements as % of Number Sold by This [Agent] [Insurance Producer] |
Listing of the 10% of [Agents] [Insurance Producers] with the Greatest Percentage of Lapses
[Agent's] [Insurance Producer's] Name | Number of Policies Sold by This [Agent] [Insurance Producer] | Number of Policies Lapsed by This [Agent] [Insurance Producer] | Number of Lapses as % of Number Sold by This [Agent] [Insurance Producer] |
Company Totals
Percentage of Replacement Policies Sold to Total Annual Sales %
Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year)%
Percentage of Lapsed Policies to Total Annual Sales%
Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) %
Wash. Admin. Code § 284-83-195
Statutory Authority: RCW 48.02.060, 48.83.070, 48.83.110, 48.83.120, 48.83.130(1), and 48.83.140(4)(a). 08-24-019 (Matter No. R 2008-09), § 284-83-195, filed 11/24/08, effective 12/25/08.
Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.