Current through Reg. 50, No. 187; September 24, 2024
(1) This rule shall not apply to life
insurance policies that accelerate benefits for long-term care.
(2) Every insurer, health care service plan,
or other entity marketing long-term care insurance (the "insurer") shall:
(a) Develop and use suitability standards to
determine whether the purchase or replacement of long-term care insurance is
appropriate for the needs of the applicant;
(b) Train its agents in the use of its
suitability standards; and,
(c)
Maintain a copy of its suitability standards and make them available for
inspection upon request by the Office of Insurance
Regulation.
(3)
(a) To determine whether the applicant meets
the standards developed by the insurer, the agent and insurer shall develop
procedures that take the following into consideration:
1. The ability to pay for the proposed
coverage and other pertinent financial information related to the purchase of
the coverage;
2. 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,
3. 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.
(b)
1. The
insurer and the agent shall make reasonable efforts to obtain the information
set out in paragraph 69O-157.116(3)(a),
F.A.C. The efforts shall include presentation to the applicant, at or prior to
application, the Long-Term Care Personal Worksheet. The personal worksheet used
by the insurer shall contain, at a minimum, the information in the format
contained in Appendix B, which is incorporated herein by reference, in not less
than 12 point type. The issuer may request the applicant to provide additional
information to comply with its suitability standards.
2. A copy of the issuer's personal worksheet
shall be filed with the Office of Insurance Regulation.
(c) A completed personal worksheet shall be
returned to the insurer prior to the insurer'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.
(d) The sale or
dissemination outside the insurer or agency by the insurer or agent of
information obtained through the personal worksheet is
prohibited.
(4) The
insurer 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.
(5)
Agents shall use the suitability standards developed by the insurer in
marketing long-term care insurance.
(6) At the same time 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 as prescribed in Appendix C, which is incorporated herein by
reference, in not less than 12 point type.
(7)
(a) If
the insurer determines that the applicant does not meet its financial
suitability standards, or if the applicant has declined to provide the
information, the insurer may reject the application.
(b) In the alternative, the insurer shall
send the applicant a letter similar to Appendix D, which is incorporated herein
by reference.
(c) If the applicant
has declined to provide financial information, the insurer may use some other
method to verify the applicant's intent.
(d) Either the applicant's returned letter or
a record of the alternative method of verification shall be made a part of the
applicant's file.
(8) The
insurer shall report annually to the Office of Insurance Regulation:
(a) The total number of applications received
from residents of this state;
(b)
The number of those who declined to provide information on the personal
worksheet;
(c) The number of
applicants who did not meet the suitability standards; and,
(d) The number of those who chose to confirm
after receiving a suitability letter.
Rulemaking Authority
624.308(1),
626.9611,
627.9407(1),
627.9408 FS. Law Implemented
624.307(1),
626.9541(1)(a),
(g),
627.9402,
627.9407(1),
627.9408 FS.
New 1-13-03, Formerly
4-157.116.
