Rule 20:06:21:0B Replacement of Individual Accident and Sickness or Long-Term Care Coverage.
DEPARTMENT OF REVENUE AND REGULATION
OF LABOR AND REGULATION
OF INDIVIDUAL ACCIDENT AND
OR LONG-TERM CARE COVERAGE
Source: 22 SDR 97, effective December 18, 1995.
TO APPLICANT REGARDING REPLACEMENT OF
ACCIDENT AND SICKNESS OR LONG-TERM CARE INSURANCE
Company's Name and Address)
SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.
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.
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.
TO APPLICANT BY AGENT (BROKER OR OTHER REPRESENTATIVE):
additional sheets, as necessary.)
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:
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.
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.
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.
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 you sign it, reread it carefully to be certain
that all information has been properly recorded.
of Agent, Broker or Other Representative)
Name and Address of Agent or Broker)
above "Notice to Applicant" was delivered to me on: ___________
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