Long-Term Care Insurance Improvement and Accountability Act

Summary

Long-Term Care Insurance Improvement and Accountability Act - Amends the Public Health Service Act to establish the Long-Term Care Insurance Standards Commission to establish and modify minimum Federal standards for long-term care insurance. Authorizes appropriations. 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. Directs the Secretary to periodically review State regulatory programs. Provides for enforcement of the prohibition. 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: (1) twisting, high pressure tactics, and cold lead advertising; and (2) the agent from completing the medical history portion of the application. Mandates minimum financial standards, including income and asset criteria, for the purchase of a long-term policy. Prohibits sales: (1) to an individual eligible for assistance under title XIX (Medicaid) of the Social Security Act; and (2) of duplicate service policies. Provides for penalties. Mandates 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. Requires guaranteed issuance to an individual if the individual meets the minimum medical requirements of the policy. Limits cancellation for nonpayment by an incapacitated individual. Requires: (1) standard definitions and terminology, a uniform format, and standard benefits; and (2) disclosure of certain matters, including an outline of benefits. Limits certain conditions on benefits, including those based on preexisting conditions. Requires: (1) that eligibility for, and the level of, benefits be based on a functional assessment; (2) inflation protection; (3) limits on premium increases; and (4) nonforfeiture benefits. Limits the period during which the issuer may cancel the policy or deny a claim based on fraud or misrepresentation. Establishes: (1) the right of a purchaser to return a policy within a specified period; and (2) civil money penalties for failure to comply with specified provisions of this Act. Defines "long-term care insurance policy," excluding: (1) any Medicare supplemental policies; (2) other insurance offered primarily to provide specified types of coverage; and (3) certain life insurance policies. Requires the Commission to issue guidelines applicable to organizations that endorse long-term policies or permit such policies to be offered through their organization. Authorizes appropriations to provide information, counseling, and assistance regarding the procurement of long-term insurance. Mandates reports to the Congress on: (1) standards to assure the solvency of insurers regarding long-term care policies; and (2) a standard measure of value for long-term care policies.

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Documents

4 official files

• Reported to Senate (text)

  Reported to Senate · EN

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• Introduced in Senate (text)

  Introduced in Senate · EN

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• Reported to Senate with amendment(s)

  summary · EN · 12 August 1992

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• Introduced in Senate

  summary · EN · 21 January 1992

  Open at official source

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