(1) Benefits under individual long-term care insurance
policies shall be deemed reasonable in relation to premiums provided the
expected loss ratio is at least-60%, calculated in a manner which
provides for adequate reserving of the long-term insurance risk. In
evaluating the expected loss ratio, due consideration shall be given to 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) mix of business by risk classification; and
(m) product features such as long elimination
periods, high deductibles and high maximum limits.
(2) Section (1) shall not apply to life
insurance policies that accelerate benefits for long-term care. A life
insurance policy or certificate 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 or certificate complies
with all of the following provisions:
(a) The interest credited internally to
determine cash value accumulations, including long-term care, if any, are
guaranteed not to be less than the minimum guaranteed interest rate for cash
value accumulations without long-term care set forth in the policy or
certificate;
(b) The portion of the policy or certificate
that provides life insurance benefits meets the nonforfeiture requirements of
33-20-201, et seq., MCA;
(c) The policy or certificate meets the
disclosure requirements of 33-20-127 and 33-20-128,
MCA;
(d) Any policy illustration that meets the
applicable requirements of the NAIC Life Insurance Illustrations Model
Regulation; and
(e) An actuarial memorandum is filed with and
reviewed by the insurance department of the-state auditor's office that
includes:
(i) A description of the basis on which the long-term
care rates were determined;
(ii) A description of the basis for the reserves;
(iii) A summary of the type of policy, benefits,
renewability, general marketing method, and limits on ages of issuance;
(iv) A description and a table of each actuarial
assumption used. For expenses, an issuer must include percent of premium
dollars per policy and dollars per unit of benefits, if any;
(v) A description and a table of the anticipated
policy reserves and additional reserves to be held in each future year for
active lives;
(vi) The estimated average annual premium per
policy or certificate and the average issue age;
(vii) 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 or certificate, the statement shall
indicate whether the enrollee or any dependent will be underwritten and when
underwriting occurs; and
(viii) 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 or certificate, both for active lives and those in long-term
care claim status.