Mich. Admin. Code R. 500.657 - Preexisting conditions

Current through Vol. 22-05, April 1, 2022

Rule 7.

(1) An advertisement which is an invitation to contract shall disclose, in negative terms, the extent to which a loss is not covered if the cause of the loss is traceable to a condition that existed before the effective date of the policy. The term "preexisting condition," without an appropriate definition or description, shall not be used.
(2) When a policy does not cover losses resulting from a preexisting condition, an advertisement of the policy shall not state or imply that the applicant's physical condition or medical history will not affect the issuance of the policy or payment of a claim thereunder. Within this context, the advertisement shall not contain the phrase "no medical examination required" or phrases of similar import. This rule does not prohibit explaining the phrase "automatic issue." If an insurer requires a medical examination for a specified policy, the advertisement, if it is an invitation to contract, shall disclose that a medical examination is required.
(3) When an advertisement contains an application form to be completed by the applicant and returned by mail, the application form shall contain a question or statement appearing in upper case type or contrasting color which reflects the preexisting condition provisions of the policy immediately preceding the blank space for the applicant's signature. An application form shall be in compliance with either of the following provisions:
(a) Contain a question or statement substantially as follows:

Do you understand that this policy will not pay __________ benefits during the first __________ month(s) after __________ the issued date for a disease or physical condition YES which you now have or have had in the past.

(b) Contain a statement substantially as follows: I understand that the policy applied for will not pay benefits for any loss incurred during the first month(s) after the issue date on account of disease or physical condition which I now have or have had in the past.

Notes

Mich. Admin. Code R. 500.657
1979 AC; 1991 AACS

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