(1) 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 the
questions may be used. With regard to a replacement policy issued to a group
defined by O.C.G.A. Section
33-42-4, 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 that the certificateholder has been notified of the
replacement.
(a) Do you have another long-term
care insurance policy or certificate in force (including health care service
contract, health maintenance organization contract)?
(b) Did you have another long-term care
insurance policy or certificate in force during the last 12 months?
(i) If so, with which company?
(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]?
(6) Life insurance policies that accelerate
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 Chapter 120-2-24. If a life insurance policy that accelerates
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 requirements.
NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL
ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE
[Insurance company's name and address]
SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE
FUTURE.
According to [your application] [information you have
furnished], you intend to lapse or otherwise terminate existing accident and
sickness or long-term care insurance and replace it with an individual
long-term care insurance policy to be 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.
You should review this new coverage carefully, comparing it
with all accident and sickness or long-term care insurance coverage you now
have, and terminate your present policy only if, after due consideration, you
find that purchase of this long-term care coverage is a wise decision.
STATEMENT TO APPLICANT BY AGENT [BROKER OR OTHER
REPRESENTATIVE]:
(Use additional sheets, as necessary.)
I have reviewed your current medical or health insurance
coverage. I believe the replacement of insurance involved in this transaction
materially improves your position. My conclusion has taken into account the
following considerations, which I call to your attention:
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 in payment of benefits
under the new policy, whereas a similar claim might have been payable under
your present policy.
2. State law
provides that your replacement policy or certificate may not contain new
preexisting conditions or probationary periods. The insurer will waive any time
periods applicable to preexisting conditions or probationary periods in the new
policy (or coverage) for similar benefits to the extent such time was spent
(depleted) under the original policy.
3. If you are replacing existing long-term
care insurance coverage, 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 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 your sign it, reread it carefully to be certain that all information has
been properly recorded.
(Signature of Agent, Broker or Other Representative)
[Typed Name and Address of Agent or Broker]
The above "Notice to Applicant" was delivered to me
on:
_____________________________ ______________________
(Applicant's Signature) (Date)
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT
AND SICKNESS OR LONG-TERM CARE INSURANCE
[Insurance company's name and address]
SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE
FUTURE.
According to [your application] [information you have
furnished], you intend to lapse or otherwise terminate existing accident and
sickness or long-term care insurance and replace it with the long-term care
insurance 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.
You should review this new coverage carefully, comparing it
with all accident and sickness or long-term care insurance coverage you now
have, and terminate your present policy only if, after due consideration, you
find that purchase of this long-term care coverage is a wise decision.
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 in payment of benefits
under the new policy, whereas a similar claim might have been payable under
your present policy.
2. State law
provides that your replacement policy or certificate may not contain new
preexisting conditions or probationary periods. Your insurer will waive any
time periods applicable to preexisting conditions or probationary periods in
the new policy (or coverage) for similar benefits to the extent such time was
spent (depleted) under the original policy.
3. If you are replacing existing long-term
care insurance coverage, 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 thirty
(30) days if any information is not correct and complete, or if any past
medical history has been left out of the application.
[Company Name]