Haw. Code R. § 16-12-11 - Requirements for application forms and replacement coverage
(a) Application forms shall include questions
designed to elicit information as to whether, as of the date of the
application, the applicant currently has Medicare supplement, Medicare
Advantage, Medicaid coverage, or other health insurance policy or certificate
in force or whether a Medicare supplement policy or certificate is intended to
replace any other accident and sickness policy or certificate presently in
force. A supplementary application or other form to be signed by the applicant
and agent may be used containing the questions and statements in substantially
the form entitled Exhibit C (revised 2019), located at the end of this chapter,
which is made a part of this section.
(b) Agents shall list any other health
insurance policies they have sold to the applicant. Agents shall:
(1) List policies sold which are still in
force; and
(2) List policies sold
in the past five years which are no longer in force.
(c) In the case of a direct response issuer,
a copy of the application or supplemental form, signed by the applicant, and
acknowledged by the insurer, shall be returned to the applicant by the insurer
upon delivery of the policy.
(d)
Upon determining that a sale will involve replacement of Medicare supplement
coverage, any issuer, other than a direct response issuer or its agent, shall
furnish the applicant, prior to issuance or delivery of the Medicare supplement
policy or certificate, a notice regarding replacement of Medicare supplement
coverage. One copy of the notice signed by the applicant and the agent, except
where the coverage is sold without an agent, shall be provided to the applicant
and an additional signed copy shall be retained by the issuer. A direct
response issuer shall deliver to the applicant at the time of the issuance of
the policy the notice regarding replacement of Medicare supplement
coverage.
(e) The notice required
by subsection (d) for an issuer, shall be provided in no less than twelve point
type, in substantially the form entitled as Exhibit B (revised 2019), located
at the end of this chapter, which is made a part of this section.
(f) Paragraphs one and two of the replacement
notice (applicable to preexisting conditions) in Exhibit B (revised 2019) may
be deleted by an issuer if the replacement does not involve application of a
new preexisting condition limitation.
Notes
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