AR-MEDAMERICA DENIED CLAIMS, LAPSE/REPLACEMENT AND SUITABILITY REPORTS
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- Kristin King
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1 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement Filing at a Glance Company: MedAmerica Insurance Company AR-MedAmerica Denied SERFF Tr Num: MEAM State: Arkansas Claims, Lapse/Replacement and Suitability Reports TOI: LTC6 Long Term Care - Other SERFF : Closed-Accepted State Tr Num: For Sub-TOI: LTC6. Long Term Care - Other Co Tr Num: AR-MEDAMERICA DENIED CLAIMS, State : Closed-Accepted for LAPSE/REPLACEMENT AND SUITABILITY REPORTS Filing Type: Form Reviewer(s): Donna Lambert Author: Lisa Culhane Disposition 4/9/212 Date Submitted: 4/9/212 Disposition : Accepted For Implementation Date Requested: On Approval Implementation 4/9/212 State Filing Description: General Information Project Name: AR- MedAmerica Denied Claims, Lapse/Replacement Project Number: AR- MedAmerica Denied Claims, Lapse/Replacement Requested Filing Mode: Explanation for Combination/Other: Submission Type: New Submission Filing Changed: 4/9/212 State Changed: 4/9/212 Created By: Lisa Culhane Corresponding Filing Tracking Number: Filing Description: Annual Reports: Denied Claims, Lapse/Replacement and Suitability of Filing in Domicile: Date Approved in Domicile: Domicile Market Type: Overall Rate Impact: Deemer Submitted By: Lisa Culhane PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
2 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement State Narrative: Company and Contact Filing Contact Information Lisa Culhane, LTC Compliance Analyst lisa.culhane@medamericaltc.com 165 Court Street [Phone] Rochester, NY [FAX] Filing Company Information MedAmerica Insurance Company CoCode: State of Domicile: Pennsylvania 165 Court Street Group Code: Company Type: Long Term Care Insurance Rochester, NY Group Name: State ID Number: (585) ext. [Phone] FEIN Number: Filing Fees Fee Required? Retaliatory? Fee Explanation: Per Company: No No No COMPANY AMOUNT DATE PROCESSED TRANSACTION # MedAmerica Insurance Company $. 4/9/212 PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
3 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement Correspondence Summary Dispositions Created By Created On Date Submitted Accepted For Donna Lambert 4/9/212 4/9/212 Informational PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
4 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other Disposition AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement Disposition 4/9/212 Implementation 4/9/212 : Accepted For Comment: Rate data does NOT apply to filing. PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
5 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement Schedule Schedule Item Schedule Item Public Access Supporting Document Flesch Certification Accepted for Supporting Document Application Accepted for Supporting Document Health - Actuarial Justification Accepted for Supporting Document Outline of Coverage Accepted for Supporting Document Denied Claims Report Accepted for Supporting Document Lapse/Replacement Report Accepted for Supporting Document Suitability Report Accepted for PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
6 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement Supporting Document Schedules Bypassed - Item: Flesch Certification Accepted for Informational Bypass Reason: N/A 4/9/212 Bypassed - Item: Application Accepted for Informational Bypass Reason: N/A 4/9/212 Bypassed - Item: Health - Actuarial Justification Accepted for Informational Bypass Reason: N/A 4/9/212 Bypassed - Item: Outline of Coverage Accepted for Informational Bypass Reason: N/A 4/9/212 Satisfied - Item: Denied Claims Report Accepted for Informational 4/9/212 PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
