OAR 836-052-0566
Initial Rate Filing Requirements

(1)

Intentionally left blank —Ed.

(a)

Except as provided in subsection (b) of this section, this rule applies to any long-term care insurance policy issued in this state on or after March 1, 2006.

(b)

Sections (2)(b)(D) and (3) of this rule apply to any long-term care policy issued in this state on or after January 1, 2016.

(2)

An insurer shall provide the following information to the Director for prior approval before making a long-term care insurance form available for sale:

(a)

A copy of the disclosure documents required in OAR 836-052-0556 (Required Disclosure of Rating Practices to Consumers); and

(b)

An actuarial certification consisting of at least the following:

(A)

A statement that the initial premium rate schedule is sufficient to cover anticipated costs under moderately adverse experience and that the premium rate schedule is reasonably expected to be sustainable over the life of the form with no future premium increases anticipated;

(B)

A statement that the policy design and coverage provided have been reviewed and taken into consideration;

(C)

A statement that the underwriting and claims adjudication processes have been reviewed and taken into consideration;

(D)

A statement that the premiums contain at least the minimum margin for moderately adverse experience defined in subparagraph (i) of this paragraph or the specification of and justification for a lower margin as required by subparagraph (ii) of this paragraph.
(i)
A composite margin shall not be less than 10 percent of lifetime claims.
(ii)
A composite margin that is less than 10 percent may be justified in uncommon circumstances. The proposed amount, full justification of the proposed amount and methods to monitor developing experience that would be the basis for withdrawal of approval for such lower margins must be submitted.
(iii)
A composite margin that is lower than otherwise considered appropriate for the stand-alone long-term care policy may be justified for long-term care benefits provided through a life policy or an annuity contract. Such lower composite margin, if used, shall be justified by appropriate actuarial demonstration addressing margins and volatility when considering the entirety of the product.
(iv)
A greater margin may be appropriate in circumstances where the company has less credible experience to support its assumptions used to determine the premium rates.

(E)

Intentionally left blank —Ed.
(i)
A statement that the premium rate schedule is not less than the premium rate schedule for existing similar policy forms also available from the insurer except for reasonable differences attributable to benefits; or
(ii)
A comparison of the premium schedules for similar policy forms that are currently available from the insurer with an explanation of the differences.

(F)

A statement that reserve requirements have been reviewed and considered. Support for this statement shall include:
(i)
Sufficient detail or sample calculations provided so as to have a complete depiction of the reserve amounts to be held; and
(ii)
A statement that the difference between the gross premium and the net valuation premium for renewal years is sufficient to cover expected renewal expenses, or if such a statement cannot be made, a complete description of the situations where this does not occur. An aggregate distribution of anticipated issues may be used as long as the underlying gross premiums maintain a reasonably consistent relationship.

(3)

An insurer must include an actuarial memorandum prepared, dated and signed by a member of the Academy of Actuaries. The actuarial memorandum shall address and support each specific item required as part of the actuarial certification and provide at a minimum all of the following information:

(a)

An explanation of the review performed by the actuary prior to making the statements in section (2)(b)(B) and (C) of this rule.

(b)

A complete description of pricing assumptions.

(c)

Sources and levels of margins incorporated into the gross premiums that are the basis for the statement in the actuarial certification required by section (2)(b)(A) of this rule and an explanation of the analysis and testing performed in determining the sufficiency of the margins. Deviations in margins between ages, sexes, plans or states shall be clearly described. Deviations in margins required to be described are other than those produced utilizing generally accepted actuarial methods for smoothing and interpolating gross premium scales.

(d)

A demonstration that the gross premiums include the minimum composite margin specified in section (2)(b)(D) of this rule.

(4)

An insurer shall provide an actuarial demonstration showing that benefits are reasonable in relation to premiums. The actuarial demonstration shall include either premium and claims experience on similar policy forms adjusted for any premium and benefit differences, or relevant and credible data from other studies, or both.

(5)

In any review of the actuarial certification and actuarial memorandum, the Director may request review by an actuary with experience in long-term care pricing who is independent of the company.

Source: Rule 836-052-0566 — Initial Rate Filing Requirements, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0566.

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 836-052-0566’s source at or​.us