OAR 836-052-0616
Requirement to Offer Inflation Protection

(1)

An insurer may not offer a long-term care insurance policy unless the insurer also offers to the policyholder, in addition to any other inflation protection offered by the insurer, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations that are meaningful to account for reasonably anticipated increases in the costs of long-term care services covered by the policy. An insurer must offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than a feature that does one of the following:

(a)

Increases benefit levels annually in a manner so that the increases are compounded annually at a rate not less than three percent.

(b)

Guarantees the insured individual periodically increased benefit levels without having to provide evidence of insurability or health status, unless the policyholder declines a periodic increase. The amount of the additional benefit shall be no less than the difference between the existing policy benefit and that benefit compounded annually at a rate of at least three percent for the period beginning with the purchase of the existing benefit and extending until the year in which the offer is made. The insurer shall notify the policyholder, at each periodic increase, that declining an inflation increase under this subsection will imperil the policy’s partnership status.

(c)

Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.

(2)

When the policy is issued to a group, the required offer in section (1) of this rule shall be made to the group policyholder, except that if the policy is issued to a group defined in ORS 743.652 (Definitions for ORS 743.650 to 743.665) (3)(d) other than to a continuing care retirement community, the offering shall be made to each proposed certificate holder.

(3)

The offer in section (1) of this section shall not be required of life insurance policies or riders containing accelerated long-term care benefits.

(4)

Intentionally left blank —Ed.

(a)

An insurer shall include the following information in or with the outline of coverage:

(A)

A graphic comparison of the benefit levels of a policy that increases benefits by three percent compounded over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20-year period.

(B)

Any expected premium increases or additional premiums to pay for automatic or optional benefit increases.

(b)

An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.

(5)

Inflation protection benefit increases under a policy that contains these benefits shall continue without regard to an insured’s age, claim status or claim history, or the length of time the person has been insured under the policy.

(6)

An offer of inflation protection that provides for automatic benefit increases shall include an offer of a premium that the insurer expects to remain constant. The offer shall disclose in a conspicuous manner that the premium may change in the future unless the premium is guaranteed to remain constant.

(7)

Intentionally left blank —Ed.

(a)

Inflation protection as provided in section (1)(a) of this rule shall be included in a long-term care insurance policy unless an insurer obtains a rejection of inflation protection signed by the policyholder as required in this section. The rejection may be either in the application or on a separate form.

(b)

The rejection shall be considered a part of the application and shall state:
I have reviewed the outline of coverage and the graphs that compare the benefits and premiums of this policy with and without inflation protection. Specifically, I have reviewed Plans_____________, and I reject inflation protection.

(8)

The following requirements apply to the inflation protection option described in section (1)(b) of this rule:

(a)

The insurer must provide that benefit increases occur automatically unless the insured specifically rejects the option to increase.

(b)

The option to increase must be offered every year through at least the insured’s attained age 76, and the policy or certificate must guarantee the insured the opportunity to increase benefit levels on an annual basis without providing evidence of insurability or health status.

(c)

The policy or certificate must be structured so that benefit levels increase annually and must otherwise satisfy the requirements of the Deficit Reduction Act of 2005. For example, compound inflation protection must be provided under policies purchased when the insured has not yet attained age 61. Benefit increases include, but are not limited to increases at a fixed interest rate or at a rate determined by an index-based formula.

(d)

The additional premium for increased benefits may not be higher than the rate based on the insured’s attained age at the time of each offer.

(e)

All options through age 76 must be accepted to retain partnership policy status. Declination of an option may not operate to prevent the insured from accepting a later option.

(f)

An insurer will continue to make offers regardless of the insured’s age while the insured is in claim if the claim begins at or before age 76.

(g)

The insurer or insurance producer must furnish an applicant a personalized illustration at the point of sale that shows the expected pattern of future premiums and benefits under the option compared to the premiums and benefits for a policy or certificate with automatic inflation protection that qualifies for partnership status.

Source: Rule 836-052-0616 — Requirement to Offer Inflation Protection, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0616.

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 836-052-0616’s source at or​.us