|TO:||Commercial Health Insurers and Fraternal Benefit Societies and Individuals or Corporations Licensed to Sell Health Insurance in Massachusetts|
|FROM:||Julianne M. Bowler, Commissioner of Insurance|
|DATE:||March 12, 2004|
|RE:||Long-Term Care Policies that are Intended to Satisfy Minimum Coverage Requirements for Certain MassHealth Exemptions|
This bulletin is being sent to remind long-term care insurance carriers and producers of certain qualifications for MassHealth eligibility and recovery exemptions. This bulletin directs long-term care insurance carriers to use the attached documents in notifying current and prospective insureds on how long-term care benefits may qualify insureds for certain MassHealth exemptions.
Plans Intended to Satisfy Minimum Coverage Requirements for Certain MassHealth Exemptions
Carriers offering long-term care insurance policies in the Commonwealth of Massachusetts are required to offer at least one plan intended to meet the MassHealth minimum coverage requirements identified in 130 CMR 515.014. In addition, carriers are required under 211 CMR 65.09(1)(e)(3) to use standard language to indicate whether the policy "(IS)(IS NOT) intended to satisfy Massachusetts' minimum long-term care insurance coverage requirements as of the policy's effective date for certain asset and liability exemptions under the Massachusetts MassHealth (Medicaid) Program."
In the same section of the policy, the policyholder is instructed to "[r]ead Your Options for Financing Long-Term Care: A Massachusetts Guide for important information about the federal and state exemptions." In the "Qualifying long-term care insurance policies" subsection of this document, under the section titled "What is a MassHealth (Medicaid) Qualified Policy?, it is specifically noted that in order for you to qualify for certain MassHealth exemptions, "when you enter a nursing home, your policy must meet" certain MassHealth standards. This does mean that the insured must have a policy that meets the MassHealth minimum benefit standards as of the day the insured enters a nursing home.
Marketing and Disclosure Materials
The Division reminds all carriers and agents that they should take care to ensure that their advertisements and marketing materials do not misrepresent MassHealth provisions if describing the MassHealth minimum coverage requirements in relation to a policy.
Carriers will be considered to be in compliance with the pertinent provisions of 211 CMR 65.00 and to have properly described the relevant provisions to existing policyholders if they forward a notice including the information identified in Attachment A to all policyholders who have bought policies intended to qualify for the MassHealth exemption on or after January 1, 2000. All such notices should be forwarded to the appropriate policyholder no later than 90 days after the date on this bulletin.
Carriers will be considered to be in compliance with the pertinent provisions of 211 CMR 40.00 - Marketing of Insured Health Plans - if the carrier provides a notice including Attachment B , as drafted, to all prospective insureds at the time of application and if the carrier or producer receives either a signed copy of Attachment B or a separate signed acknowledgement to keep on file as proof that the applicant has received a copy of Attachment B . If a separate signed acknowledgement is used, it must indicate that the prospective insured has received and read Attachment B and must contain the dated signature of the prospective insured. The requirement to distribute Attachment B to prospective insureds shall take effect 90 days after the date of this bulletin.
Carriers are reminded that Attachment A shall be issued on Division of Insurance letterhead and Attachment B shall be headed by the corporate name of the long-term care insurance carrier and presented in no less than 12-point type size. Each carrier is to forward a copy of Attachment B , and, if used, the separate signed acknowledgement sheet to the Division of Insurance for their files.
If you have any questions regarding this bulletin, please contact the Health Unit of the State Rating Bureau at 617-521-7347.