7 TOI: LTC6 Long Term Care - Other Sub-TOI: LTC6. Long Term Care - Other AR-MedAmerica Denied Claims, Lapse/Replacement AR- MedAmerica Denied Claims, Lapse/Replacement /AR- MedAmerica Denied Claims, Lapse/Replacement Attachment: AR_69515_denied_211_116_I.pdf Satisfied - Item: Lapse/Replacement Report Accepted for Informational Attachment: AR_69515_rep_lapse_211_116.pdf 4/9/212 Satisfied - Item: Suitability Report Accepted for Informational Attachment: AR_69515_suit_211_116.pdf 4/9/212 PDF Pipeline for SERFF Tracking Number MEAM Generated 4/9/212 4:11 PM
8 Long-Term Care Insurance Claims Denial Reporting Form For The State of ARKANSAS For The Reporting Year of 211 Company Name MedAmerica Insurance Company Address: Administrative Office: 165 COURT STREET ROCHESTER,NY NAIC Number: Contact Person Angela L. Hoteling, Esq. Phone Number: Line of Business Individual Instructions: The purpose of this form is to report all long-term claim denials under in force long-term care policies or insurance policies. Indicate the manner of reporting by checking one of the boxes below: X Per Claimant - counts each individual who makes one or a series of claim requests Per Transaction - counts each claim payment request "Denied" means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because and applicable preexisting condition. It does not include a request for payment that is in excess of the applicable contractual limits. Inforce Data Total Number of Inforce Policies as of December 31st Claims and Denial Data Total Number of Long-Term Care Claims Reported Total Number of Long-Term Care Claims Denied/Not Paid Number of Claims Not Paid due to Preexisting Condition Exclusion Number of Claims Not Paid due to Waiting (Elimination) Period Not Met Net Number of Long-Term Care Claims Denied for Reporting (Line 2 Minus Line 3 Minus Line 4) State Data 31 State Data Nationwide Data Nationwide Data Percentage of Long-Term Care Claims Denied of Those Reported (Line 5 Divided By Line 1) Number of Long-Term Care Claims Denied due to: % 3.3% 8 Long-Term Care Services Not Covered under the Policy 49 9 Provider/Facility Not Qualified under the Policy 2 1 Benefit Eligibility Criteria Not Met Other: Duplicate Submission, Discharged from Facility, No Coverage in Policy, Incomplete Claim, Repayment of Overpayment 143
9 Long-Term Care Insurance Replacement and Lapse Reporting Form For The State Of ARKANSAS For The Reporting Year 211 Company Name MedAmerica Insurance Company Address: Administrative Office: 165 COURT STREET ROCHESTER,NY NAIC Number: Contact Person Angela L. Hoteling, Esq. Phone Number: Instructions: The purpose of this form is to report, on a statewide basis, information regarding long-term care insurance policy replacement and lapses. Specifically, every insurer shall maintain records for each agent on that agent's amount of long-term care insurance replacement sales as a percent of the agent's total annual sales and the amount of lapses of long-term care insurance policies sold by the agent as a percent of the agent's total annual sales. The tables below should be used to report the ten percent (1%) of the insurer's agents with the greatest percentages of replacement and lapses. Listing of the 1% of Agents with the Greatest Percentage of Replacements Agent's Name Number of Policies Sold By This Agent Number of Policies Replaced By This Agent Number of Replacements As % of Number Sold By This Agent Listing of the 1% of Agents with the Greatest Percentage of Lapses Agent's Name Number of Policies Sold By This Agent Number of Policies Lapsed By This Agent Number of Lapses As % of Number Sold By This Agent Company Totals: Percentage of Replacement Policies Sold to Annual Sales Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year) Percentage of Lapsed Policies Sold to Annual Sales Percentage of Lapsed Policies Sold to Policies In Force (as of the end of the preceding calendar year) <1% <1% 212.5% 5.4% Page 1 of 1
