Establishment of Federal Standards for Long-Term Care Insurance
Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance.
Prohibits the offering of a long-term care insurance policy in a State unless the State has a regulatory program meeting the requirements of this Act or the policy has been certified by the Secretary of Health and Human Services. Authorizes grants to States for demonstration programs to improve enforcement of the standards.
Imposes on agents selling long-term policies a duty of good faith and fair dealing.
Prohibits twisting, high pressure tactics, and cold lead advertising.
Mandates minimum financial standards, including income and asset criteria, for advising individuals considering the purchase of a long-term policy.
(1) to an individual eligible for assistance under title XIX (Medicaid) of the Social Security Act;
(2) of duplicate service policies; and
(3) of policies that reduce, limit, or coordinate benefits on the basis of eligibility for other coverage or benefits.
(1) criminal and civil penalties; and
(2) agent training and certification.
Sets forth additional carrier responsibilities relating to refunding of premiums, mailing of policies, providing information on denials of claims, reporting of information, and limiting compensation to agents for the sale or renewal of policies.
Prohibits cancellation or nonrenewal of a long-term care policy except for nonpayment of premium or material misrepresentation.
Sets forth continuation and conversion rights for group policies, regulating premiums for converted policies.
Requires guaranteed issuance to an individual if the individual meets the minimum medical requirements of the policy.
Mandates standards regarding upgraded benefits.
Limits cancellation for nonpayment by an incapacitated individual.
(1) subject to exceptions, uniform language and definitions, a uniform format, and at least one standard benefit package; and
(2) disclosure of certain matters, including an outline of coverage.
Mandates recommendations by the National Association of Insurance Commissioners (NAIC) regarding informing consumers on the long-term economic viability of long-term care insurance carriers.
Limits certain conditions on benefits.
Requires, if benefits are provided for home health care or community-based services, that certain minimum benefits be provided.
Prohibits treating cognitive or mental impairments (including Alzheimer's disease and mental illness) differently from other medical conditions.
Limits preexisting condition requirements.
(1) each claimant to have a functional assessment by an individual or entity meeting NAIC qualifications and unconnected to the policy issuer;
(2) inflation protection, unless rejected in writing by a policyholder;
(3) disclosure of certain premium increases; and
(4) nonforfeiture benefits.
Prohibits a carrier from contesting a policy or claim based on fraud or misrepresentation unless notice is provided within a time period set by NAIC. Establishes the right of a purchaser to return a policy within a specified period.
Defines "long-term care insurance policy," excluding:
(1) any basic Medicare supplemental policies;
(2) other insurance offered primarily to provide specified types of coverage; and
(3) certain life insurance policies.
Authorizes grants for programs to provide information, counseling, and assistance regarding the procurement of long-term insurance.
Subtitle : Protection of Assets Under Medicaid Through Use of Qualified Long-term Care Insurance - Amends the title XIX of the Social Security Act to require State Medicaid plans to disregard some or all of the individual's assets attributable to coverage under a qualified long-term care insurance contract in determining the individual's eligibility for long-term care services.