(a) An application form shall include a
question designed to elicit information as to whether the insurance to be
issued is intended to replace any other accident and health insurance presently
in force. A supplementary application or other form to be signed by the
applicant containing the question may be used.
(b) 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 (c) below. The insurer shall retain a copy of the notice. A
direct response insurer shall deliver to the applicant upon issuance of the
policy, the notice described in (d) below. In no event, however, will the
notices be required in the solicitation of the following types of policies:
accident-only and single-premium nonrenewable policies.
(c) The notice required by (b) above for an
insurer, other than a direct response insurer, shall provide, in substantially
the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT
OF ACCIDENT AND HEALTH INSURANCE
According to [your application] [information you have
furnished], you intend to lapse or otherwise terminate existing accident and
health insurance and replace it with a policy to be issued by [insert company
name] Insurance Company. For your own information and protection you should be
aware of and seriously consider certain factors that may affect the insurance
protection available to you under the new policy.
(1) 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
present under the new policy, whereas a similar claim might have been payable
under your present policy.
(2) 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.
(3) 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)
(d) The notice required by subparagraph (b)
for a direct response insurer shall be as follows:
NOTICE TO APPLICANT REGARDING REPLACEMENT
OF ACCIDENT AND HEALTH INSURANCE
According to [your application] [information you have
furnished], you intend to lapse or otherwise terminate existing accident and
health insurance and replace it with a policy to be issued by [insert 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 that m
(1) Health conditions
that 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 present under the new policy, whereas a similar claim might
have been payable under your present policy.
(2) 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.
(3) [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 [insert company name and
address] within 10 days if any information is not correct and complete, or if
any past medical history has been left out of the application.
ay
affect the insurance protection available to you under the new
policy.
