Illinois Administrative Code › Title 50 - INSURANCE › Part 2012 - LONG-TERM CARE INSURANCE › Exhibit C - Standard Format Outline of Coverage

Current through Register Vol. 48, No. 28, July 12, 2024
[COMPANY NAME]
[ADDRESS - CITY & STATE]
[TELEPHONE NUMBER]
LONG-TERM CARE INSURANCE
OUTLINE OF COVERAGE
[Policy Number or Group Master Policy and
				Certificate Number]
[Except for policies or certificates which are guaranteed
				issue, the following caution statement, or language substantially similar, must
				appear as follows in the outline of coverage.]
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]
1. This policy is [an
			 individual policy of insurance] ([a group policy] which was issued in the
			 [indicate jurisdiction in which group policy was issued]).
2. PURPOSE OF OUTLINE OF COVERAGE. This
			 outline of coverage provides a very brief description of the important features
			 of the policy. You should compare this outline of coverage to outlines of
			 coverage for other policies available to you. This is not an insurance
			 contract, but only a summary of coverage. Only the individual or group policy
			 contains governing contractual provisions. This means that the policy or group
			 policy sets forth in detail the rights and obligations of both you and the
			 insurance company. Therefore, if you purchase this coverage, or any other
			 coverage, it is important that you READ YOUR POLICY (OR CERTIFICATE)
			 CAREFULLY!
3. FEDERAL TAX
			 CONSEQUENCES.
This [POLICY] [CERTIFICATE] is intended to be a federally
				tax-qualified long-term care insurance contract within the meaning of the
				Internal Revenue Code of 1986, as amended (
				26 USC
				7702 B(b) ).
OR
Federal Tax Implications of this [POLICY] [CERTIFICATE]. This
				[POLICY] [CERTIFICATE] is not intended to be a federally tax-qualified
				long-term care insurance contract within the meaning of the Internal Revenue
				Code of 1986 as amended (
				26 USC
				7702 B(b) ). Benefits received under the
				[POLICY] [CERTIFICATE] may be taxable as income.
4. TERMS UNDER WHICH THE POLICY OR
			 CERTIFICATE MAY BE CONTINUED IN FORCE OR DISCONTINUED.
a) [For long-term care health insurance
			 policies or certificates include one of the following permissible policy
			 renewability provisions:]
1) Policies and
			 certificates that are guaranteed renewable shall contain the following
			 statement: RENEWABILITY: THIS POLICY [CERTIFICATE] IS GUARANTEED RENEWABLE.
			 This means you have the right, subject to the terms of your policy
			 [certificate], to continue this policy as long as you pay your premiums on
			 time. [Company Name] cannot change any of the terms of your policy on its own,
			 except that, in the future, IT MAY INCREASE THE PREMIUM YOU PAY.
2) Policies and certificates that are
			 noncancellable shall contain the following statement: RENEWABILITY: THIS POLICY
			 [CERTIFICATE] IS NONCANCELLABLE. This means that you have the right, subject to
			 the terms of your policy, to continue this policy as long as you pay your
			 premiums on time. [Company Name] cannot change any of the terms of your policy
			 on its own and cannot change the premium you currently pay. However, if your
			 policy contains an inflation protection feature where you choose to increase
			 your benefits, [Company Name] may increase your premium at that time for those
			 additional benefits.