(1) All applications for long-term care
insurance policies or certificates except those which are guaranteed issue
shall contain clear and unambiguous questions designed to ascertain the health
condition of the applicant.
(a) If an application for long-term care
insurance contains a question which asks whether the applicant has had
medication prescribed by a physician, it must also ask the applicant to list
the medication that has been prescribed.
(b) If the medications listed in the
application were known by the insurer, or should have been known at the time of
application, to be directly related to a medical condition for which coverage
would otherwise be denied, then the policy or certificate may not be rescinded
for that condition.
All applications shall clearly indicate the payment plan selected by the
Except for policies
or certificates which are guaranteed issue:
the following language shall be set out
conspicuously and in close conjunction with the applicant's signature block on
an application for a long-term care insurance policy or certificate:
Caution: If your answers on this application are incorrect or
untrue, (company) has the right to deny benefits or rescind your policy.
the following language, or
language substantially similar to the following, shall be set out conspicuously
on the long-term care insurance policy or certificate at the time of delivery:
Caution: The issuance of this long-term care insurance
(policy) (certificate) was based upon your responses to the questions on your
application. A copy of your (application) (enrollment form) (is enclosed) (was
retained by you when you applied). If your answers are incorrect or untrue, the
company has the right to deny benefits or rescind your policy. The best time to
clear up any questions is now, before a claim arises! If, for any reason, any
of your answers are incorrect, contact the company at this address: (insert
Prior to issuance of a long-term care policy or certificate to an applicant age
80 or older, the insurer shall obtain one of the following:
(a) a report of a physical
(b) an assessment of
attending physician's statement; or
(d) copies of medical records.
(6) A copy of the completed
application or enrollment form, whichever is applicable, shall be delivered to
the insured no later than at the time of delivery of the policy or certificate
unless it was retained by the applicant at the time of application.
Application forms shall include the
following questions designed to elicit information as to whether, as of the
date of the application, the applicant has another long-term care insurance
policy or certificate in force or whether a long-term care policy or
certificate is intended to replace any other accident and sickness or long-term
care policy or certificate presently in force. A supplementary application or
other form to be signed by the applicant and agent, except where the coverage
is sold without an agent, containing these questions may be used. With regard
to a replacement policy issued to a group, other than employee and labor union
groups, the following questions may be modified only to the extent necessary to
elicit information about health or long-term care insurance policies other than
the group policy being replaced; provided, however, that the certificateholder
has been notified of the replacement.
you have another long-term care insurance policy or certificate in force,
including health care service contract, health maintenance organization
Did you have another
long-term care insurance policy or certificate in force during the last 12
(i) If so, with which
(ii) If that policy
lapsed, when did it lapse?
(c) Are you covered by Medicaid?
(d) Do you intend to replace any of your
medical or health insurance coverage with this policy/certificate?
Agents shall list any other
health insurance policies they have sold to the applicant.
(a) List policies sold which are still in
(b) List policies sold in
the past five years which are no longer in force.
(9) Solicitations Other than Direct Response.
Upon determining that a sale will involve replacement, an insurer; other than
an insurer using direct response solicitation methods, or its agent; shall
furnish the applicant, prior to issuance or delivery of the individual
long-term care insurance policy, a notice regarding replacement of accident and
sickness or long-term care coverage. One copy of this notice shall be retained
by the applicant and an additional copy signed by the applicant shall be
retained by the insurer. The required notice shall be provided in the manner
detailed in Table I, Notice to Applicant Regarding Replacement of Individual
Accident and Sickness or Long-Term Care Insurance.
(10) Direct Response Solicitations. Insurers
using direct response solicitation methods shall deliver a notice regarding
replacement of accident and sickness or long-term care coverage to the
applicant upon issuance of the policy. The required notice shall be provided in
the manner detailed in Table II, Notice to Applicant Regarding Replacement of
Accident and Sickness or Long-Term Care Insurance.
(11) Where replacement is intended, the
replacing insurer shall notify, in writing, the existing insurer of the
proposed replacement. The existing policy shall be identified by the insurer,
name of the insured and policy number or address including zip code. The notice
shall be made within five working days from the date the application is
received by the insurer or the date the policy is issued, whichever is
(12) Life insurance
policies and certificates that provide benefits for long-term care shall comply
with this section if the policy being replaced is a long-term care insurance
policy. If the policy being replaced is a life insurance policy, the insurer
shall comply with the replacement requirements of R590-93, Replacement of Life
Insurance and Annuities. If a life insurance policy that provide benefits for
long-term care is replaced by another such policy, the replacing insurer shall
comply with both the long-term care and the life insurance replacement
Enrollment for Group Policies:
In the case
of a group policy, any requirement that a signature of an insured be obtained
by an agent or insurer shall be deemed satisfied if:
(i) the consent is obtained by telephonic or
electronic enrollment by the group policyholder or insurer. A verification of
enrollment information shall be provided to the enrollee;
(ii) the telephonic or electronic enrollment
provides necessary and reasonable safeguards to assure the accuracy, retention
and prompt retrieval of records; and
(iii) the telephonic or electronic enrollment
provides necessary and reasonable safeguards to assure the confidentiality of
individually identifiable information and "privileged information" as defined
by the Utah Government Records Access and Management Act, Section
insurer shall make available, upon request of the commissioner, records that
will demonstrate the insurer's ability to confirm enrollment and coverage