(a) All
applications for long-term care insurance policies or certificates, except
those that are guaranteed issue, must contain clear and unambiguous questions
designed to ascertain the health condition of the applicant.
(b) If an application for long-term care
insurance contains a question that asks whether the applicant has had
medication prescribed by a physician, it must also ask the applicant to list
the medication that has been prescribed. If the medications listed in the
application were known by the insurer, or should have been known at the time of
application, to be directly related to a medical condition for which coverage
would otherwise be denied, then the policy or certificate may not be rescinded
for that condition.
(c) Except for
policies or certificates that are guaranteed issue;
(1) the following language must be set out
conspicuously and in close conjunction with the applicant's signature block on
an application for a long-term care insurance policy or certificate;
Caution: If your answers on this application are
incorrect or untrue, [company] has the right to deny benefits or rescind your
policy.;
(2) the
following language, or language substantially similar to the following, must be
set out conspicuously on the long-term care insurance policy or certificate at
the time of delivery:
Caution: The issuance of this long-term care
insurance [policy] [certificate] is based upon your responses to the questions
on your application. A copy of your [application] [enrollment form] [is
enclosed] [was retained by you when you applied]. If your answers are incorrect
or untrue, the company has the right to deny benefits or rescind your policy.
The best time to clear up any questions is now, before a claim arises! If, for
any reason, any of your answers are incorrect, contact the company at this
address: ]insert address]; and
(3) before issuance of a long-term care
policy or certificate to an applicant 80 years of age or older, the insurer
shall get one of the following.
(A) a report
of a physical examination;
(B) an
assessment of functional capacity;
(C) an attending physician's statement;
or
(D) copies of medical
records.
(d)
The completed application or enrollment form, whichever is applicable, is part
of the policy and shall be delivered to the insured with the policy or
certificate unless it was retained by the applicant at the time of
application.
(e) Every insurer or
other entity selling or issuing long-term care insuranee benefits shall
maintain a record of all policy or certificate rescissions, both state and
nation wide, except those that the insured voluntarily effectuated and shall
annually furnish this information to the director in the format prescribed by
the director.
