Ariz. Admin. Code § R20-6-1007 - Required Disclosure Provisions
A. Riders and endorsements. Except for riders
or endorsements by which an insurer effectuates a request made in writing by
the insured under an individual long-term care insurance policy, if an insurer
adds a rider or endorsement to an individual long-term care insurance policy
after date of issue or at reinstatement or renewal that reduces or eliminates
benefits or coverage in the policy, the insurer shall require signed acceptance
by the individual insured. After the date of policy issue, any rider or
endorsement that increases benefits or coverage with a concomitant increase in
premium during the policy term shall require the signed written agreement of
the insured unless the increased benefits or coverage are required by law. If
the insurer charges a separate additional premium for benefits provided in
connection with riders or endorsements, the premium charge shall be set forth
in the policy, rider, or endorsement.
B. Payment of Benefits. A long-term care
insurance policy that provides for the payment of benefits based on standards
described as "usual and customary," "reasonable and customary" or words of
similar import shall define the terms and explain them in its accompanying
outline of coverage.
C. Disclosure
of tax consequences. For life insurance policies that provide an accelerated
benefit for long-term care, an insurer shall provide a disclosure statement at
the time of application for the policy or rider and at the time the accelerated
benefit payment request is submitted, that receipt of these accelerated
benefits may be taxable, and that assistance should be sought from a personal
tax adviser. The disclosure statement shall be prominently displayed on the
first page of the policy or rider and any other related documents. This
subsection shall not apply to qualified long-term care insurance
contracts.
D. Benefit triggers. A
long-term care insurance policy shall use activities of daily living and
cognitive impairment to measure an insured's need for long-term care. The
long-term care insurance policy shall describe these terms and provisions in a
separate paragraph in the policy labeled "Eligibility for the Payment of
Benefits" that includes and explains:
1. Any
additional benefit triggers,
2.
Benefit triggers that result in payment of different benefit levels,
and
3. Any requirement that an
attending physician or other specified person certify a certain level of
functional dependency for the insured to be eligible for benefits.
E. A long-term care insurance
contract shall contain a disclosure statement in the policy and in the outline
of coverage indicating whether it is intended to be a qualified long-term care
insurance contract as specified in the outline of coverage in Appendix J,
paragraph 3. The contract shall also include a Specification Page which shall
include the benefits, amounts, durations, the premium rate including all
optional benefits selected by the insured, and any other benefit data
applicable to the insured.
Notes
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