a) All applications for long-term care
insurance policies or certificates except those which are guaranteed issue
shall contain unambiguous questions designed to ascertain the health condition
of the applicant.
1) 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.
2) If the medications listed in the
application were known by the insurer, or should be 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 shall not be
rescinded for that condition.
b) Except for policies or certificates that
are guaranteed issue:
1) The following
language shall be set out conspicuously and in close conjunction with the
applicant's signature block on an application for a traditional long-term care
insurance policy or certificate:
Caution: If your answers on this application are incorrect or
untrue, [company] may have the right to deny benefits or rescind your
policy.
2) The following
language shall be set out 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] is 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 may have 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 address]
3) 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
examination;
B) An assessment of
functional capacity;
C) An
attending physician's statement; or
D) Copies of medical records.
c) 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.
d) Every insurer, as
defined in Section
2012.30 of this Part,
selling or issuing long-term care insurance benefits shall maintain a record of
all policy or certificate rescissions, both State and countrywide, except those
the insured voluntarily effectuated and shall annually furnish this information
to the Director of Insurance in the format prescribed in Exhibit D.