Regulators Work On LTC Model Update

An insurance company executive could not persuade regulators here to oppose a long term care insurance external review proposal.[@@]

Regulators attending the winter meeting of the National Association of Insurance Commissioners, Kansas City, Mo., talked about possible revisions to an existing NAIC LTC insurance model regulation.

One issue that surfaced was the idea of offering insureds access to independent external reviews of LTC insurance claim denials.

Many states already require health carriers to offer insureds external reviews of claim denials.

Robert Glowacki, a vice president in the Bedford, Texas, office of Aegon N.V., argued that requiring external reviews could affect the stability of LTC insurance prices, by forcing LTC insurers to pay benefits even when insureds fail to meet the eligibility triggers built into the policies.

Normally, policies require that insureds be unable to perform at least 2 “activities of daily living” before collecting benefits, Glowacki said.

But Wisconsin Commissioner Jorge Gomez said that Wisconsin’s external review requirement has had little effect on claims and that external reviewers do look at contract language when reviewing claim decisions.

Bonnie Burns, an NAIC “funded consumer” who works for California Health Advocates, Scotts Valley, Calif., agreed that any internal or external review must be based on contract requirements.

But external reviews can be important because companies may look at triggers in different ways, Burns said.