23 CAR pt. 125, Appendix A. Solicitation Disclosure Form

Appendix A Solicitation Disclosure Form Important Consumer Information Regarding the Arkansas Long-Term Care Insurance Partnership Program Some long-term care insurance policies [certificates] sold in Arkansas may qualify for the Arkansas Long-Term Care Insurance Partnership Program (the Partnership Program). The Partnership Program is a partnership between state government and private insurance companies to assist individuals in planning their long-term care needs. Insurance companies voluntarily agree to participate in the Partnership Program by offering long-term care insurance coverage that meets certain State and Federal requirements. Long-term care insurance policies [certificates] that qualify as Partnership Policies [Certificates] may protect the policyholder's [certificate holder’s] assets through a feature known as "Asset Disregard" under Arkansas Medicaid program. Asset Disregard means that an amount of the policyholder's [certificate holder’s] assets equal to the amount of long-term care insurance benefits received under a qualified Partnership Policy [Certificate] will be disregarded for the purpose of determining the insured's eligibility for Medicaid. This generally allows a person to keep assets equal to the insurance benefits received under a qualified Partnership Policy [Certificate] without affecting the person's eligibility for Medicaid. All other Medicaid eligibility criteria will apply. Asset Disregard is not available under a long-term care insurance policy [certificate] that is not a Partnership Policy [Certificate]. Therefore, you should consider whether Asset Disregard is important to you, and whether a Partnership Policy meets your needs. The purchase of a Partnership Policy does not automatically qualify you for Medicaid. What are the Requirements for a Partnership Policy [Certificate]. In order for a policy [certificate] to qualify as a Partnership Policy [Certificate], it must, among other requirements: • be issued to an individual after January 1, 2008; • cover an individual who was an Arkansas resident when coverage first becomes effective under the policy; • be a tax-qualified policy under Section 7702(B)(b) of the Internal Revenue Code of 1986; • meet stringent consumer protection standards; and, • must provide annual inflation protection for ages 75 and younger. If you apply and are approved for long-term care insurance coverage, [carrier name] will provide you with written documentation as to whether your policy [certificate] qualifies as a Partnership Policy [Certificate]. What Could Disqualify a Policy [Certificate] as a Partnership Policy. Certain types of changes to a Partnership Policy [Certificate] could affect whether such policy [certificate] continues to be a Partnership Policy [Certificate]. If you purchase a Partnership Policy [Certificate] and later decide to make any changes, you should first consult with [carrier name] to determine the effect of a proposed change. In addition, if you move to a state that does not maintain a Partnership Program or does not recognize your policy [certificate] as a Partnership Policy [Certificate], you would not receive beneficial treatment of your policy [certificate] under the Medicaid program of that state. The information contained in this disclosure is based on current Arkansas and Federal laws. These laws may be subject to change. Any change in law could reduce or eliminate the beneficial treatment of your policy [certificate] under Arkansas's Medicaid program. Additional Information. If you have questions regarding long-term care insurance policies [certificates] please contact [carrier name.] If you have questions regarding current laws governing Medicaid eligibility, you should contact the Arkansas Department of Human Services.