(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rescinded for that condition.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 which
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] has 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 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]
(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:
(i)
A report of a physical examination;
(ii) An assessment of functional
capacity;
(iii) An attending
physician's statement; or
(iv)
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.
(5) Every insurer or other entity selling or
issuing long-term care insurance benefits shall maintain a record of all policy
or certificate rescissions, both state and countrywide, except those that the
insured voluntarily effectuated and shall annually furnish this information to
the Commissioner in the format prescribed by the National Association of
Insurance Commissioners in Appendix A.
Notes
Ga. Comp. R.
& Regs. R.
120-2-16-.11
O.C.G.A. Secs.
33-2-9,
33-42-6,
33-42-7,
49-4-164,
49-4-165.
Original Rule entitled
"Prohibitions Against Post-Claims Underwriting" adopted. F.
Mar. 27, 2008; eff.
Apr. 16,
2008.
