Current through Register Vol. 35, No. 18, September 24, 2024
A. All applications for long-term care
insurance policies or certificates, except those which are guaranteed issue,
shall contain clear and unambiguous questions designed to ascertain the health
condition of the applicant.
(1) If an
application for long-term care insurance contains a question which asks whether
the applicant has had medication prescribed by a physician, it must also ask
the applicant to list the medication that has been prescribed.
(2) If the medications listed in such
application were known by the insurer, or should have been known at the time of
application, to be directly related to a medical condition for which coverage
would otherwise be denied, then the policy or certificate shall not be
rescinded for that condition.
B. Except for policies or certificates which
are guaranteed issue:
(1) The following
language shall be set out conspicuously and in close conjunction with the
applicant's signature block on an application for a long-term care insurance
policy or certificate: "Caution: If your answers on this application are
incorrect or untrue, [company] has the right to deny benefits or rescind your
policy."
(2) The following
language, or language substantially similar to the following, shall be set out
conspicuously on the long-term care insurance policy or certificate at the time
of delivery: "Caution: The issuance of this long-term care insurance [policy]
[certificate] is based upon your responses to the questions on your
application. A copy of your [application] [enrollment form]/[is enclosed] [was
retained by you when you applied]. If your answers are incorrect or untrue, the
company has the right to deny benefits or rescind your policy. The best time to
clear up any questions is now, before a claim arises! If, for any reason, any
of your answers are incorrect, contact the company at this address [insert
address]."
(3) Prior to issuance of
a long-term care policy or certificate to an applicant age eighty (80) or
older, the insurer shall obtain one of the following:
(a) a report of a physical
examination;
(b) an assessment of
functional capacity;
(c) an
attending physicians statement; or
(d) copies of medical records.
C. A copy of the
completed application or enrollment form (whichever is applicable) shall be
delivered to the insured no later than at the time of delivery of the policy or
certificate unless it was retained by the applicant at the time of
application.
D. Every insurer or
other entity selling or issuing long-term care insurance benefits shall
maintain a record of all policy or certificate rescissions, both state and
countrywide, except those which the insured voluntarily effectuated, and shall
annually furnish this information to the Superintendent in the format
prescribed by the National Association of Insurance Commissioners in
13.10.15.49 NMAC.
