69O-157.102. Applicability and Scope

(1) Except as otherwise specifically provided, the provisions of this rule chapter shall apply to long-term care insurance policies delivered or issued for delivery in this state, and to policies delivered or issued for delivery outside this state to the extent provided in Section 627.9406, F.S., and Rule 69O-157.114, F.A.C., by an insurer, a fraternal benefit society as defined in Section 632.601, F.S., a health care services plan as defined in Section 641.01, F.S., a prepaid health clinic as defined in Section 641.402, F.S., or a multiple-employer welfare arrangement as defined in Section 624.437, F.S.

(2) Pursuant to Section 627.9403, F.S., the provisions of this rule chapter shall also apply to limited benefit policies that limit coverage to care in a nursing home only or to one or more lower levels of care. For limited benefit policies, the term and reference to Long Term Care as used within this rule chapter, shall be considered to be, and replaced by, the term Limited Benefit.

(3) The provisions of this rule chapter apply to policies having indemnity benefits that are triggered by activities of daily living and sold as disability income insurance, if:

(a) The benefits of the disability income policy are dependent upon or vary in amount based on the receipt of long-term care services;

(b) The disability income policy is advertised, marketed or offered as insurance for long-term care services; or

(c) Benefits under the policy may commence after the policyholder has reached Social Security’s normal retirement age unless benefits are designed to replace lost income or pay for specific expenses other than long-term care services.

(4) The provisions of this rule chapter shall apply to all long-term care policies or certificates issued on or after March 1, 2003. Notwithstanding the above, for certificates issued under a group long-term care insurance policy as defined in Section 627.9405(1)(a), F.S., which policy was in force at the time this amended rule chapter became effective, the provisions of this rule chapter shall apply to certificates issued on or after the policy anniversary following September 1, 2003.

(5)(a) The provisions of Rule Chapter 69O-149, F.A.C., shall apply to long-term care insurance coverage filings. In the event of conflict between Rule Chapter 69O-149, F.A.C., and this Part II, the provisions of this Part II shall prevail.

(b) In filing the required annual rate certification filings pursuant to Section 627.410(7)(b), F.S., and Rule 69O-149.007, F.A.C., the annual rate certification filing shall include the certification required by paragraph 69O-157.108(1)(c), F.A.C.

Specific Authority 624.308(1), 627.9407(1), 627.9408 FS. Law Implemented 624.307(1), 627.9403, 627.9406 FS. History–New 1-13-03, Formerly 4-157.102.