Ill. Admin. Code tit. 50, § 2012.83 - Incontestability Period
a) For a policy
or certificate that has been in force for less than 6 months, an insurer may
rescind a long-term care insurance policy or certificate or deny an otherwise
valid long-term care insurance claim upon a showing of misrepresentation that
is material to the acceptance for coverage.
b) For a policy or certificate that has been
in force for at least 6 months but less than 2 years, an insurer may rescind a
long-term care insurance policy or certificate or deny an otherwise valid
long-term care insurance claim upon a showing of misrepresentation that is both
material to the acceptance for coverage and that pertains to the condition for
which benefits are sought.
c) After
a policy or certificate has been in force for 2 years, it is not contestable
upon the grounds of misrepresentation alone; the policy or certificate may be
contested only upon a showing that the insured knowingly and intentionally
misrepresented relevant facts relating to the insured's health.
d) A long-term care insurance policy or
certificate may be field issued based on medical or health status if the
compensation to the field issuer is not based on the number of policies or
certificates issued. For purposes of this Section, "field issued" means a
policy or certificate issued by a producer or an agent or a third-party
administrator pursuant to the underwriting authority granted to the producer,
agent or third party administrator by an insurer and using the insurer's
underwriting guidelines.
e) If an
insurer has paid benefits under the long-term care insurance policy or
certificate, the benefit payments may not be recovered by the insurer in the
event that the policy or certificate is rescinded.
f) In the event of the death of the insured,
this Section shall not apply to the remaining death benefit of a life insurance
policy that accelerates benefits for long-term care. In this situation, the
remaining death benefits under these policies shall be governed by Section
224(1)(c) of the Code. In all other situations, this Section shall apply to
life insurance policies that accelerate benefits for long-term care.
Notes
Added at 32 Ill. Reg. 7600, effective May 5, 2008
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