SERFF Tracking #: MASS State Tracking #: Company Tracking #: 2015 ANNUAL LTC REPORTS

Transcription

1 SERFF Tracking #: MASS State Tracking #: Company Tracking #: 2015 ANNUAL LTC REPORTS State: District of Columbia Filing Company: Massachusetts Mutual Life Insurance Company TOI/Sub-TOI: LTC06 Long Term Care - Other/LTC Long Term Care - Other Product Name: 2015 Annual Reports for LTC Access Rider Project Name/Number: 2015 Annual LTC Reports/2015 Annual LTC Reports Filing at a Glance Company: Massachusetts Mutual Life Insurance Company Product Name: 2015 Annual Reports for LTC Access Rider State: District of Columbia TOI: LTC06 Long Term Care - Other Sub-TOI: LTC Long Term Care - Other Filing Type: Form Date Submitted: 06/10/2016 SERFF Tr Num: MASS SERFF Status: Assigned State Tr Num: State Status: Co Tr Num: 2015 ANNUAL LTC REPORTS Implementation Date Requested: Author(s): Reviewer(s): Disposition Date: Disposition Status: Implementation Date: Joanne Hendricks, Dale Bihlmeyer, Abi Levesque Dustin Schaefer (primary) PDF Pipeline for SERFF Tracking Number MASS Generated 06/27/ :13 AM

2 SERFF Tracking #: MASS State Tracking #: Company Tracking #: 2015 ANNUAL LTC REPORTS State: District of Columbia Filing Company: Massachusetts Mutual Life Insurance Company TOI/Sub-TOI: LTC06 Long Term Care - Other/LTC Long Term Care - Other Product Name: 2015 Annual Reports for LTC Access Rider Project Name/Number: 2015 Annual LTC Reports/2015 Annual LTC Reports General Information Project Name: 2015 Annual LTC Reports Status of Filing in Domicile: Not Filed Project Number: 2015 Annual LTC Reports Date Approved in Domicile: Requested Filing Mode: Informational Domicile Status Comments: Explanation for Combination/Other: Market Type: Individual Submission Type: New Submission Individual Market Type: Overall Rate Impact: Filing Status Changed: 06/13/2016 State Status Changed: Deemer Date: Created By: Dale Bihlmeyer Submitted By: Dale Bihlmeyer Corresponding Filing Tracking Number: Filing Description: Annual LTC reports due 6/30. Please see cover letter attached in supporting documentation. Company and Contact Filing Contact Information Abi Levesque, Product Filing Specialist 1295 State Street Springfield, MA 0111 Filing Company Information Massachusetts Mutual Life Insurance Company 1295 State Street MIP: M381 Springfield, MA (800) ext. [Phone] [email protected] [Phone] CoCode: Group Code: 435 Group Name: FEIN Number: State of Domicile: Massachusetts Company Type: State ID Number: Filing Fees Fee Required? Retaliatory? Fee Explanation: No No PDF Pipeline for SERFF Tracking Number MASS Generated 06/27/ :13 AM

3 SERFF Tracking #: MASS State Tracking #: Company Tracking #: 2015 ANNUAL LTC REPORTS State: District of Columbia Filing Company: Massachusetts Mutual Life Insurance Company TOI/Sub-TOI: LTC06 Long Term Care - Other/LTC Long Term Care - Other Product Name: 2015 Annual Reports for LTC Access Rider Project Name/Number: 2015 Annual LTC Reports/2015 Annual LTC Reports Supporting Document Schedules Satisfied - Item: Comments: Attachment(s): Item Status: Status Date: LTC Annual Reports DC - LTC Claims Denial Report.pdf DC - LTC Replacement & Lapse Report.pdf DC - LTC Suitability Report.pdf PDF Pipeline for SERFF Tracking Number MASS Generated 06/27/ :13 AM

