Current through Register Vol. 63, No. 9, September 1, 2024
(1) An
insurer offering long-term care insurance coverage in this state shall deliver
a disclosure statement as provided in this rule to the insured under a
long-term care insurance policy, rider or certificate or separately but at the
same time as delivery of the policy, rider or certificate.
(2) The disclosure statement must include the
following matters:
(a) A statement of the
premium. The statement must give the total annual premium for the policy, rider
or certificate and, if the premium varies with an applicant's choice among
benefits options, must indicate the portion of annual premium corresponding to
each benefit option;
(b) The terms
of renewability. The terms used to describe renewability must be used in
accordance with OAR 836-052-0526. The terms must be
stated on the first page of the policy and must be one of the following,
defined as follows:
(A) A policy is
"guaranteed renewable" when renewal cannot be declined by the insurer for any
reason, but the insurer can revise rates on a class basis;
(B) A policy is "noncancellable" if the
insurer cannot decline renewal and cannot revise rates.
(c) Initial and subsequent conditions of
eligibility;
(d) A statement of
nonduplication of coverage provisions;
(e) Coverage of dependents;
(f) Preexisting conditions;
(g) Termination of insurance;
(h) Continuation or conversion of
coverage;
(i) Any probationary
periods;
(j) Limitations,
exceptions and reductions;
(k)
Elimination periods;
(l)
Requirements for replacement;
(m)
Recurrent conditions;
(n)
Definitions of terms;
(o) Option to
apply for new benefits
(3) The disclosure statement:
(a) Must be printed in not less than twelve
point type;
(b) May not contain
material of an advertising nature.
(4) The disclosure statement must include the
following statement: CAUTION: Issuance of this long-term care insurance
(policy) (rider) (certificate) is based upon your answers to the questions on
your application. (A copy of your (application) (enrollment form) is enclosed.)
-OR- (You retained a copy of your (application) (enrollment form) when you
applied.) If your answers are incorrect or untrue, the company may deny
benefits or rescind your policy.
(5) When long term care benefits are provided
through early payment of a portion of a life insurance policy death benefit,
the disclosure statement must include the following statements:
(a) "NOTICE: The long term care benefits
described here are provided as part of a life insurance policy. Your premiums
pay for life insurance. Whenever long term care benefits are paid from this
policy, the payments will reduce the available cash value and death benefit
under the life insurance policy";
(b) A statement of disclosure regarding tax
consequences, as described in OAR
836-052-0546(6).
Stat. Auth.: ORS
731.244,
742.023,
743.013,
743.655,
743.656 &
746.240
Stats. Implemented: ORS
742.003,
742.005,
743.650,
743.655 &
743.656
