Arizona Administrative Code › Title 20 - COMMERCE, FINANCIAL INSTITUTIONS, AND INSURANCE › Chapter 06 - DEPARTMENT OF INSURANCE AND FINANCIAL INSTITUTIONS - INSURANCE DIVISION › Article 10 - LONG-TERM CARE INSURANCE › Appendix C - Notice to Applicant Regarding Replacement of Individual Health or Long-term Care Insurance

Current through Register Vol. 30, No. 28, July 12, 2024
NOTICE TO APPLICANT REGARDING REPLACEMENT OF INDIVIDUAL
				  HEALTH OR LONG-TERM CARE INSURANCE
[Insurance company's name and address]
SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE
				  FUTURE.
According to [your application] [information you have
				  furnished], you intend to lapse or otherwise terminate existing health or
				  long-term care insurance and replace it with an individual long-term care
				  insurance policy to be issued by [company name] Insurance Company. Your new
				  policy provides thirty (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.
You should review this new coverage carefully, comparing it
				  with all health or long-term care insurance coverage you now have, and
				  terminate your present policy only if, after due consideration, you find that
				  purchase of this long-term care coverage is a wise decision.
STATEMENT TO APPLICANT BY [INSURANCE PRODUCER OR OTHER
				  REPRESENTATIVE]:
Use additional sheets, as necessary.)
I have reviewed your current medical or health insurance
				  coverage. I believe the replacement of insurance involved in this transaction
				  materially improves your position. My conclusion has taken into account the
				  following considerations which I call to your attention:
1. Health conditions that you may presently have (preexisting
				  conditions), may not be immediately or fully covered under your new policy.
				  This could result in denial or delay in payment of benefits under the new
				  policy, whereas a similar claim might have been payable under your present
				  policy.
2. State law provides that your replacement policy or
				  certificate may not contain new preexisting conditions or probationary periods.
				  The insurer will waive any time periods applicable to preexisting conditions or
				  probationary periods in the new policy (or coverage) for similar benefits to
				  the extent such time was spent (depleted) under the original policy.
3. If you are replacing existing long-term care insurance
				  coverage, 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 interest to make sure you
				  understand all of the relevant factors involved in replacing your present
				  coverage.
4. 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, reread it carefully to
				  be certain that all information has been properly recorded.
________________________________________________
(Signature of Insurance Producer or Other
				  Representative)
(Typed Name and Address of Insurance Producer)
The above "Notice to Applicant" was delivered to me
				  on:
______________________________
(Date)
______________________________
(Applicant's Signature)