This Bill provides substantially as follows:

1. Features of this Bill apply to all long-term care, home health care and disability based long term care policies.

2. Does not apply to long-term care benefits of less than 12 months of coverage that are contained in Medicare supplements.

3. It sets forth guidelines for group long-term care policies.

4. It requires any policy or certificate limited to institutional care to be called a "nursing home facility only policy," one limited to home care to be called a "home care only policy" and would permit only those that provide both institutional care and home health care to be called "comprehensive long-term care insurance".

5. It requires a specified notice regarding untrue statements on an application. It provides that where an insurer does not complete medical underwriting and resolve all reasonable questions arising from information submitted on or with an application before issuing the policy or certificate, then the insurer may only rescind the policy or certificate or deny any otherwise valid claim, upon clear and convincing evidence of fraud or material misrepresentation of the risk by the applicant.

6. It provides that the contestable period is two years.

7. It provides that no long-term care policy or certificate may be field issued.

8. In addition to the existing prohibition that long-term care insurance that provides home health care benefits from limiting or excluding benefits on certain grounds, this Bill would also require long-term care insurance that provides home health care benefits or home care or community-based services to provide specified benefits.

9. It also provides that in every long-term care policy or certificate that provides home health care benefits, the threshold establishing eligibility for home health care benefits shall be at least as permissive as a provision that the insured will qualify if either one of 2 specified criteria is met.

(1) impairment in two activities of daily living. These include eating, bathing, dressing, ambulating, transferring, tolieting and continence. (2) Impairment of cognitive ability. This means deterioration or loss of intellectual capacity due to organic mental disease, including Alzheimer's disease or related illnesses, that require continual supervision to protect oneself or others.The standard "usual and customary" or similar words may not be used.

10. Every long-term care policy or certificate that purports to provide benefits of home health care or community-based services, shall provide at least the following:

(1) Home health care. (2) Adult day care. (3) Personal care. (4) Homemaker services. (5) Hospice services. (6) Respite care.

11. Home care benefits shall not be limited or excluded by any of the following:

(a) Requiring a need for care in a nursing home if home care services are not provided. (b) Requiring that skilled nursing or therapeutic services be used before unskilled services. (c) Requiring the existence of an acute condition. (d) Limiting benefits to those provided by Medicare certified providers or agencies. (e) Limiting benefits to services provided by licensed or skilled personnel when other providers could provide the service. (f) Defining the provider in a manner that is more restrictive than used to license that provider by the state where the service is provided. (g) Requiring "medical necessity" or similar standard as a criteria for benefits.

12. Every comprehensive long-term care policy or certificate that provides for both institutional care and home health care and that sets a daily, weekly or monthly benefit payment maximum, shall pay a maximum payment for home health care that is at least 50% of the maximum benefit payment for institutional care, and in no event shall home health care benefits be paid at a rate less than $50 per day.

13. Every such comprehensive long-term care policy or certificate that sets a durational maximum for institutional care, limiting the length of time that benefits may be received during the life of the policy or certificate, shall allow a similar durational maximum for home care that is at least one-half of the length of time allowed for institutional care.

14. This Bill provides that if a policy replaces another long-term care policy, the replacing insurer shall waive any time periods applicable to pre-existing conditions and probationary periods to the extent that similar exclusions have been satisfied.

15. Existing law imposes various requirements related to advertisements and lead generating devices. This Bill recasts those provisions. It deletes a provision requiring advertisements designed to produce leads to contain a prominent disclosure that the person may be contacted. It imposes requirements relating to marketing practices, and prohibits certain unfair trade practices, including cold lead advertising without disclosing that contact will be made by an insurance agent or company.

16. This Bill requires every insurer providing long-term care coverage in California to provide a copy of any advertisement to the commissioner at least 30 days before dissemination.

17. This Bill also requires long-term care insurers to establish marketing procedures, as specified, submit to the commissioner a list of all agents or other insurer representatives authorized to solicit long-term care insurance sales, and to provide continuing education to these agents or representatives.

18. In addition to the insurer or agent furnishing the applicant a notice containing specified information now required by existing law, this Bill requires that a notice to also include a specified statement relating to replacement coverage to be signed by the agent.

19. This Bill requires long-term care policies issued to individuals to be either guaranteed renewable or noncancellable, as specified and may not provide coverage for skilled nursing care only or provide significantly more coverage for skilled care in a facility than coverage for lower levels of care.

20. This Bill requires the agent to make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.

21. This Bill also requires every long-term insurer to file its commission structure or an explanation of the insurer's compensation plan with the commissioner.

22. If any time long-term coverage is replaced, the sales commission paid by the insurer shall be calculated based on the difference between the annual premium of the replacement coverage and that of the original coverage. Replacement shall be contingent upon the insurer's declaration that the replacement policy materially improves the position of the insured, pursuant to Section 10235.16.

23. This Bill recasts existing law authorizing the Insurance Commissioner to impose penalties for violations related to long-term care insurance, pursuant to the Administrative Procedure Act, and instead provides for a hearing before the Administrative Law Bureau of the Department of Insurance, except where a fine exceeds to $100,000, in which case the Administrative Procedure Act applies.

24. Any broker or agent, or other entity engaging in the business of insurance who violates the C.I.C. chapter containing the provision of SB1943, is liable for an administrative penalty of not less than $250 for each first violation. For committing a subsequent violation, the penalty shall not be less than $1,000 and not more than $25,000 for each violation. In addition to the above, the agent or broker may have his license suspended or revoked.

25. This Bill also prohibits the following acts and practices.

(a) Twisting. Knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance with another insurer. (b) High pressure tactics. Employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance. (c) Cold lead advertising. Making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance agent or insurance company.

26. In recommending the purchase or replacement of any long-term care insurance, an agent, shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.

27. This Bill requires that an "Outline of Coverage" to be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation. The Outline of Coverage is set forth in section 10233.5 C.I.C. as to text and sequence of text, and its use is mandatory.

28. This Bill repeals provisions regarding continuation of coverage applicable to group policies and requires group insurance to provide for continuation or conversion coverage for the insured, except for specified reasons.

29. This Bill also makes its changes to the long-term insurance act inapplicable to the California Partnership for Long Term Care Pilot Program.