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February 10, 2002 at 07:00 PM
LTC Sellers: More Uniform Licensing Of Facilities Would Help Sales Grow
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Long-term care insurers are taking stock of what lies in store for the product over the next few years and believe that more uniform licensing of LTC facilities would accelerate sales. But they leave no doubt there will be plenty of qualified producers to make those sales even if greater uniformity is not immediately achieved.
While the Health Insurance Portability and Accountability Act of 1996 helped clarify standards such as benefit triggers, diverse state licensing requirements still create disparity in what is covered in different states. HIPAA requires at least two of six activities of daily living be met before benefits are triggered where, for example, previously some states looked at two of seven ADLs.
States vary in how they regulate the product, according to Jack Kispert, vice president-claims with IDS Life Insurance Company, a unit of American Express Financial Corp. in Minneapolis. In some cases, that variation is significant, he adds. There are also differences among product, although the core features of are similar, Kispert notes.
The issue was recently brought to the attention of regulators by consumer advocates during a meeting of the National Association of Insurance Commissioners, Kansas City, Mo.
For example, the definition of a nursing home can vary because of requirements such as the number of beds, type of care provided and required staff, such as licensed nurses, Kispert says.
The laws of the state in which the product is issued govern the terms of the product, says Marie Roche, director of LPC contracts and legislative services with John Hancock Financial Services in Boston.
So, if a policy is purchased in a state where, for instance, home health care is not paid if the insured is in a facility that offers institutional care, then those requirements would apply.
But it works both ways, Roche says. If a contract is purchased in a state like California where home health care benefits can be received even if the insured is in an institutional setting, then that would hold if the insured moved to another state with more restrictive requirements, she adds.
“We do occasionally get questions when people move across the country,” she says, but “for the most part, it is not a problem.”
What is important, Roche continues, is to create consistency in what the contract states and what the customer feels has been purchased.
“Uniformity in state licensing would be a godsend to the insurance industry,” she adds. Lack of uniformity can confuse consumers, she says.