10 Suitability Report for 211 Company Name: MedAmerica Insurance Company NAIC Company Code: Total Number of Applications Received from residents of Arkansas 2 2. Number of Applicants Who Declined to Provide Information on the Personal Worksheet 3. Number of Applicants Who Did Not Meet the Suitability Standards 1 4. Number of Those Who Chose to Confirm After Receiving A Suitability Letter
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Filing at a Glance Companies: American Home Assurance Company, AIU Insurance Company, American International South Insurance Company, AIG Casualty Company, Commerce and Industry Insurance Company, Granite
More informationL09I.001 Single Life Adjustable Life Flexible Premium Adjustable Life Insurance Policy Kemper Investors Life Insurance Company/0146PAL02-08
SERFF Tracking Number: MLLM-126729865 State: Arkansas Filing Company: Kemper Investors Life Insurance Company State Tracking Number: 46401 Company Tracking Number: 0146PAL02-08 TOI: L09I Individual Life
More informationSERFF Tracking #: AESP-128603015 State Tracking #: Company Tracking #: ICC 12 OL 3004 0812
Product Name: TransACE Long Term Care Rider Consumer Flyer Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: Transamerica Life Insurance Company TransACE Long Term Care Rider
More informationSERFF Tracking Number: ULCC-125284734 State: Arkansas Filing Company: Ulico Casualty Company State Tracking Number: AR-PC-07-026039
SERFF Tracking Number: ULCC-125284734 State: Arkansas Filing Company: Ulico Casualty Company State Tracking Number: AR-PC-07-026039 Company Tracking Number: UCC-2007-AR-WC-03 TOI: 16.0 Workers Compensation
More informationThis advertising material is new and does not replace any advertisements filed by Genworth Life Insurance Company.
SERFF Tracking Number: GEFA-125987509 State: Wisconsin Filing Company: Genworth Life Insurance Company State Tracking Number: Company Tracking Number: TOI: LTC03I Individual Long Term Care Sub-TOI: LTC03I.001
More informationSERFF Status: Closed State Tr Num: EFT $25 Made/Occurrence
Project Name/Number: GL Forms In Response To Terrorism Risk Insurance Program Reauthorization Act Of 2007/08-091-001-GL-AR Filing at a Glance Company: QBE Insurance Corporation Product Name: GL Forms In
More informationSERFF Tracking #: HART-129755512 State Tracking #: Company Tracking #: FN.09.076025.2015.01
SERFF Tracking #: HART-129755512 State Tracking #: Company Tracking #: FN.09.076025.2015.01 State: District of Columbia Filing Company: Hartford Casualty Insurance Company TOI/Sub-TOI: 17.2 Other Liability-Claims
More informationSERFF Tracking #: USAA-130216478 State Tracking #: Company Tracking #: PA1520097
State: Pennsylvania First Filing Company: Garrison Property and Casualty Insurance Company,... Filing at a Glance Companies: State: TOI: Sub-TOI: Filing Type: Garrison Property and Casualty Insurance Company
More informationSERFF Tracking #: MALF-128641392 State Tracking #: Company Tracking #: 12 SSA CE-D
SERFF Tracking #: MALF-128641392 State Tracking #: Company Tracking #: 12 SSA CE-D State: Arkansas Filing Company: John Hancock Life Insurance Company (U.S.A.) TOI/Sub-TOI: A05I Individual Annuities- Immediate
More informationTOI: 17.0 Other Liability-Occ/Claims Made Sub-TOI: 17.0001 Commercial General Liability
Care, Custody or Control- Self Storage Items- 97307 (2/08)/ Filing at a Glance Companies: American Home Assurance Company, American International South Insurance Company, AIG Casualty Company, Commerce
More informationStatus of Filing in Domicile:
