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.
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(PDF) Claims Denial Reporting Form (Due Annually on June 30)
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(PDF) Replacement and Lapse Reporting Form (Due Annually on June 30)
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(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 [email protected]