044-37 Wyo. Code R. §§ 37-21 - Suitability
(a) This section shall not apply to life
insurance policies that accelerate benefits for long-term care.
(b) Every insurer, health care service plan
or other entity marketing long-term care insurance shall:
(i) Develop and use suitability standards to
determine whether the purchase or replacement of long-term care insurance is
appropriate for the need of the applicant;
(ii) Train its agents in the use of its
suitability standards; and
(iii)
Maintain a copy of its suitability standards and make them available for
inspection upon request by the Commissioner.
(c)
(i) To
determine whether the applicant meets the standards developed by the issuer,
the agent and issuer shall develop procedures that take the following into
consideration:
(A) The ability to pay for the
proposed coverage and other pertinent financial information related to the
purchase of the coverage;
(B) The
applicant's goals or needs with respect to long-term care and the advantages
and disadvantages of insurance to meet these goals or needs; and
(C) The values, benefits and costs of the
applicant's existing insurance, if any, when compared to the values, benefits
and costs of the recommended purchase or replacement.
(ii) The issuer, and where an agent is
involved, the agent shall make reasonable efforts to obtain the information set
out in paragraph (i) above. The efforts shall include presentation to the
applicant, at or prior to application, the "Long-Term Care Insurance Personal
Worksheet." The personal worksheet used by the issuer shall contain, at a
minimum, the information contained in Appendix B, in not less than twelve (12)
point type. The issuer may request the applicant to provide additional
information to comply with its suitability standards. A copy of the issuer's
personal worksheet shall be filed with the Commissioner.
(iii) A completed personal worksheet shall be
returned to the issuer prior to the issuer's consideration of the applicant for
coverage, except the personal worksheet need not be returned for sales of
employer group long-term care insurance to employees and their
spouses.
(iv) The sale or
dissemination outside the company or agency by the issuer or agent of
information obtained through the personal worksheet in Appendix B is
prohibited.
(d) The
issuer shall use the suitability standards it has developed pursuant to this
section in determining whether issuing long-term care insurance coverage to an
applicant is appropriate.
(e)
Agents shall use the suitability standards developed by the issuer in marketing
long-term care insurance.
(f) At
the same time as the personal worksheet is provided to the applicant, the
disclosure form entitled "Things You Should Know Before You Buy Long-Term Care
Insurance" shall be provided. The form shall be in the format contained in
Appendix C, in not less than twelve (12) point type.
(g) If the issuer determines that the
applicant does not meet its financial suitability standards, or if the
applicant has declined to provide the information, the issuer may reject the
application. In the alternative, the issuer shall send the applicant a letter
similar to Appendix D. However, if the applicant has declined to provide
financial information, the issuer may use some other method to verify the
applicant's intent. Either the applicant's returned letter or a record of the
alternative method of verification shall be made part of the applicant's
file.
(h) The issuer shall report
annually to the Commissioner the total number of applications received from
residents of this state, the number of those who declined to provide
information on the personal worksheet, the number of applicants who did not
meet the suitability standards and the number of those who chose to confirm
after receiving a suitability letter.
Notes
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