Instructions for LTC Annual Report Submission

Please limit the reported information to standalone long term care insurance.  Do not include riders such as accelerated death benefit riders attached to life insurance policies.  Long term care insurance includes tax-qualified coverage, non tax-qualified coverage, nursing home insurance only, home care insurance only, and nursing home and home care insurance. (See 11 NYCRR 52.12 and 11 NYCRR 52.13)

For group coverage:

  • Include any group policy delivered or issued for delivery in New York State and each certificate issued under such group policies.
    • Do not include any group policy (or certificate holder thereof) delivered or issued for delivery outside New York State unless the group to which the policy was issued is a type of group specified in New York Insurance Law §4235(c)(1)(D)*, (K), (L) or (M).  For a policy issued outside NYS to any of these categories of groups, please include all certificates delivered to a resident of NYS.

      * For purposes of the long term care reports, reference to Insurance Law §4235(c)(1)(D) is limited to a group policy issued to a trustee of a fund established or participated in by two or more employers not in the same industry.

  • Where a certificate holder currently works or resides is irrelevant regarding jurisdiction for purposes of these three reports.

For individual coverage:

  • Include any individual policies that were delivered or issued for delivery in New York State.
  • Where a policy holder currently works or resides is irrelevant regarding jurisdiction for purposes of these three reports.

Below are specific instructions regarding each of the three annual long term care reports:  The Rescission Report, the Claims Denial Report, and the Replacement and Lapse Report.

Rescission Report

New York State Insurance Regulation 11 NYCRR 52.25(d)(6) requires the submission of an annual rescission report in the format prescribed by the National Association of Insurance Commissioners (NAIC). The rescission report is due by March 1st of the following calendar year.  Please follow the steps below regarding the submission of the annual rescission report:

  1. Within SERFF, find the filing type ‘LTC Rescission Report’ and complete the attached form ‘LTC Rescission Form’.
    1. Fill in every field in the top portion of the form. Please note if the report is being submitted on behalf of a different company.
    2. If you have any questions regarding the Instructions, please contact the DFS by replying to this email or calling Jeremy Bollam at (518) 486-7815.  Please limit one rescission per form.  Fill out multiple forms if there are multiple rescissions.
    3. If you have no rescissions to report, check the ‘no rescissions’ box on the form.
  2. If you have a rescission to report on an individual policy, there is no Certificate Form # to report.
  3. Any reported rescission requires a detailed reason in the space provided on the form.
  4. Attach the LTC Rescission Form to your SERFF submission.

Claims Denial Report

Federal law 26 USC 7702B(g)(3), 26 USC 4980(C), and section 15(F) of the NAIC Long Term Care Insurance Model Regulation require the submission of an annual claims denial report in the format prescribed by the NAIC.  The claims denial report is due by June 30th of the following calendar year.  Please follow the steps below regarding the submission of the annual claims denial report:

  1. Within SERFF, find the filing type ‘LTC Claims Denial Report’ and complete the attached form ‘LTC Claims Denial Form’.
    1. Fill in every field in the top portion of the form.  Please note if the report is being submitted on behalf of a different company.
    2. If you have any questions regarding the Instructions, please contact the DFS by replying to this email or calling Jeremy Bollam at (518) 486-7815.
    3. Please indicate the manner of reporting by checking either the ‘Per Claimant’ or ‘Per Transaction’ box on the form.
    4. Report the Total Number of Inforce Policies delivered in New York State, and report the Total Number of Inforce Policies delivered in the United States (including New York State Policies).  For group coverage, report the Total Number of Inforce Certificates delivered in New York State, and report the Total Number of Inforce Certificates delivered in the United States (including New York State Certificates).
    5. Fill in the Claims & Denial Data chart. In the column labeled ‘U.S. Data’, the U.S. data should be inclusive of New York State data.
  2. Attach the LTC Claims Denial Form to your SERFF submission.

Replacement and Lapse Report

Federal law 26 USC 7702B(g)(3), 26 USC 4980(C), and section 15(B) of the NAIC Long Term Care Insurance Model Regulation require the submission of an annual replacement and lapse report in the format prescribed by the NAIC.  The replacement and lapse report is due by June 30th of the following calendar year.  Please follow the steps below regarding the submission of the annual replacement and lapse report:

  1. Within SERFF, find the filing type ‘LTC Replacement and Lapse Report’ and complete the attached form ‘LTC Replacement and Lapse Form’.
    1. Fill in every field in the top portion of the form.  Please note if the report is being submitted on behalf of a different company.
    2. If you have any questions regarding the Instructions, please contact the DFS by replying to this email or calling Jeremy Bollam at (518) 486-7815.  If necessary, attach separate sheets.
    3. Fill in the Company Totals.  In the column labeled ‘Number of Policies Sold By This Agent’, identify whether the Policies sold were Group or Individual.
  2. Attach the LTC Replacement and Lapse Form to your SERFF submission.

Updated 11/17/2016