N.J. Admin. Code § 11:4-17.5
Current through Register Vol. 56, No. 24, December 18, 2024
Section 11:4-17.5 - Replacement(a) All licensees involved in the sale of individual health insurance, other than health benefits plans, shall diligently inquire of each applicant as to the existence of any health insurance on any proposed insured. The licensee shall obtain either in the application or in a separate form, a statement, dated and signed by the applicant, indicating whether any health insurance is presently in force, the names of the companies which issued the insurance, the type of coverage, and where possible the policy number.(b) For direct response solicitations, application forms shall include a question designed to elicit information as to whether the insurance to be issued is intended to replace any health insurance presently in force.(c) Upon determining that a sale will involve replacement, a licensee shall at the time of the application, furnish the applicant with the notice described in (d) below. One copy of such notice shall be delivered to the applicant and an additional copy signed by the applicant shall be submitted with the application and retained by the insurer. A direct response insurer shall, upon issuance of the policy, deliver to the applicant the notice described in (e) below. In no event, however, will such a notice be required in the solicitation of accident only and single premium short-term nonrenewable policies.(d) The notice required by (c) above for a licensee shall be as follows: NOTICE TO APPLICANT REGARDING
REPLACEMENT OF HEALTH INSURANCE
According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing health insurance and replace it with a policy issued by (insert Company Name) Insurance Company. For your own information and protection, you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
(1) Health conditions which you may presently have, (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, re-read it carefully to be certain that all information has been properly recorded. The above "Notice to Applicant" was delivered to me on:
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| (Date) |
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| (Applicant's Signature) |
(e) The notice required by (c) above for a direct response insurer shall be as follows: NOTICE TO APPLICANT REGARDING
REPLACEMENT OF HEALTH INSURANCE
According to (your application) (information you have furnished), you intend to lapse or otherwise terminate existing health insurance and replace it with the policy delivered herewith issued by (insert Company Name) Insurance Company. Your new policy provides 30 days within which you may decide without cost whether you desire to keep the policy. For your own information and protection you should be aware of and seriously consider certain factors which may affect the insurance protection available to you under the new policy.
(1) Health conditions which you may presently have, (preexisting conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.(3) (To be included only if the application is attached to the policy.) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to (insert Company Name and Address) within 10 days if any information is not correct and complete, or if any past medical history has been left out of the application. | ............................................ |
| (Company Name) |
(f) Item 1 of the notices required by (d) and (e) above may be omitted if the replacement policy covers all pre-existing conditions from the effective date of coverage.N.J. Admin. Code § 11:4-17.5
Amended by 51 N.J.R. 618(a), effective 5/6/2019