A bill to amend the Public Health Service Act to improve the quality of long-term care insurance through the establishment of Federal standards, and for other purposes.
Long-Term Care Insurance Improvement and Accountability Act - Amends the Public Health Service Act to mandate the establishment of model Federal standards for long-term care insurance. Provides for the establishment of a related advisory committee.
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. Authorizes appropriations.
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. Prohibits sales: (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. Provides for: (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.
Requires: (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. Requires: (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: (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 basic Medicare supplemental policies; (2) other insurance offered primarily to provide specified types of coverage; and (3) certain life insurance policies. Declares that, notwithstanding any other provision of this Act, this Act applies to any product advertised, marketed, or offered as a long-term insurance policy, rider, or certificate.
Requires NAIC to issue guidelines applicable to organizations (other than employers and labor organizations that do not accept compensation) that endorse long-term policies or permit such policies to be offered through their organization.
Authorizes grants for programs to provide information, counseling, and assistance regarding the procurement of long-term insurance. Authorizes appropriations.
Introduced in Senate
Read twice and referred to the Committee on Labor and Human Resources.
Committee on Labor and Human Resources. Hearings held.
Committee on Labor and Human Resources. Ordered to be reported with an amendment in the nature of a substitute favorably.
Committee on Labor and Human Resources. Reported to Senate by Senator Kennedy with an amendment in the nature of a substitute. With written report No. 102-375.
Committee on Labor and Human Resources. Reported to Senate by Senator Kennedy with an amendment in the nature of a substitute. With written report No. 102-375.
Placed on Senate Legislative Calendar under General Orders. Calendar No. 638.
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