Section 16-12-11 - Requirements for application forms and replacement coverage(a) Application forms shall include questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or other health insurance policy or certificate in force or whether a Medicare supplement policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and agent may be used containing the questions and statements in substantially the form entitled Exhibit C (revised 2019), located at the end of this chapter, which is made a part of this section.(b) Agents shall list any other health insurance policies they have sold to the applicant. Agents shall: (1) List policies sold which are still in force; and(2) List policies sold in the past five years which are no longer in force.(c) In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant, and acknowledged by the insurer, shall be returned to the applicant by the insurer upon delivery of the policy.(d) Upon determining that a sale will involve replacement of Medicare supplement coverage, any issuer, other than a direct response issuer or its agent, shall furnish the applicant, prior to issuance or delivery of the Medicare supplement policy or certificate, a notice regarding replacement of Medicare supplement coverage. One copy of the notice signed by the applicant and the agent, except where the coverage is sold without an agent, shall be provided to the applicant and an additional signed copy shall be retained by the issuer. A direct response issuer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of Medicare supplement coverage.(e) The notice required by subsection (d) for an issuer, shall be provided in no less than twelve point type, in substantially the form entitled as Exhibit B (revised 2019), located at the end of this chapter, which is made a part of this section.(f) Paragraphs one and two of the replacement notice (applicable to preexisting conditions) in Exhibit B (revised 2019) may be deleted by an issuer if the replacement does not involve application of a new preexisting condition limitation.[Eff 5/17/82; am and comp 10/28/89; am and comp 12/27/90; am and comp 9/3/92; am and comp 7/6/99; am and comp 10/15/01; comp 12/9/02; am and comp 10/8/05; am and comp 9/25/09] (Auth: HRS §§ 431:2-201, 431:10A-304, 431:10A-305, 431:10A-307) (Imp: HRS §§ 431:2-201, 431:10A-305, 431:10A-307)