Utah Admin. Code R590-285-13 - Requirements for Application Forms and Replacement Coverage
(1)
(a) An
application or enrollment form shall include questions to elicit information as
to whether, as of the date of the application, the applicant:
(i) currently has:
(A) a limited long-term care insurance policy
or certificate; or
(B) a long-term
care insurance policy or certificate; and
(ii) whether the policy or certificate is
intended to replace any other accident and health insurance policy or
certificate currently in force.
(b) The questions in Subsection (1)(a) shall
include:
(i) "Do you currently have limited
long-term care insurance or long-term care insurance?";
(ii) "Did you have limited long-term care
insurance or long-term care insurance in force during the last twelve (12)
months?
If so, with which company?
If the policy lapsed, when did it lapse?";
(iii) "Are you covered by Medicaid?;
and
(iv) "Do you intend to replace
any of your medical or health insurance coverage with this policy or
certificate?"
(c) A
supplementary application signed by the applicant and producer may be used,
except when the coverage is sold without a producer.
(d) For a replacement policy issued to a
group, the questions may be modified to the extent necessary to elicit
information about other health insurance or limited long-term care insurance
other than the group policy being replaced, provided the certificate holders
have been notified of the replacement.
(2) A producer shall list other accident and
health insurance policies they sold to the applicant, identifying policies
sold:
(a) that are still in force;
and
(b) in the past five years that
are no longer in force.
(3)
(a)
(i) An insurer using a direct response
solicitation method shall deliver a notice regarding replacement of accident
and health insurance, limited long-term care insurance, or long-term care
insurance to the applicant when the policy or certificate is issued.
(ii)
(A) If
replacement is intended, the replacing insurer shall notify the existing
insurer in writing of the proposed replacement identifying the insurer, the
insured, and the policy number or address including zip code.
(B) The notice shall be made within five
working days from the date the application is received by the insurer or the
date the policy or certificate is issued, whichever is sooner.
(b)
(i) An insurer using a solicitation method
other than direct response shall, upon determining that a sale will involve a
replacement, provide to the applicant, before issuance or delivery of the
individual policy, a notice regarding replacement of accident and health
insurance, limited long-term care insurance, or long-term care
insurance.
(ii) A copy of the
notice shall be provided to the applicant and an additional copy signed by the
applicant shall be retained by the insurer.
(c) A replacement notice shall be provided in
a manner substantially similar to the following NAIC Limited Long-Term Care
Insurance Model Regulation form:
(i) "NOTICE
TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL ACCIDENT AND SICKNESS OR
LIMITED LONG-TERM CARE INSURANCE OR LONG-TERM CARE INSURANCE"; or
(ii) "NOTICE TO APPLICANT REGARDING
REPLACEMENT OF ACCIDENT AND SICKNESS OR LIMITED LONG-TERM CARE INSURANCE OR
LONG-TERM CARE INSURANCE".
Notes
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