Current through Reg. 50, No. 187; September 24, 2024
(1) Application forms shall include the
following questions designed to elicit information as to whether, as of the
date of the application, the applicant has another long-term care insurance
policy or certificate in force or whether a long-term care policy or
certificate is intended to replace any other accident and sickness or long-term
care policy or certificate presently in force. A supplementary application or
other form to be signed by the applicant and agent containing the questions may
be used. With regard to a replacement policy issued to a group defined by
Section 627.9405(1)(a),
F.S., the following questions may be modified only to the extent necessary to
elicit information about health or long-term care insurance policies other than
the group policy being replaced, provided that the certificateholder has been
notified of the replacement.
(a) Do you have
another long-term care insurance policy or certificate in force (including
health care service contract, health maintenance organization
contract)?
(b) Did you have another
long-term care insurance policy or certificate in force during the last 12
months?
1. If so, with which
company?
2. If that policy lapsed,
when did it lapse?
(c)
Are you covered by Medicaid?
(d) Do
you intend to replace any of your medical or health insurance coverage with
this policy [certificate]?
(2) Agents shall list any other health
insurance policies they have sold to the applicant.
(a) List policies sold that are still in
force.
(b) List policies sold in
the past 5 years that are no longer in force.
(3) Solicitations Other than Direct Response.
(a) Upon determining that a sale will involve
replacement, an insurer, other than an insurer using direct response
solicitation methods or its agent; shall furnish the applicant prior to
issuance or delivery of the individual long-term care insurance policy a notice
regarding replacement of accident and sickness or long-term care
coverage.
(b) One copy of the
notice shall be retained by the applicant and an additional copy signed by the
applicant shall be retained by the insurer.
(c) The notice shall be provided in the
format prescribed in Appendix G, "Notice to Applicant Regarding Replacement"
(10/02), which is incorporated herein by reference.
(4) Direct Response Solicitations.
(a) Whenever a sale will involve replacement,
an insurer using direct response solicitation methods shall deliver a notice
regarding replacement of accident and sickness or long-term care coverage to
the applicant upon issuance of the policy.
(b) The notice shall be provided in the
format prescribed in Appendix H, "Notice of Applicant Regarding Replacement",
(10/02), which is incorporated herein by reference.
(5) Where replacement is intended, the
replacing insurer shall notify in writing the existing insurer of the proposed
replacement.
(a) The existing policy shall be
identified by the insurer, name of the insured, and policy number or address
including zip code.
(b) Notice
shall be made within 5 working days from the date the application is received
by the insurer or the date the policy is issued, whichever is
sooner.
Rulemaking Authority 624.308(1), 626.9611, 627.9407(1),
627.9408 FS. Law Implemented
624.307(1),
626.9541(1)(a),
(k),
627.9402,
627.9407(1),
627.9408
FS.
New 1-13-03, Formerly
4-157.110.
