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<regulation prefix="Regulation" num=".05" citation="COMAR 31.14.02.05" title_num="31" subtitle_num="14" chapter_num="02" heading="Loss Ratio.">
  <paragraph num="A.">
    <text>This regulation applies to all long-term care insurance policies or certificates except those covered under Regulations .04, .06, and, .06-1 of this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Minimum Loss Ratios.</text>
    <paragraph num="(1)">
      <text>Benefits under long-term care insurance policies shall be deemed reasonable in relation to premiums if the expected loss ratio is at least 60 percent, calculated in a manner which provides for adequate reserving of the long-term care insurance risk.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>In evaluating the expected loss ratio described in §B(1) of this regulation, due consideration shall be given to all relevant factors, including:</text>
      <paragraph num="(a)">
        <text>Statistical credibility of incurred claims experience and earned premiums;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The period for which rates are computed to provide coverage;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Experienced and projected trends;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Concentration of experience within early policy duration;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Expected claim fluctuation;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Experience refunds, adjustments, or dividends;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Renewability features;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>All appropriate expense factors;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Interest;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Experimental nature of the coverage;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Policy reserves;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Mix of business by risk classification; and</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Product features such as long elimination periods, high deductibles, and high maximum limits.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Life Insurance Policies that Accelerate Benefits for Long-Term Care.</text>
    <paragraph num="(1)">
      <text>Section B of this regulation does not apply to life insurance policies that accelerate benefits for long-term care.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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 all of the following requirements are met:</text>
      <paragraph num="(a)">
        <text>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;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements of Insurance Article, Title 16, Subtitle 3, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The policy meets the disclosure requirements of Insurance Article, §§18-108 and 18-117, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Any policy illustration used for the policy meets the applicable requirements of COMAR 31.09.09; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>An actuarial memorandum is filed with the Commissioner that includes:</text>
        <paragraph num="(i)">
          <text>A description of the basis on which the long-term care rates were determined;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>A description of the basis for the reserves;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>A description and a table of each actuarial assumption used;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>The estimated average annual premium per policy and the average issue age;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>A statement as to whether underwriting is performed at the time of application; and</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>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.</text>
        </paragraph>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>For the expense assumptions under §C(2)(e)(iv) of this regulation, an insurer shall include the percent of premium dollars per policy and the dollars per unit of benefits, if any.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The statement required by §C(2)(e)(vii) of this regulation shall indicate whether underwriting is used. If underwriting is used, the statement shall include a description of the type or types of underwriting used, such as medical underwriting or functional assessment underwriting. If coverage is under a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs.</text>
    </paragraph>
  </paragraph>
</regulation>