69O-157.111. Reporting Requirements

(1) Every insurer shall maintain records for each agent of that agent’s amount of replacement sales as a percentage of the agent’s total annual sales in this state and the amount of lapses of long-term care insurance policies sold by the agent as a percentage of the agent’s total annual sales in this state.

(2) Every insurer shall report annually by June 30 the 10 percent of its agents with the greatest percentages of lapses and replacements as measured by subsection 69O-157.111(1), F.A.C., in the format as prescribed in Appendix J, “Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555,” effective 07/23 hereby incorporated by reference and available at www.flrules.org/Gateway/reference.asp?No=Ref-16244.

(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 agent activities regarding the sale of long-term care insurance in this state.

(4) Every insurer shall report annually by June 30 the number of lapsed policies as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the end of the preceding calendar year in this state in the format as prescribed in Appendix J, “Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555” (06/2017), which is incorporated herein by reference.

(5) Every insurer shall report annually by June 30 the number of replacement policies sold as a percentage of its total annual sales and as a percentage of its total number of policies in force as of the preceding calendar year in this state in the format as prescribed in Appendix J, “Long-Term Care Insurance Replacement and Lapse Reporting Form OIR-B2-1555” (06/2017), which is incorporated herein by reference.

(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 in this state in the format as prescribed in Appendix E, “Annual Long-Term Care Claims Denial Reporting Form” OIR-B2-1553, effective 07/23, hereby incorporated by reference and available at www.flrules.org/Gateway/reference.asp?No=Ref-16245.

(7) For purposes of this section:

(a) “Policy” means only long-term care insurance;

(b) “Claim” means, subject to paragraph 69O-157.111(7)(c), F.A.C., 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;

(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

(d) “Report” means on a statewide basis.

(8) Every insurer shall report annually by June 30 the information required by subsection 69O-157.116(8), F.A.C.

(9) Based on the provisions of Rule 69O-157.109, F.A.C., every insurer or other entity selling or issuing long-term care insurance benefits shall maintain a record of all policy or certificate rescissions, both state and countrywide, except those that the insured voluntarily effectuated and shall annually furnish this information, by March 1 of each year, in the format as prescribed in Appendix A, “Long-Term Care Rescission Reporting Form” OIR-B2-1552,” effective 07/23, hereby incorporated by reference and available at www.flrules.org/Gateway/reference.asp?No=Ref-16246.

(10) Reports required under this Rule 69O-157.111, F.A.C., shall be filed electronically through the Florida Office of Insurance Regulation, Industry Portal at http://www.floir.com/iportal.

(11) All forms adopted in this rule are available for review on the Office’s website at http://www.floir.com/iportal.

Rulemaking Authority 624.308(1), 627.9407(1), 627.9408 FS. Law Implemented 624.424, 624.307(1), 627.9407(1), 627.410(7) FS. History–New 1-13-03, Formerly 4-157.111, Amended 7-30-17, 1-4-24.