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5 APPENDIX E Claims Denial Reporting Form Long-Term Care Insurance For the State of District of Columbia For the Reporting Year of 2015 Company Name: Massachusetts Mutual Life Due: June 30 Annually Company Address: 1295 State Street Springfield, MA Company NAIC Number: Contact Person: James P. Hausmann Phone Number: (413) Line of Business: Individual X Group Instructions The purpose of this form is to report all long-term care claims denials under in force long-term care insurance policies. 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 of an applicable preexisting condition. State Data Nationwide Data 1 1 Total Number of Long-Term Care Claims Reported Total Number of Long-Term Care Claims Denied/Not Paid 0 0 Number of Claims Not Paid due to Preexisting Condition 3 Exclusion 0 0 Number of Claims Not Paid due to Waiting (Elimination) Period 4 Not met 0 0 Net Number of Long-Term Care Claims Denied for Reporting 5 Purposes (Line 2 Minus Line 3 Minus Line 4) 0 0 Percentage of Long-Term Care Claims Denied of Those Reported 6 (Line 5 Divided by Line 1) 0% 0% 7 Number of Long-Term Care Claims Denied due to: 8 Long-term Care Services Not Covered under the Policy Provider/Facility Not Qualified under the Policy Benefit Eligibility Criteria Not Met Other The nationwide data may be viewed as a more representative and credible indicator where the data for claims reported and denied for your state are small in number. 2. Example home health care claim filed under a nursing home only policy. 3. Example a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy. 4. Examples a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care. NOTE: This report pertains to: (1) individual MassMutual Whole Life insurance policies with a long term care rider that allows policyowners to accelerate the payment of a portion of their Whole Life policy death benefit during their lifetime to help pay for covered long term care services and (2) individual MassMutual single premium Whole Life insurance policies with a qualified long term care insurance rider

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7 Long-Term Care Insurance Replacement and Lapse Reporting Form For the State of District Of Columbia For the Reporting Year of 2015 Due: June 30 Annually Company Name: Massachusetts Mutual Life Insurance Company Company NAIC Number: Address: 1295 State Street; Springfield, MA Contact Person: James P. Hausmann Phone Number: (413) Instructions The purpose of this form is to report on a statewide basis information regarding long-term care insurance policy replacements 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 (10%) of the insurer s agents with the greatest percentages of replacements and lapses. Listing of the 10% 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 Christopher Cocores % Listing of the 10% 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 None Not Applicable Not Applicable Not Applicable Number of Lapses As % of Number Sold By This Agent Company Totals Percentage of Replacement Policies Sold to Total Annual Sales 7.69% Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year) 4.17% Percentage of Lapsed Policies to Total Annual Sales 0.00% Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) 0.00% Number of Policies Sold 13 Number of Policies In-Force at Year End (as of the end of the preceding calendar year) 24 NOTE: This report pertains to: (1) individual MassMutual Whole Life insurance policies with a long term care rider that allows policyowners to accelerate the payment of a portion of their Whole Life policy death benefit during their lifetime to help pay for covered long term care services and (2) individual MassMutual single premium whole life insurance policies with a qualified long term care rider.

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9 APPENDIX H Suitability Reporting Form Long-Term Care Insurance For the State of District Of Columbia For the Reporting Year of 2015 Due: June 30 annually Company Name: Massachusetts Mutual Life Insurance Company Company Address: 1295 State Street Springfield, MA Company NAIC Number: Contact Person: James P. Hausmann Phone Number: (413) Instructions The purpose of this form is to report all long-term care activity related to the total number of applications received from residents of this state, the number of those who declined to provide information on the personal worksheet, the number of applicants who did not meet the suitability standards, and the number of applicants who chose to confirm after receiving a suitability letter. 1. Total Number of Applications Received 2 2. Number of Applicants Who Declined to Provide Information on the Personal Worksheet 0 3. Number of Applicants Who Did Not Meet The Suitability Standards 0 4. Number of Applicants Who Chose to Confirm After Receiving a Suitability Letter 0 * This report pertains to individual MassMutual single premium whole life insurance policies with a qualified long term care insurance rider.