OAR 836-052-0666
Loss Ratio

(1)

This rule applies to all long-term care insurance policies, certificates and riders except those that are subject to OAR 836-052-0566 (Initial Rate Filing Requirements) and 836-052-0676 (Premium Rate Schedule Increases).

(2)

Benefits under long-term care insurance policies and riders shall be deemed reasonable in relation to premiums only if the expected loss ratio is at least 60 percent and is calculated in a manner providing for adequate reserving of the long-term care insurance risk.

(3)

In evaluating the expected loss ratio under section (2) of this rule, an insurer shall consider all relevant factors, including:

(a)

Statistical credibility of incurred claims experience and earned premiums;

(b)

The period for which rates are computed to provide coverage;

(c)

Experienced and projected trends;

(d)

Concentration of experience within early policy duration;

(e)

Expected claim fluctuation;

(f)

Experience refunds, adjustments or dividends;

(g)

Renewability features;

(h)

All appropriate expense factors;

(i)

Interest;

(j)

Experimental nature of the coverage;

(k)

Policy reserves;

(L)

The mix of business by risk classification;

(m)

Product features, such as long elimination periods, high deductibles and high maximum limits.

(4)

The loss ratio requirements under this rule apply with respect to Oregon policyholders. Subject to the approval of the Director, an insurer may use national or regional loss ratio experience to modify the Oregon experience when the experience for Oregon policyholders is small and statistically unreliable. Oregon experience and national or regional experience must be submitted in separate tables and the modification approved by the Director.

(5)

The experience under all policy and rider forms insuring a class of insureds with similar benefits and underwriting requirements shall be combined when demonstrating compliance with the requirements of this section.

(6)

The effect on loss ratios of all requirements necessary to qualify for benefits shall be included in the calculations required under this rule.

(7)

Sections (1) to (6) of this rule do not apply to life insurance policies that accelerate benefits for long-term care. A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums paid if the policy complies with all of the following provisions:

(a)

The interest credited internally to determine cash value accumulations, including long-term care, if any, is guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;

(b)

The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of ORS 743.204 (Standard Nonforfeiture Law for Life Insurance) or 743.275 (Standard Nonforfeiture Law for Individual Deferred Annuities);

(c)

The policy or rider meets the disclosure requirements of ORS 743.655 (Rules)(9) to (11);

(d)

Any life policy illustration meets the applicable requirements of OAR 836-051-0500 (Purpose; Authority) to 836-051-0600 (Trade Practice Regulation); and

(e)

An actuarial memorandum filed with the Director must be submitted by a qualified actuary in good standing with the American Academy of Actuaries. The memorandum must include:

(A)

A description of the basis on which the long-term care rates were determined;

(B)

A description of the basis for the reserves;

(C)

A summary of the type of policy, benefits, renewability, general marketing method and limits on ages of issuance;

(D)

A description and a table of each actuarial assumption used. For expenses, an insurer must include percent of premium dollars per policy and dollars per unit of benefits, if any;

(E)

A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;

(F)

The estimated average annual premium per policy and the average issue age;

(G)

A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used and, if used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and

(H)

A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values and reserves on the underlying life insurance policy, both for active lives and those in long-term care claim status.

Source: Rule 836-052-0666 — Loss Ratio, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-052-0666.

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 836-052-0666’s source at or​.us