02-031 C.M.R. ch. 425, § 29 - Delivery of Outline of Coverage; Standard Format for Outline

Current through 2022-14, April 6, 2022

A. Every solicitation or marketing of a long-term care insurance policy, rider or certificate must include delivery of an outline of each long-term care product the producer or insurer is soliciting or marketing to the individual. The outline(s) shall be delivered to the prospective applicant or enrollee no later than the time of "first solicitation," through means that prominently direct the attention of the recipient to the document.

B. "First solicitation" means, in the case of producer solicitations, the time when the producer initially sends or presents to the individual any document materially relating to the long-term care insurance coverage the producer is soliciting. Procedural communications, such as setting up an appointment or direct mail asking the consumer to return a post card if he wishes further information, are not material, and therefore not first solicitations. For direct response solicitations, the "first solicitation" is the time the insurer initially sends or presents to the individual any document the prospective applicant requested in the response. The producer in any event shall deliver the outline(s) at the earliest possible time before sending or presenting an application or enrollment form, and the insurer shall deliver the outline(s) no later than the time it submits the application or enrollment form for signature.

D. Every application, enrollment or similar form shall contain an acknowledgement of receipt of the outline of coverage. The acknowledgement shall provide for the applicant's signature, the date the applicant receives the outline, and a statement that the outline was received on the first solicitation by the producer or insurer.

E. For every producer-solicited application there shall be a producer's statement in the application, enrollment or similar form. The producer's statement shall include the producer's signature, the date the producer delivers the outline, and a statement that the delivery was made at the time of the first solicitation.

E. For group insurance, the insurer may request the superintendent to allow use of a substitute form in place of the outline of coverage.

F. The mandatory contents for the outline of coverage appear in Appendix F. The outline of coverage shall be a free-standing document, using no smaller than 12 point type, and shall contain no material of an advertising nature. Text that is capitalized or underscored in the standard format outline of coverage may be emphasized by other means that provide prominence equivalent to the capitalization or underscoring.

Notes

02-031 C.M.R. ch. 425, § 29