Section 284-83-195. Form for reporting replacement and lapse of long-term care insurance policies.

The following form must be used in this state to report replacements and lapses of long-term care insurance.

Long-Term Care Insurance Replacement and Lapse Reporting Form

For the State of            For the Reporting Year of         

Company Name:                           

Due: June 30, Annually

Company Address:                        

Company NAIC Number:                    

Contact Person:                         Phone Number:                    

Instructions

The purpose of this form is to report on a statewide basis information regarding long-term care insurance policy replacements and lapses. Specifically, every issuer must maintain records for each [agent] [insurance producer] on that [agent's] [insurance producer's] amount of long-term care insurance replacement sales as a percent of the [agent's] [insurance producer's] total annual sales and the amount of lapses of long-term care insurance policies sold by the [agent] [insurance producer] as a percent of the [agent's] [insurance producer's] total annual sales. The tables below should be used to report the ten percent of the issuer's [agents] [insurance producers] with the greatest percentages of replacements and lapses.

Listing of the 10% of [Agents] [Insurance Producers] with the Greatest Percentage of Replacements

Listing of the 10% of [Agents] [Insurance Producers] with the Greatest Percentage of Lapses

Company Totals

Percentage of Replacement Policies Sold to Total Annual Sales      %

Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year)     %

Percentage of Lapsed Policies to Total Annual Sales     %

Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year)      %

[Statutory Authority: RCW 48.02.060, 48.83.070, 48.83.110, 48.83.120, 48.83.130(1), and 48.83.140 (4)(a). WSR 08-24-019 (Matter No. R 2008-09), § 284-83-195, filed 11/24/08, effective 12/25/08.]

Reviser's note: The brackets and enclosed material in the text of the above section occurred in the copy filed by the agency.

RCW 48.02.060, 48.83.070, 48.83.110, 48.83.120, 48.83.130(1), and 48.83.140 (4)(a). WSR 08-24-019 (Matter No. R 2008-09), § 284-83-195, filed 11/24/08, effective 12/25/08.