Filing at a Glance Company: Marquette National Life Insurance Company SERFF Tr Num: UNAM-126105722 State: ArkansasLH TOI: MS06 Medicare Supplement - Other SERFF Status: Closed State Tr Num: 42074 Sub-TOI:
More informationFiling Status Changed: 12/09/2010 State Status Changed: Deemer Date: 01/07/2011
n Filing/ Filing at a Glance Companies: Great American Insurance Company, Great American Assurance Company, Great American Insurance Company of New York, Great American Alliance Insurance Company Alt Mkts
More informationFiling at a Glance. Sagicor Life Insurance Company Baltimore Life/Sagicor Assumption District of Columbia L01.000 Life - Assumption Agreement
Filing at a Glance Company: State: TOI: Sub-TOI: Filing Type: Sagicor Life Insurance Company District of Columbia L01 Life - Assumption Agreement L01.000 Life - Assumption Agreement Date Submitted: 11/12/2014
More information05.1003 Commercial Package Portion Only
TRIA Update/ Filing at a Glance Company: Florists' Mutual Insurance Company SERFF Tr Num: FLWR-125579209 State: Arkansas SERFF Status: Closed State Tr Num: EFT $50 Co Tr Num: State Status: Fees verified
More informationTOI: 01.0 Property SERFF Status: Closed State Tr Num: EFT $100 Sub-TOI: 01.0001 Commercial Property (Fire and Allied Lines)
Project Name/Number: /20080107-08 Filing at a Glance Company: American Modern Home Insurance Company SERFF Tr Num: AMMH-125583707 State: Arkansas TOI: 01.0 Property SERFF Status: Closed State Tr Num: EFT
More informationSERFF Tracking #: AMGN-130338720 State Tracking #: Company Tracking #: 109249-DC-2015, ET AL
SERFF Tracking #: AMGN-130338720 State Tracking #: Company Tracking #: 109249-DC-2015, ET AL State: District of Columbia Filing Company: American General Life Insurance Company TOI/Sub-TOI: L07I Individual
More informationProject Number: TC40584(0708) Date Approved in Domicile: 04/24/2000
LTC Riders Flyer/(0708) Filing at a Glance Company: National Life Insurance Company Individual Long Term Care SERFF Tr Num: NALF-125810842 State: ArkansasLH Rider LTC05I Individual Long Term Care - SERFF
More informationSERFF Tracking #: HNVX-G129898950 State Tracking #: Company Tracking #: DC150350100010
Product Name: *MPL- Miscellaneous Professional Liability Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: The Hanover Insurance Company *MPL- Miscellaneous Professional Liability
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05.0 Commercial Multi-Peril - & Non- Sub- Filing at a Glance Company: American Modern Home Insurance Company SERFF Tr Num: AMMH-125647073 State: Arkansas 05.0 Commercial Multi-Peril - & SERFF Status: Closed
More informationTOI: VS01 Viatical Settlements Sub-TOI: VS01.000 Viatical Settlements Product Name:
Project Name/Number: Broker report revised/020 Filing at a Glance Company: Crump Life Insurance Services, Inc SERFF Tr Num: MI-127848599 State: Arkansas TOI: VS01 Viatical Settlements SERFF Status: Closed-Filed-
More informationSERFF Tracking #: MRTN-130013987 State Tracking #: Company Tracking #: CL DC008230200009
Product Name: Cover Pro Miscellaneous Professional Liability Short Renewal Application Filing at a Glance Company: Product Name: State: TOI: Sub-TOI: Filing Type: Philadelphia Indemnity Insurance Company
More informationTOI: 17.2 Other Liability-Occ Only SERFF Status: Closed State Tr Num: Sub-TOI: 17.2020 Commercial Umbrella & Co Tr Num: NWIES0707
Project Name/Number: /NWES0707 Filing at a Glance Companies: American Automobile Insurance Company, Associated Indemnity Corporation, Fireman's Fund Insurance Company, National Surety Corporation, The
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Filing at a Glance Company: Access Account Payout Life SERFF Tr Num: TCRE-125874453 State: ArkansasLH Annuities SERFF Status: Closed State Tr Num: 40688 A05I.000 Annuities - Immediate Nonvariable Co Tr
