054.00.13 Appendix G. Long-Term Care Insurance Replacement and Lapse Reporting Form.
AR ADC 054.00.13 Appendix GArkansas Administrative Code
Ark. Admin. Code 054.00.13 Appendix G
054.00.13 Appendix G. Long-Term Care Insurance Replacement and Lapse Reporting Form.
Long-Term Care Insurance Replacement and Lapse Reporting Form
For the State of ______________________________ | For the Reporting Year of | |
Company Name: ______________________________ | Due: June 30 annually | |
Company Address: ______________________________ | Company NAIC Number: __________ | |
Contact Person: ______________________________ | Phone Number: (___)_____________ | |
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 |
|---|---|---|---|
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 | Number of Lapses As % of Number Sold By This Agent |
|---|---|---|---|
Company Totals
Percentage of Replacement Policies Sold to Total Annual Sales __________%
Percentage of Replacement Policies Sold to Policies In Force (as of the end of the preceding calendar year) __________%
Percentage of Lapsed Policies to Total Annual Sales __________%
Percentage of Lapsed Policies to Policies In Force (as of the end of the preceding calendar year) __________%
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.13 Appendix G, AR ADC 054.00.13 Appendix G
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