90TH GENERAL ASSEMBLY
Taken up for Perfection February 29, 2000.
House Committee Substitute for House Bill No. 1737 ordered Perfected and printed, as amended.
ANNE C. WALKER, Chief Clerk
To repeal sections 376.955 and 376.956, RSMo 1994, relating to long-term care insurance policy consumer guides, and to enact in lieu thereof two new sections relating to the same subject.
Section A. Sections 376.955 and 376.956, RSMo 1994, are repealed and two new sections enacted in lieu thereof, to be known as sections 376.955 and 376.956, to read as follows:
376.955. 1. The director may adopt regulations that include standards for full and fair disclosure setting forth the manner, content and required disclosures for the sale of long-term care insurance policies, terms of renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions and definitions of terms. Regulations adopted pursuant to sections 376.951 to 376.958 shall be in accordance with the provisions of chapter 536, RSMo.
2. Every long-term care insurance policy sold after January 1, 2001, shall clearly identify whether it is tax-qualified or nontax qualified pursuant to federal law.
3. No long-term care insurance policy may:
(1) Be canceled, nonrenewed or otherwise terminated on the grounds of the age or the deterioration of the mental or physical health of the insured individual or certificate holder; or
(2) Contain a provision establishing a new waiting period in the event existing coverage is converted to or replaced by a new or other form within the same company, except with respect to an increase in benefits voluntarily selected by the insured individual or group policyholder; or
(3) Provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than for lower levels of care.
[3.] 4. No long-term care insurance policy or certificate other than a policy or certificate thereunder issued to a group as defined in paragraph (a) of subdivision (4) of subsection 2 of section 376.951:
(1) Shall use a definition of preexisting condition which is more restrictive than the following: "Preexisting condition" means a condition for which medical advice or treatment was recommended by, or received from, a provider of health care services, within six months preceding the effective date of coverage of an insured person;
(2) May exclude coverage for a loss or confinement which is the result of a preexisting condition unless such loss or confinement begins within six months following the effective date of coverage of an insured person.
(3) May offer coverage to pay for abortions except to save the life of the mother.
(4) May offer coverage to pay for counseling that encourages abortion except to save the life of the mother.
[4.] 5. The director may extend the limitation periods set forth in subdivisions (1) and (2) of subsection 3 of this section as to specific age group categories in specific policy forms upon findings that the extension is in the best interest of the public.
[5.] 6. The definition of preexisting condition provided in subsection 3 of this section does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant, and, on the basis of the answers on that application, from underwriting in accordance with that insurer's established underwriting standards. Unless otherwise provided in the policy or certificate, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until the waiting period described in subdivision (2) of subsection 3 of this section expires. No long-term care insurance policy or certificate may exclude or use waivers or riders of any kind to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions beyond the waiting period described in subdivision (2) of subsection 3 of this section.
[6.] 7. No long-term care insurance policy may be delivered or issued for delivery in this state if such policy:
(1) Conditions eligibility for any benefits on a prior hospitalization requirement; or
(2) Conditions eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care; or
(3) Conditions eligibility for any benefits on a prior institutionalization requirement, except in the case of waiver of premium, post-confinement, post-acute care or recuperative benefits.
[7.] 8. A long-term care insurance policy containing post-confinement, post-acute care or recuperative benefits shall clearly label in a separate paragraph of the policy or certificate entitled "Limitations or Conditions on Eligibility for Benefits" such limitations or conditions, including any required number of days of confinement.
[8.] 9. A long-term care insurance policy or rider which conditions eligibility of noninstitutional benefits on the prior receipt of institutional care shall not require a prior institutional stay of more than thirty days.
[9.] 10. No long-term care insurance policy or rider which provides benefits only following institutionalization shall condition such benefits upon admission to a facility for the same or related conditions within a period of less than thirty days after discharge from the institution.
[10.] 11. The director may adopt regulations establishing loss ratio standards for long-term care insurance policies provided that a specific reference to long-term care insurance policies is contained in the regulation.
[11.] 12. Long-term care insurance applicants shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Long-term care insurance policies and certificates shall have a notice prominently printed on the first page or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate, other than a certificate issued pursuant to a policy issued to a group defined in paragraph (a) of subdivision (4) of subsection 2 of section 376.951, the applicant is not satisfied for any reason.
376.956. 1. The director shall prepare a guide [that explains the factors to be considered in selecting long-term care insurance and the consequences of particular clauses and exclusions. The guide shall be made available to the public and to interested organizations upon request. Any advertisement in this state relating to long-term care insurance shall include notice of availability of this guide from the director] to assist consumers in selecting long-term care insurance. The guide shall be made available to the public and interested organizations upon request, shall be updated at least annually and shall contain the following information:
(1) An explanation of all public programs which provide or fund long-term care as well as any and all information regarding asset qualifications for said program;
(2) The tax consequences of purchasing different types of long-term care insurance policies;
(3) An explanation of how rate costs may vary based on different waiting and benefits periods, purchase age, daily benefit amounts, inclusion or exclusion of inflation protection riders, premium payment method and any other relevant factors affecting rate costs;
(4) An explanation of the different conditions, circumstances or events that trigger payment of benefits by various long-term care insurance policies;
(5) A cost comparison between basic long-term care insurance policies without optional benefits such as home care or inflation protection and with similar benefit designs, identical daily benefits, similar waiting periods and identical benefit periods available offered by companies currently selling such insurance in Missouri. The comparison shall note that the plans quoted are similar but not identical and should advise consumers to read policies to determine specific coverages provided;
(6) A comparison rating of all companies licensed to write and sell long-term care insurance in Missouri, which rating may be based upon complaint issues, performance indicators, liquidity indicators and any other data relevant to the organization's operational capacity;
(7) A list of other available reference guides and sources; and
(8) Any other current information that may be relevant to consumers in purchasing long-term care insurance.
2. All insurers shall promptly and accurately provide any information to the director that is reasonably necessary to prepare the guide.
3. Any advertisement in this state relating to long-term care insurance shall include a notice of availability of the
guide from the director.
Missouri House of Representatives