Fla. Admin. Code Ann. R. 69O-157.110 - Requirements for Application Forms and Replacement Coverage

(1) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate in force or whether a long-term care policy or certificate is intended to replace any other accident and sickness or long-term care policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent containing the questions may be used. With regard to a replacement policy issued to a group defined by Section 627.9405(1)(a), F.S., the following questions may be modified only to the extent necessary to elicit information about health or long-term care insurance policies other than the group policy being replaced, provided that the certificateholder has been notified of the replacement.

(a) Do you have another long-term care insurance policy or certificate in force (including health care service contract, health maintenance organization contract)?

(b) Did you have another long-term care insurance policy or certificate in force during the last 12 months?

1. If so, with which company?

2. If that policy lapsed, when did it lapse?

(c) Are you covered by Medicaid?

(d) Do you intend to replace any of your medical or health insurance coverage with this policy [certificate]?

(2) Agents shall list any other health insurance policies they have sold to the applicant.

(a) List policies sold that are still in force.

(b) List policies sold in the past 5 years that are no longer in force.

(3) Solicitations Other than Direct Response.

(a) Upon determining that a sale will involve replacement, an insurer, other than an insurer using direct response solicitation methods or its agent; shall furnish the applicant prior to issuance or delivery of the individual long-term care insurance policy a notice regarding replacement of accident and sickness or long-term care coverage.

(b) One copy of the notice shall be retained by the applicant and an additional copy signed by the applicant shall be retained by the insurer.

(c) The notice shall be provided in the format prescribed in Appendix G, "Notice to Applicant Regarding Replacement" (10/02), which is incorporated herein by reference.

(4) Direct Response Solicitations.

(a) Whenever a sale will involve replacement, an insurer using direct response solicitation methods shall deliver a notice regarding replacement of accident and sickness or long-term care coverage to the applicant upon issuance of the policy.

(b) The notice shall be provided in the format prescribed in Appendix H, "Notice of Applicant Regarding Replacement", (10/02), which is incorporated herein by reference.

(5) Where replacement is intended, the replacing insurer shall notify in writing the existing insurer of the proposed replacement.

(a) The existing policy shall be identified by the insurer, name of the insured, and policy number or address including zip code.

(b) Notice shall be made within 5 working days from the date the application is received by the insurer or the date the policy is issued, whichever is sooner.

Notes

Fla. Admin. Code Ann. R. 69O-157.110

Rulemaking Authority 624.308(1), 626.9611, 627.9407(1), 627.9408 FS. Law Implemented 624.307(1), 626.9541(1)(a), (k), 627.9402, 627.9407(1), 627.9408 FS.

New 1-13-03, Formerly 4-157.110.

New 1-13-03, Formerly 4-157.110.