Md. Code Regs. 31.14.01.06

Current through Register Vol. 51, No. 22, November 1, 2024

Section 31.14.01.06 - Requirements for Applications

A. If the application for a long-term care insurance policy is to be made part of the policy or certificate, the insurer shall print:

(1) Conspicuously and in close conjunction with the applicant's signature block on the application form for the policy or certificate:

(2) On the first page of the policy or certificate the following or substantially similar language:

B. Application forms for individual policies and for certificate holders under group policies other than employer-employee groups shall include the questions in §C of this regulation, designed to elicit information as to whether at the time 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 long-term care policy or certificate or other insurance then in force. A supplementary application to be signed by the applicant may be used for this purpose.

C. Application questions include the following:

(1) "Do you have other long-term care insurance in force or other health insurance, including membership in a health maintenance organization";

(2) "Did you have another long-term care insurance policy or certificate in force during the last 12 months":

(a) "If so, with which company";

(b) "If that policy lapsed, when did it lapse";

(c) "Are you covered by Medicaid"; and

(d) "Do you intend to replace any of your medical or health insurance coverage with this policy (certificate)".

D. An agent soliciting applications for long-term care insurance shall list any other long-term care coverage or other health insurance policies which the applicant has or has had. The agent shall list policies which:

(1) Are still in force;

(2) Have lapsed or otherwise terminated during the past 5 years.

E. Solicitations Other Than Direct Response. Upon determining that a sale will involve replacement, the agent or the insurer, other than an insurer using direct response solicitation, shall furnish the applicant a notice regarding replacement of long-term care coverage or other health insurance before delivering an individual long-term care insurance policy. A copy of the notice shall be given to the applicant, and another copy signed by the applicant shall be retained by the insurer. The required notice shall be substantially in the form and language shown in Regulation .22 of this chapter.

F. Direct Response Solicitation. Insurers using direct response solicitation shall deliver a notice regarding replacement of long-term care coverage or other health insurance to the applicant upon issuance of a long-term care policy. The required notice shall be substantially in the form and language shown in Regulation .23 of this chapter.

G. When replacement is intended, the replacing insurer shall give written notice to the existing insurer of the proposed replacement. This notice shall identify the insured and the policy number or the address of the insured. The notice shall be given within 5 working days from the date the application for the newly applied coverage is received at the home office of the insurer, or the date the policy is issued, whichever is earlier.

H. Before issuing a long-term care insurance policy or certificate to an applicant 80 years old or older, unless the policy or certificate is to be issued on a guaranteed issue basis, the insurer shall obtain at least one of the following:

(1) A report of a recent physical examination;

(2) An assessment by a qualified person of the applicant's functional capacity;

(3) An attending physician's statement; or

(4) A copy of recent medical records.

I. A copy of the completed application or enrollment form shall be delivered to the insured at the time of delivery of the policy or certificate.

J. Life Insurance Policies.

(1) Life insurance policies that accelerate death benefits for long-term care shall comply with this section if the policy being replaced is a long-term care insurance policy.

(2) If the policy being replaced is a life insurance policy, the insurer shall comply with the replacement requirements of COMAR 31.09.05.

(3) If a life insurance policy that accelerates the death benefits for long-term care is replaced by another life insurance policy that accelerates the death benefits for long-term care, the replacing insurer shall comply with both the long-term care and the life insurance replacement requirements.

Md. Code Regs. 31.14.01.06