Okla. Admin. Code § 365:10-5-44.1

Current through Vol. 42, No. 7, December 16, 2024

Section 365:10-5-44.1 - Prohibition against post-claims underwriting

(a)Application question regarding health condition. 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.

(b)Application question regarding prescriptions.

(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to a medical condition for which coverage would otherwise be denied, then the policy or certificate shall not be rescinded for that condition.

(c)Except guaranteed issue. 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 long-term care policy or certificate to an applicant age seventy-five (75) 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 physician's statement; or

(D) Copies of medical records.

(d)Copy of application attached to delivered policy. 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 the delivery of the policy or certificate unless it was retained by the applicant at the time of application.

(e)Maintain record of rescissions. 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 Insurance Commissioner in the format prescribed by the National Association of Insurance Commissioners (see Appendix C of this Chapter).

Okla. Admin. Code § 365:10-5-44.1

Added at 10 Ok Reg 397, eff 11-12-93 (emergency); Added at 10 Ok Reg 3033, eff 7-15-93