OAR 836-052-0531
Long Term Care Insurance Partnership Program

(1)

As used in this rule, “qualified long term care insurance partnership policy” or “partnership policy” means a long term care insurance policy that meets all of the following requirements:

(a)

The policy was issued on or after January 1, 2008 or exchanged as provided in section (8) of this rule on or after January 1, 2008, and covers an insured who was a resident of this state or of another state that has entered into a reciprocal agreement with this state when coverage first became effective under the policy.

(b)

The policy is a qualified long term care insurance policy.

(c)

The policy meets all of the applicable requirements of ORS 743.650 (Long Term Care Insurance Act) to 743.656 (Eligibility for benefits) and OAR 836-052-500 to 836-052-0786 (Requirement to Deliver Shopper’s Guide) and the requirements of the National Association of Insurance Commissioners long term care insurance model act and model regulation as those requirements are set forth in sec. 1917(b)(5)(A) of the Social Security Act (42 USC sec. 1396p(b)(5)(A)).

(d)

The policy provides the following inflation protections:

(A)

If the policy is sold to an individual who has not attained age 61 as of the date of purchase, the policy shall provide a compound annual inflation protection that is at least equivalent to the option for inflation protection in OAR 836-052-0616 (Requirement to Offer Inflation Protection)(1)(a).

(B)

If the policy is sold to an individual who has attained age 61 but has not attained age 76 as of the date of purchase, the policy shall provide an inflation protection that is at least equivalent to an option for inflation protection in OAR 836-052-0616 (Requirement to Offer Inflation Protection).

(C)

If the policy is sold to an individual who has attained age 76 as of the date of purchase, the policy may provide inflation protection, but must at least comply with the provisions for inflation protections in OAR 836-052-0616 (Requirement to Offer Inflation Protection).

(2)

An insurer may use as one means of providing inflation protection under section (1)(d) of this rule a guarantee of automatic benefit increases of not less than an annual percentage change in the Consumer Price Index or an alternative index approved by the Director. If this inflation protection is included in a policy sold to a person who has not attained age 61, the index adjustments must be made on a compounding basis.

(3)

Any person who purchases a partnership policy that meets the inflation protection criteria specified in section (1)(d) of this rule may adjust the person’s inflation protection as the person ages. The person’s policy will maintain partnership status as long as the inflation protection continues to meet the minimum requirements for the attained age.

(4)

An insurer or insurance producer soliciting or offering to sell a policy that is intended to qualify as a partnership policy shall provide to each prospective applicant the notice prescribed in Exhibit 1 to this rule, indicating the requirements and benefits of a partnership policy. The notice shall be provided with the required Outline of Coverage.

(5)

A partnership policy or certificate delivered or issued for delivery in this state shall include a Partnership Disclosure Notice prescribed in Exhibit 2 or 3 to this rule as appropriate, explaining the benefits associated with a partnership policy or certificate and indicating that, at the time issued, the policy or certificate is a qualified state long term care insurance partnership policy or certificate.

(6)

When an insurer is made aware that a policyholder has initiated action that will result in the loss of partnership status, the insurer shall provide an explanation of how such action impacts the insured in writing. The policyholder shall also be advised how to retain partnership status, if retention is possible. If a partnership policy subsequently loses partnership status, the insurer shall explain to the policyholder in writing the reason for the loss of status.

(7)

Each insurer offering a partnership policy shall provide regular reports to the United States Secretary of Health and Human Services in accordance with regulations of the Secretary that include notification of the date benefits were paid, the amount paid, the date the policy terminates, and such other information as the Secretary determines may be appropriate to the administration of partnership policies.

(8)

An insurer must file a long term care insurance policy for approval for use as a partnership policy.

(9)

A long term care insurance policy that is not a qualified partnership policy may be exchanged for a qualified partnership policy, subject to underwriting criteria and any increased premium, as provided in this section. The qualified policy so exchanged is treated as newly issued and as such is eligible for partnership status. A rider, endorsement or change in schedule page that is made to a policy issued prior to January 1, 2008, but after February 8, 2006 for the purpose of meeting the requirements of this rule may be treated as giving rise to an exchange.

(10)

At the request of the insured or an authorized representative of the insured, an insurer shall provide to the insured or representative a copy of the Approved Long Term Care Partnership Program Policy Summary prescribed in Exhibit 4 to this rule.
[ED. NOTE: Exhibits referenced are available from the agency.]

Source: Rule 836-052-0531 — Long Term Care Insurance Partnership Program, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0531.

