(1)
Application forms shall include a question designed to elicit information as to
whether the insurance to be issued is intended to replace any other accident
and sickness insurance presently in force. A supplementary application or other
form to be signed by the applicant containing such a question may be
used.
(2) Upon determining that a
sale will involve replacement, an insurer, other than a direct response
insurer, or its agent shall furnish the applicant, prior to issuance or
delivery of the policy, the notice described in 36.8(3). One copy of such
notice shall be retained by the applicant and an additional copy signed by the
applicant shall be retained by the insurer A direct response insurer shall
deliver to the applicant upon issuance of the policy, the notice described in
36.8(4). In no event, however, will such a notice be required in the
solicitation of the following types of policies: accident only and single
premium nonrenewable policies.
(3)
The notice required by 36.8(2) for an insurer, other than a direct response
insurer, shall provide, in substantially the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND
SICKNESS INSURANCE
According to (your application) (information you have
furnished), you intend to lapse or otherwise terminate existing accident and
sickness insurance and replace it with a policy to be issued by (Company Name)
Insurance Company. For your own information and protection, you should be aware
of and seriously consider certain factors which may affect the insurance
protection available to you under the new policy.
a. Health conditions which you may presently
have (preexisting conditions) may not be immediately or fully covered under the
new policy. This could result in denial or delay of a claim for benefits under
the new policy, whereas a similar claim might have been payable under your
present policy.
b. You may wish to
secure the advice of your present insurer or its agent regarding the proposed
replacement of your present policy. This is not only your right, but it is also
in your best interest to make sure you understand all the relevant factors
involved in replacing your present coverage.
c. If, after due consideration, you still
wish to terminate your present policy and replace it with new coverage, be
certain to truthfully and completely answer all questions on the application
concerning your medical-health history. Failure to include all material medical
information on an application may provide a basis for the company to deny any
future claims and to refund your premium as though your policy had never been
in force. After the application has been completed and before you sign it,
reread it carefully to be certain that all information has been properly
recorded.
The above "Notice to Applicant" was delivered to me
on:
______________________________
(Date)
______________________________
(Applicant's Signature)
(4) The notice required by subrule 36.8(2)
above for a direct response insurer shall be as follows:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND
SICKNESS INSURANCE
According to (your application) (information you have
furnished), you intend to lapse or otherwise terminate existing accident and
sickness insurance and replace it with the policy delivered herewith issued by
(Company Name) Insurance Company. Your new policy provides 30 days within which
you may decide without cost whether you desire to keep the policy. For your own
information and protection, you should be aware of and seriously consider
certain factors which may affect the insurance protection available to you
under the new policy.
a. Health
conditions which you may presently have (preexisting conditions) may not be
immediately or fully covered under the new policy. This could result in denial
or delay of a claim for benefits under the new policy, whereas a similar claim
might have been payable under your present policy.
b. You may wish to secure the advice of your
present insurer or its agent regarding the proposed replacement of your present
policy. This is not only your right, but it is also in your best interests to
make sure you understand all the relevant factors involved in replacing your
present coverage.
c. (To be
included only if the application is attached to the policy.) If, after due
consideration, you still wish to terminate your present policy and replace it
with new coverage, read the copy of the application attached to your new policy
and be sure that all questions are answered fully and correctly. Omissions or
misstatements in the application could cause an otherwise valid claim to be
denied. Carefully check the application and write to (Company Name and Address)
within 30 days if any information is not correct and complete, or if any past
medical history has been left out of the application.
_______________________________
(Company Name)