More informationSERFF Tracking #: BFLI-128726934 State Tracking #: Company Tracking #: AR B 21092 TV3
Product Name: Medicare Supplement Television Commercials Filing at a Glance Company: Product Name: State: Bankers Fidelity Life Insurance Company Medicare Supplement Television Commercials Arkansas TOI:
More informationSERFF Tracking #: SMPJ-130229500 State Tracking #: Company Tracking #: 15-I-GL-9011
SERFF Tracking #: SMPJ-130229500 State Tracking #: Company Tracking #: 15-I-GL-9011 State: District of Columbia Filing Company: Sompo Japan Insurance Company of America TOI/Sub-TOI: 17.0 Other Liability-Occ/Claims
More informationTOI: 20.0 Commercial Auto SERFF Status: Closed State Tr Num: #? $50 Co Tr Num: AR-CA-010709-BHHC- State Status: Fees verified
Filing at a Glance Companies: Cypress Insurance Company, Cornhusker Casualty Company SERFF Tr Num: CORN-125933535 State: Arkansas TOI: 20.0 SERFF Status: Closed State Tr Num: #? $50 Sub-TOI: 20.0002 Garage
More informationSERFF Tracking Number: LMUG-125263431 State: Arkansas First Filing Company: Liberty Insurance Corporation,... State Tracking Number: AR-PC-07-025842
LC Tobacco Exclusion - LC 21 54 08 07/ Filing at a Glance Companies: Liberty Insurance Corporation, Liberty Mutual Fire Insurance Company, LM Insurance Corporation, Liberty Mutual Insurance Company, The
More informationTOI: 04.0 Homeowners Sub-TOI: 04.0000 Homeowners Sub-TOI Combinations Revised Rule 521 Water Sewer Backup for HCIC
Project Name/Number: Homeowners Multi Peril/ Filing at a Glance Company: Hartford Casualty Insurance Company Revised Rule 521 Water Sewer SERFF Tr Num: HART-125929339 State: Arkansas Backup for HCIC TOI:
More informationSTATE OF NEVADA. December 5, 2011
BRIAN SANDOVAL Governor STATE OF NEVADA TERRY JOHNSON Director SCOTT J. KIPPER Commissioner DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF INSURANCE 1818 East College Pkwy., Suite 103 Carson City, Nevada
More informationFiling at a Glance. Metropolitan Life Insurance Company GCERT2000 Series - Business Overhead Expense
SERFF Tracking #: META-128701397 State Tracking #: Company Tracking #: T12-135 - State: Arkansas Filing Company: Metropolitan Life Insurance Company TOI/Sub-TOI: H11G Group Health - Disability Income/H11G.001
More informationSERFF Tracking #: NCCI-127176855 State Tracking #: Company Tracking #: B-1423 (MJ)
SERFF Tracking #: NCCI-127176855 State Tracking #: Company Tracking #: B-1423 (MJ) State: Missouri Filing Company: NCCI TOI/Sub-TOI: 16.0 Workers Compensation/16.0004 Standard WC Product Name: B-1423 Elimination
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SERFF Tracking Number: USPH-6RKSLB602/00-00/00-00/00 State: Wisconsin Filing Company: American Family Mutual Insurance Company State Tracking Number: Company Tracking Number: TOI: MS06 Medicare Supplement
More informationClosed Sub-TOI: L04I.500 Other Co Tr Num: PLA-740 State Status: Approved-Closed
SERFF Tracking Number: PRMD-126265843 State: Arkansas Filing Company: Primerica Life Insurance Company State Tracking Number: 43419 Company Tracking Number: PLA-740 TOI: L04I Individual Life - Term Sub-TOI:
More informationTOI: 16.0 Workers Compensation Sub-TOI: 16.0004 Standard WC
SERFF Tracking Number: QBCL-125829164 State: Arkansas First Filing Company: Southern Guaranty Insurance Company,... State Tracking Number: EFT $50 Company Tracking Number: 010109 11202S TOI: 16.0 Workers
More informationSERFF Tracking Number: AGNY-126887843 State: District of Columbia National Union Fire Insurance Company of. State Tracking Number: Pittsburgh, Pa.
SERFF Tracking Number: AGNY-126887843 State: District of Columbia Filing Company: National Union Fire Insurance Company of State Tracking Number: Pittsburgh, Pa. Company Tracking Number: CHS-10-EO-22 TOI:
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