{"data":{"id":"us-hi/haw.-rev.-stat.-431-10h-226","jurisdiction":"us-hi","citation":"Haw. Rev. Stat. § 431:10H-226","heading":"Loss ratio.","body":"(a) Benefits under long-term care insurance policies shall be deemed reasonable in relation to premiums; provided that the expected loss ratio is at least sixty per cent and calculated in a manner that provides for adequate reserving of the long-term care insurance risk. Prior to any approval, the commissioner shall evaluate the expected loss ratio, and due consideration shall be given to all relevant factors, including:\n\n(1) Statistical credibility of incurred claims experience and earned premiums;\n\n(2) The period for which rates are computed to provide coverage;\n\n(3) Experienced and projected trends;\n\n(4) Concentration of experience within early policy duration;\n\n(5) Expected claim fluctuation;\n\n(6) Experience refunds, adjustments, or dividends;\n\n(7) Renewability features;\n\n(8) All appropriate expense factors;\n\n(9) Interest;\n\n(10) Experimental nature of the coverage;\n\n(11) Policy reserves;\n\n(12) Mix of business by risk classification, if applicable; and\n\n(13) Product features such as long elimination periods, high deductibles, and high maximum limits.\n\n(b) For purposes of this section, the commissioner shall consult with a qualified long-term care actuary.\n\n(c) Subsection (a) shall not apply to life insurance policies that accelerate benefits for long-term care. A life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums paid, if the policy complies with all of the following provisions:\n\n(1) The interest credited internally to determine cash value accumulations, including long-term care, if any, are guaranteed not to be less than the minimum guaranteed interest rate for cash value accumulations without long-term care set forth in the policy;\n\n(2) The portion of the policy that provides life insurance benefits meets the nonforfeiture requirements for life insurance;\n\n(3) The policy meets the disclosure requirements of section 431:10H-114 as applicable;\n\n(4) Any policy illustration that meets the applicable requirements for policy illustration;\n\n(5) An actuarial memorandum is filed with the insurance division that includes:\n\n(A) A description of the basis on which the long-term care rates were determined;\n\n(B) A description of the basis for the reserves;\n\n(C) A summary of the type of policy, benefits, renewability, general marketing method, and limits on ages of issuance;\n\n(D) A description and a table of each actuarial assumption used. For expenses, an insurer shall include per cent of premium dollars per policy and dollars per unit of benefits, if any;\n\n(E) A description and a table of the anticipated policy reserves and additional reserves to be held in each future year for active lives;\n\n(F) The estimated average annual premium per policy and the average issue age;\n\n(G) A statement as to whether underwriting is performed at the time of application. The statement shall indicate whether underwriting is used, and if used, the statement shall include a description of the type or types of underwriting used such as medical underwriting or functional assessment underwriting. Concerning a group policy, the statement shall indicate whether the enrollee or any dependent will be underwritten and when underwriting occurs; and\n\n(H) A description of the effect of the long-term care policy provision on the required premiums, nonforfeiture values, and reserves on the underlying life insurance policy, both for active lives and those in long-term care claim status.\n\n(d) This section shall apply to all long-term care insurance policies or certificates except those covered under sections 431:10H-207.5 and 431:10H-226.5.","path":["Hawaii Code","Division 2","Title 24","Chapter 431"],"source_url":"http://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010H-0226.htm","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:11Z","sha256":"9cde33f52142a39c5505bf1d19a76da97ad2800cb8ecd4e89660f0852a5da42e","source_id":"us-hi","stale":false,"prev":"us-hi/haw.-rev.-stat.-431-10h-225","next":"us-hi/haw.-rev.-stat.-431-10h-226.5"},"notice":"GroundRules: Original legal text. Not legal advice."}