Long-Term Care Reporting Forms

The following forms are required from all insurers either writing long-term care insurance and/or insurers that have long-term care policies in force.

  1. (PDF) Claims Denial Reporting Form (Due Annually on June 30)

  2. (PDF) Replacement and Lapse Reporting Form (Due Annually on June 30)

  3. (PDF) Rescission Reporting Form for Long-Term Care Policies (Due Annually on March 1)

The forms should be mailed to the following address:

State of Hawaii
Dept. of Commerce and Consumer Affairs (“DCCA”)
Insurance Division
ATTN:  MARKET CONDUCT
P. O. Box 3614
Honolulu, HI   96811-3614

OR

State of Hawaii
Dept. of Commerce and Consumer Affairs (“DCCA”)
Insurance Division
ATTN:  MARKET CONDUCT
335 Merchant Street, Room 213
Honolulu, HI   96813

Refer to the Hawaii Annual Filing Requirements for further information on the Long-Term Care Reporting Forms.

If you have any questions, please contact Colin Hayashida at (808) 586-2790 or via e-mail at insrpa@dcca.hawaii.gov