W. Va. Code R. § 114-32-13

Current through Register Vol. XLI, No. 50, December 13, 2024

Section 114-32-13 - Reporting Requirements

13.1. Every insurer shall maintain records for each producer of that producer's amount of replacement sales as a percent of the producer's total annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a percent of the producer's total annual sales.

13.2. Every insurer shall report annually by June 30 the ten percent (10%) of its producers with the greatest percentages of lapses and replacements as measured by subsection 13.1 of this section. (Appendix G)

13.3. Reported replacement and lapse rates do not alone constitute a violation of insurance laws or necessarily imply wrongdoing. The reports are for the purpose of reviewing more closely producer activities regarding the sale of long-term care insurance.

13.4. Every insurer shall report annually by June 30 the number of lapsed policies as a percent of its total annual sales and as a percent of its total number of policies in force as of the end of the preceding calendar year. (Appendix G)

13.5. Every insurer shall report annually by June 30 the number of replacement policies sold as a percent of its total annual sales and as a percent of its total number of policies in force as of the preceding calendar year. (Appendix G)

13.6. Every insurer shall report annually by June 30, for qualified long-term care insurance contracts, the number of claims denied for each class of business, expressed as a percentage of claims denied. (Appendix E)

13.7. For purposes of this section:

13.7.a. "Policy" means only long-term care insurance;

13.7.b. Subject to subdivision c of this subsection, "claim" means a request for payment of benefits under an in force policy regardless of whether the benefit claimed is covered under the policy or any terms or conditions of the policy have been met;

13.7.c. "Denied" means the insurer refuses to pay a claim for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition; and

13.7.d. "Report" means on a statewide basis.

13.8. Reports required under this section shall be filed with the Commissioner.

W. Va. Code R. § 114-32-13