(a) Application forms shall include a
question designed to elicit information as to whether a long term care
insurance, nursing home insurance only, home care insurance only, or nursing
home and home care insurance policy is intended to replace any other accident
and health insurance policy presently in force. The application form must
require a list of all existing accident and health insurance policies and
require identification of those being replaced.
(b) The application for long term care
insurance, nursing home insurance only, home care insurance only, or nursing
home and home care insurance, taken by an
agent shall include, or have
attached
thereto, a statement signed by the
agent as follows:
"I have reviewed the current accident and health insurance
coverage of the applicant and find that the indicated replacement, or the
additional coverage of the type and amount applied for, is appropriate for the
applicant's needs."
(c)
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 long term care insurance, nursing home insurance
only, home care insurance only, or nursing home and home care insurance policy,
a notice regarding replacement of accident and health insurance coverage. One
copy of such notice shall be provided to 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 at the time of the issuance of the
policy the notice regarding replacement of accident and health insurance
coverage.
(d) The notice required
by subdivision (c) of this section for an
insurer, other than a direct response
insurer, shall be provided in substantially the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND
HEALTH INSURANCE
AND THE PURCHASE OF MULTIPLE ACCIDENT AND HEALTH
POLICIES
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 (Company Name)
Insurance Company.
Your new policy provides (insert appropriate number) 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.
1. Health
conditions which you may presently have may be considered preexisting
conditions and 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 (this paragraph may be modified if preexisting conditions are covered
under the new policy).
2. You
should be aware that the premium rate for the replacement policy may be higher
than what you are paying for the existing policy that you plan to replace. If
the premium for your existing policy is based on your age when it was issued,
you have built up equity in that policy which may be lost if you terminate
it.
3. 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.
4.
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 requested 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)
I have reviewed the current health insurance coverage of
the applicant and find that replacement and/or additional coverage of the type
and amount applied for is appropriate for the applicant's needs.
__________
(Agent's Signature)
(e) The notice required by subdivision (c) of
this section 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 the policy delivered herewith issued by
(Company Name)
Insurance Company. Your new policy provides thirty (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.
1. Health conditions which you may presently
have may be considered preexisting conditions and 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 (this paragraph may be modified if
preexisting conditions are covered under the new policy).
2. You should be aware that the premium rate
for the replacement policy may be higher than what you are paying for the
existing policy that you plan to replace. If the premium for your existing
policy is based on your age when it was issued, you have built up equity in
that policy which may be lost if you terminate it.
3. 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.
4. (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 ten (10) days if any information
is not correct and complete.
__________
(Company Name)
