463
Title II, Subtitle B
tion thus withheld or misrepresented, and the in-
sured individual’s response to such request;
(2) the insurer presents medical records or
other evidence showing that the insured individual
knew or should have known that such response was
false, incomplete, or misleading;
(3) notice of cancellation is furnished to the in-
sured individual before the date 3 years after the ef-
fective date of the policy (or such earlier date as the
Secretary may specify in regulations); and
(4) the insured individual is afforded the oppor-
tunity to review and refute the evidence presented by
the insurer pursuant to paragraphs (1) and (2).
(d) INSURER’S RIGHT TO CANCEL FOR NONPAYMENT
OF PREMIUMS.—
(1) IN GENERAL.—Insurers shall have the right
to cancel long-term care insurance policies for non-
payment of premiums, subject to the provisions of
this subsection and subsection (e) (relating to non-
forfeiture).
(2) NOTICE AND ACKNOWLEDGEMENT.—
(A) IN GENERAL.—The insurer may not
cancel coverage of an insured individual until—
(i) the insurer, not earlier than the
date when such payment is 30 days past
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Title II, Subtitle B
due, has given written notice to the insured
individual (by registered letter or the
equivalent) of such intent, and
(ii) 30 days have elapsed since the in-
surer obtained written acknowledgment of
receipt of such notice from the insured in-
dividual (or the designated representative,
at the insured individual’s option or in the
case of an insured individual determined to
be incapacitated in accordance with para-
graph (4)).
(B) 
ADDITIONAL
REQUIREMENT
FOR
GROUP POLICIES.—In the case of a group long-
term care insurance policy, the notice and ac-
knowledgement requirements of subparagraph
(A) apply with respect to the policyholder and
to each insured individual.
(3) REINSTATEMENT OF COVERAGE OF INCA-
PACITATED INDIVIDUALS.—In any case where the
coverage of an individual under a long-term care in-
surance policy has been canceled pursuant to para-
graph (2), the insurer shall be required to reinstate
full coverage of such individual under such policy,
retroactive to the effective date of cancellation, if the
insurer receives from such individual (or the des-
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Title II, Subtitle B
ignated representative of such individual), within 5
months after such date—
(A) evidence of a determination of such in-
dividual’s incapacitation in accordance with
paragraph (4) (whether made before or after
such date), and
(B) payment of all premiums due and past
due, and all charges for late payment.
(4) DETERMINATION OF INCAPACITATION.—For
purposes of this subsection, the term ‘‘determination
of incapacitation’’ means a determination by a quali-
fied health professional (in accordance with such re-
quirements as the Secretary may specify), that an
insured individual has suffered a cognitive impair-
ment or loss of functional capacity which could rea-
sonably be expected to render the individual perma-
nently or temporarily unable to deal with business or
financial matters. The standard used to make such
determination shall not be more stringent than the
threshold conditions for the receipt of covered bene-
fits.
(5) DESIGNATION OF REPRESENTATIVE.—The
insurer shall be required—