(1) All applications for long-term care
insurance policies or certificates except those that are guaranteed issue shall
contain clear and unambiguous questions designed to ascertain the health
condition of the applicant.
(2)
(a) 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.
(b) 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 shall not be
rescinded for that condition.
(3) Except for policies or certificates that
are guaranteed issue:
(a) The following
language shall 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] may have the right to deny benefits or rescind your
policy."
(b) The following
language, or language substantially similar to the following, shall 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 may have 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]
(c) Prior
to issuance of a long-term care policy or certificate to an applicant age 80 or
older, the insurer shall obtain one of the following:
1. A report of a physical
examination;
2. An assessment of
functional capacity;
3. An
attending physician's statement; or
4. Copies of medical
records.
(4) A
copy of the completed application or enrollment form (whichever is applicable)
shall be delivered to the insured no later than at the time of delivery of the
policy or certificate unless it was retained by the applicant at the time of
application.
Notes
Fla. Admin.
Code Ann. R. 69O-157.109
Rulemaking Authority 624.308(1), 626.9611, 627.9407(1),
627.9408 FS. Law Implemented
624.307(1),
626.9541(1)(a), (g), (i),
(k),
627.9402,
627.9407(1),
627.9408
FS.
New 1-13-03, Formerly
4-157.109.
New 1-13-03, Formerly
4-157.109.
