Florida Administrative Code › 69 - DEPARTMENT OF FINANCIAL SERVICES › 69O - OIR - Insurance Regulation › Chapter 69O-151 - REQUIREMENTS FOR REPLACEMENT OF LIFE AND HEALTH COVERAGE › Section 69O-151.105 - Notice Furnished by Forms

Current through Reg. 50, No. 138; July 16, 2024
(1) Upon
				determining that a sale will involve replacement, an insurer, other than a
				direct response insurer, shall furnish the applicant, upon issuance or delivery
				of the policy, or prior thereto, the notice described below. Once copy of such
				notice shall be given to the applicant and an additional copy signed by the
				applicant shall be retained by the insurer in its home office for at least
				three years or until the conclusion of the next succeeding regular examination
				by the Insurance Department of its state of domicile, whichever is later. This
				notice required for an insurer, other than a direct response Insurer, shall be
				provided in substantially the following form:
NOTICE TO APPLICANT REGARDING REPLACEMENT OF ACCIDENT AND
				  SICKNESS INSURANCE
According to (your application) (information you have
				  furnished), you intend to lapse or otherwise terminate existing accident and
				  sickness insurance (insert policy number) you have with (insert Company name)
				  and replace it with a policy to be issued by (insert Company name). For your
				  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, (pre-existing 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 (to be included if
				pre-existing conditions are not covered under the replacement
				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 that all questions on the application concerning your medical/health
				history are truthfully and completely answered. 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 it should be
				carefully reviewed before being signed to be certain that all information has
				been properly recorded.
(4) New
				policies may be issued at an older age than that used for issuance of your
				present policy; therefore, the cost of the new policy, depending upon the
				benefits, may be higher than you are paying for your present policy.
(5) The renewal provisions of the new policy
				should be reviewed so as to make sure of your rights to periodically renew the
				policy.
The above "Notice to Applicant" was delivered to me
				  on:
______________________________________________
(date)
Witness _______________________________________
(Writing Agent)
______________________________________________
(Applicant's Signature)