836‑052‑0103
Purpose 836‑052‑0107
Authority 836‑052‑0114
Applicability and Scope 836‑052‑0119
Definitions 836‑052‑0124
Policy Definitions and Terms 836‑052‑0129
Policy Provisions 836‑052‑0132
Benefit Standards for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery with an Effective Date of Coverage on or After June 1, 2010 836‑052‑0133
Benefit Standards for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010 836‑052‑0134
Minimum Benefit Standards for Policies or Certificates Issued for Delivery Prior to July 1, 1992 836‑052‑0136
Standard Medicare Supplement Benefit Plans for 1990 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery on or After July 1, 1992 and with an Effective Date of Coverage Prior to June 1, 2010 836‑052‑0138
Open Enrollment 836‑052‑0139
Medicare Select Policies and Certificates 836‑052‑0140
Standards for Claims Payment 836‑052‑0141
Standard Medicare Supplement Benefit Plans for 2010 Standardized Medicare Supplement Benefit Plan Policies or Certificates with an Effective Date of Coverage on or After June 1, 2010 836‑052‑0142
Guaranteed Issue for Eligible Persons 836‑052‑0143
Annual Opportunity to Select Another Medicare Supplement Policy or Certificate 836‑052‑0144
Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or after January 1, 2020. 836‑052‑0145
Loss Ratio Standards and Refund or Credit of Premium 836‑052‑0151
Filing and Approval of Policies and Certificates and Premium Rates 836‑052‑0156
Permitted Compensation Arrangements 836‑052‑0160
Required Disclosure Provisions 836‑052‑0165
Requirements for Application Forms, Replacement Coverage 836‑052‑0170
Filing Requirements for Advertising 836‑052‑0175
Standards for Marketing 836‑052‑0180
Appropriateness of Recommended Purchase and Excessive Insurance 836‑052‑0185
Reporting of Multiple Policies 836‑052‑0190
Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies and Certificates 836‑052‑0192
Prohibition Against Use of Genetic Information and Requests for Genetic Testing 836‑052‑0194
Separability 836‑052‑0225
Durational Limits for Health Maintenance Organizations 836‑052‑0230
Provider Services Limits for Insurers and Health Care Contractors 836‑052‑0500
Statutory Authority 836‑052‑0508
Definitions 836‑052‑0516
Policy Definitions 836‑052‑0526
Policy Practices and Provisions 836‑052‑0531
Long Term Care Insurance Partnership Program 836‑052‑0546
Required Policy Provisions 836‑052‑0556
Required Disclosure of Rating Practices to Consumers 836‑052‑0566
Initial Rate Filing Requirements 836‑052‑0576
Prohibition Against Post-Claims Underwriting, Applications 836‑052‑0586
Minimum Standards for Home Health and Community Care Benefits in Long-Term Care Insurance Policies 836‑052‑0596
Standards for Covered Services 836‑052‑0606
Use and Definition of “Home” or Similar Wording 836‑052‑0616
Requirement to Offer Inflation Protection 836‑052‑0626
Requirements for Application Forms and Replacement Coverage 836‑052‑0636
Reporting Requirements 836‑052‑0637
Annual Rate Certification Requirements 836‑052‑0639
Training for Insurance Producers 836‑052‑0646
Benefits Provided Through Advancement of Life Insurance Proceeds 836‑052‑0656
Reserve Standards 836‑052‑0666
Loss Ratio 836‑052‑0676
Premium Rate Schedule Increases 836‑052‑0680
Premium Rate Schedule Increases for Policies Subject to Loss Ratio Limits Related to Original Filings 836‑052‑0686
Filing Requirements for Out-of-State Group Policies 836‑052‑0696
Filing Requirements for Advertising 836‑052‑0706
Standards for Marketing 836‑052‑0716
Disclosure Statement 836‑052‑0726
Suitability 836‑052‑0736
Prohibition Against Preexisting Conditions, Waiting Periods and Probationary Periods in Replacement Policies and Certificates 836‑052‑0738
Availability of New Services or Providers 836‑052‑0740
Right to Reduce Coverage and Lower Premiums 836‑052‑0746
Nonforfeiture Benefit Requirement 836‑052‑0756
Standards for Benefit Triggers 836‑052‑0766
Additional Standards for Benefit Triggers for Qualified Long-Term Care Insurance Contracts 836‑052‑0768
Appealing An Insurer’s Determination That The Benefit Trigger Is Not Met 836‑052‑0770
Prompt Payment of Clean Claims 836‑052‑0776
Standard Format Outline of Coverage 836‑052‑0786
Requirement to Deliver Shopper’s Guide 836‑052‑0790
Disclosure of Benefits Paid 836‑052‑0800
Purpose 836‑052‑0810
Replacement Upon Termination 836‑052‑0840
Termination of Coverage 836‑052‑0850
Multiple Employer Trusts 836‑052‑0860
Form of Notice to Group Policyholder 836‑052‑1000
Prosthetic and Orthotic Devices
Last Updated

Jun. 8, 2021

Rule 836-052-0531’s source at or​.us